Periodontal bacterial species in hopeless dentitions with severe periodontitis: comparison of levels before extraction and 90 days after immediate implant placement.

The aim of this study was to evaluate changes in periodontal bacterial species during the transition from hopeless teeth to denture-supporting immediate implants. Biofilm and saliva samples were collected from 13 women and 7 men before the extraction of hopeless teeth with severe periodontitis (baseline) and 90 days after the placement of immediate implants that supported immediately loaded complete dentures (day 90). The levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Streptococcus oralis were analyzed by real-time polymerase chain reaction. Differences in the levels of bacterial species in the subgingival biofilm and saliva and between baseline and day 90 were evaluated by a 2-way analysis of variance followed by the Tukey test. There was a significant reduction in the levels of T forsythia from baseline to day 90 in saliva and subgingival biofilms (P < 0.05) and a tendency toward a reduction of the other bacterial species. The total bacterial load was higher in saliva than in subgingival biofilm at baseline and day 90 (P < 0.05), while the individual levels of all species were higher in the biofilm than in saliva at both times (P < 0.05). The results showed an overall reduction in the levels of pathogenic bacterial species, particularly T forsythia, during the transition from hopeless dentition to implant-supported dentures. The subgingival biofilm harbored considerable levels of pathogenic species, suggesting that implant placement immediately after extraction of teeth with severe periodontitis may induce changes that favor colonization by pathogenic microorganisms.

Salivary nitrite and systemic biomarkers in obese individuals with periodontitis submitted to FMD.

The objective of this 9-month clinical study is to assess the impact of one-stage full-mouth disinfection (FMD) on salivary nitrite levels and systemic biomarkers and its correlation with total subgingival bacterial load in obese and non-obese patients with periodontitis. In total, 94 patients (55 obese and 39 non-obese) were initially evaluated, seven were lost during follow-up, resulting in 87 individuals at the end of the study. Outcomes were assessed at baseline, 3, 6, and 9 months post periodontal treatment by FMD. Salivary nitrite levels were determined using Griess reagent. Blood samples were collected to determine C-Reactive Protein (CRP), alkaline phosphatase and fasting blood glucose. Real-time PCR was used to determine the total subgingival bacterial load. FMD protocol resulted in increased salivary nitrite levels at 6- and 9-months post-treatment in the non-obese group (p<0.05). In obese individuals, FMD treatment led to an increase in salivary nitrite levels at 6 months (p<0.05); however, at 9 months, the nitrite levels returned to baseline levels. For both groups, the highest nitrite values were observed at 6 months. In addition, in both groups, FMD was associated with a decrease in biomarkers related to systemic inflammation and cardiovascular diseases, such as CRP (p<0.05) and alkaline phosphatase (p<0.05), and had no impact on the fasting blood glucose. This study demonstrates that obese patients with periodontitis present similar salivary nitrite levels when compared with non-obese individuals. FMD protocol resulted in increases in salivary nitrite levels and was associated with a positive impact on systemic biomarkers, regardless of obesity status.

Periodontal therapy on the oral health-related quality of life of obese and non-obese individuals.

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.

Salivary nitrite and systemic biomarkers in obese individuals with periodontitis submitted to FMD

Abstract The objective of this 9-month clinical study is to assess the impact of one-stage full-mouth disinfection (FMD) on salivary nitrite levels and systemic biomarkers and its correlation with total subgingival bacterial load in obese and non-obese patients with periodontitis. In total, 94 patients (55 obese and 39 non-obese) were initially evaluated, seven were lost during follow-up, resulting in 87 individuals at the end of the study. Outcomes were assessed at baseline, 3, 6, and 9 months post periodontal treatment by FMD. Salivary nitrite levels were determined using Griess reagent. Blood samples were collected to determine C-Reactive Protein (CRP), alkaline phosphatase and fasting blood glucose. Real-time PCR was used to determine the total subgingival bacterial load. FMD protocol resulted in increased salivary nitrite levels at 6- and 9-months post-treatment in the non-obese group (p<0.05). In obese individuals, FMD treatment led to an increase in salivary nitrite levels at 6 months (p<0.05); however, at 9 months, the nitrite levels returned to baseline levels. For both groups, the highest nitrite values were observed at 6 months. In addition, in both groups, FMD was associated with a decrease in biomarkers related to systemic inflammation and cardiovascular diseases, such as CRP (p<0.05) and alkaline phosphatase (p<0.05), and had no impact on the fasting blood glucose. This study demonstrates that obese patients with periodontitis present similar salivary nitrite levels when compared with non-obese individuals. FMD protocol resulted in increases in salivary nitrite levels and was associated with a positive impact on systemic biomarkers, regardless of obesity status.

Resumo O objetivo deste estudo clínico, é avaliar o impacto da desinfecção bucal completa (DBC) nos níveis de nitrito salivar e biomarcadores sistêmicos e sua correlação com a carga bacteriana subgengival total em pacientes obesos e não obesos com periodontite. No total, 94 pacientes (55 obesos e 39 não obesos) foram avaliados inicialmente, sete foram perdidos durante o estudo, resultando em 87 indivíduos ao final. Os resultados foram avaliados no início do estudo, 3, 6 e 9 meses após o tratamento periodontal por DBC. Os níveis de nitrito salivar foram determinados usando o reagente de Griess. Amostras de sangue foram coletadas para determinação da Proteína C Reativa (PCR), fosfatase alcalina e glicemia de jejum. A PCR em tempo real foi usada para determinar a carga bacteriana subgengival total. O protocolo de DBC resultou em níveis aumentados de nitrito salivar em 6 e 9 meses após o tratamento no grupo de não obesos (p <0,05). Em indivíduos obesos, o tratamento da DBC levou a um aumento nos níveis de nitrito salivar em 6 meses (p <0,05); no entanto, aos 9 meses, os níveis de nitrito voltaram aos níveis basais. Para ambos os grupos, os maiores valores de nitrito foram observados aos 6 meses. Além disso, em ambos os grupos, a DBC foi associada à diminuição dos biomarcadores relacionados à inflamação sistêmica e doenças cardiovasculares, como PCR (p <0,05) e fosfatase alcalina (p <0,05), e não teve impacto na glicemia de jejum. Este estudo demonstra que pacientes obesos com periodontite apresentam níveis de nitrito salivar semelhantes quando comparados a indivíduos não obesos. O protocolo de DBC resultou em aumentos nos níveis de nitrito salivar e foi associado a um impacto positivo nos biomarcadores sistêmicos, independentemente do status de obesidade.

The Effects of Patient Compliance in Supportive Periodontal Therapy on Tooth Loss: A systematic Review and Meta-analysis.

BACKGROUND: The present review aimed to assess the impact of being a complier to supportive periodontal therapy (SPT), when compared to not being a complier, on tooth loss in patients with periodontitis. METHODS: Prospective and retrospective observational studies were included. MEDLINE, EMBASE, and LILACS databases were searched up to May 2019. The odds-ratio (OR) and standard error (SE) values of the studied groups (compliant or non-compliant) were converted to logOR, and the results of individual studies were grouped using a random effects model. RESULTS: From a total of 1815 articles initially searched, 13 retrospective studies and one prospective study comparing tooth loss of complier and non-complier individuals in SPT were included. Meta-analysis of eight studies showed that non-compliers in SPT have an increased risk of tooth loss when compared with compliers. Overall meta-analysis demonstrated that non-compliant patients in SPT have a 26% increased risk of tooth loss when compared with compliant patients (OR = 1.26; 95% CI = 1.06 to 1.51, Heterogeneity: I2 = 0%, p = 0.008). CONCLUSIONS: Patients with periodontitis who do not comply in SPT have a higher risk of tooth loss than compliant patients. Oral health professionals should implement measures to obtain optimal adherence by patients in SPT.

Clinical and microbiological effects of non-surgical periodontal treatment in individuals with rheumatoid arthritis: a controlled clinical trial.

The effect of periodontal treatment on clinical, microbiological and serological parameters of patients with rheumatoid arthritis (RA) are scarce and controversial. The aim of this study was to investigate the influence of non-surgical periodontal treatment on clinical periodontal status, subgingival bacterial levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and RA activity through a controlled clinical trial on individuals with RA and periodontitis (PE). From a convenience sample, 107 individuals were considered eligible and consecutively allocated in four groups: (1) individuals without PE and RA (- PE-RA, n = 30); (2) individuals without PE and with RA (- PE + RA, n = 23); (3) individuals with PE and RA (+ PE + RA, n = 24); and (4) individuals with PE and without RA (+ PE-RA, n = 30). Full-mouth periodontal clinical examinations, microbiological analysis and Disease Activity Score (DAS-28) evaluations were performed at baseline (T1) and 45 days after non-surgical periodontal treatment (T2). At T1, individuals + PE + RA showed greater severity of PE than + PE-RA individuals. At T2, significant reductions were observed in all periodontal clinical parameters in both groups (p < 0.001) with a significant reduction in DAS-28 in + PE + RA (p = 0.011). Individuals + PE-RA and + PE-RA showed significant reductions for all bacteria (p < 0.001). Additionally, P. gingivalis demonstrated an expressively significant reduction in + PE + RA (p < 0.001). Non-surgical periodontal treatment was effective on improving the clinical periodontal condition, improving the RA clinical status and reducing the presence of periodontal pathogens. Brazilian Registry of Clinical Trials (ReBEC) protocol #RBR-8g2bc8 ( https://www.ensaiosclinicos.gov.br/rg/RBR-8g2bc8/ ).

Azithromycin and Full-Mouth Scaling For the Treatment of Generalized Stage III and IV Periodontitis: A 6-Month Randomized Comparative Clinical Trial.

The effectiveness of azithromycin combined with full-mouth scaling procedures was compared to quadrant-wise scaling combined with the same dosage of azithromycin when treating periodontitis patients over a 6-month period. In this randomized clinical trial study, thirty-four individuals diagnosed with generalized stage III and IV periodontitis underwent baseline, 3-month, and 6-month post-treatment examinations. The study population was randomly assigned to either full-mouth scaling (FMS) or quadrant-wise scaling and root planning (QSRP) in addition to their taking of systemic azithromycin (500 mg/day) for three consecutive days. Periodontal probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were monitored along with the quantification of total bacterial load and red complex bacterial species (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) in subgingival samples by real time polymerase chain reaction. The volume of gingival crevicular fluid (GCF) was also monitored over time. The primary outcomes included improvements of PD and CAL. Data was statistically analyzed through a repeated-measures analysis of variance (ANOVA) test, multiple least significant difference (LSD) comparisons, Kruskal-Wallis, Friedman, and paired Student t-tests (p<0.05). FMS and QSRP provided similar PD, CAL, GI, PI, and GCF improvements. After treatment, the FMS group displayed lower mean values of total bacterial load and red complex bacterial species in comparison to the QSRP group. FMS and QSRP in conjunction with systemic azithromycin appeared to be an effective and reliable short-term therapeutic approach for the treatment of generalized stage III and IV periodontitis. However, FMD demonstrated superiority in regard to the 6-month antibacterial effects when compared to QSRP.

Azithromycin and full-mouth scaling for the treatment of generalized stage iii and iv periodontitis: a 6-month randomized comparative clinical trial

Abstract The effectiveness of azithromycin combined with full-mouth scaling procedures was compared to quadrant-wise scaling combined with the same dosage of azithromycin when treating periodontitis patients over a 6-month period. In this randomized clinical trial study, thirty-four individuals diagnosed with generalized stage III and IV periodontitis underwent baseline, 3-month, and 6-month post-treatment examinations. The study population was randomly assigned to either full-mouth scaling (FMS) or quadrant-wise scaling and root planning (QSRP) in addition to their taking of systemic azithromycin (500 mg/day) for three consecutive days. Periodontal probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were monitored along with the quantification of total bacterial load and red complex bacterial species (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) in subgingival samples by real time polymerase chain reaction. The volume of gingival crevicular fluid (GCF) was also monitored over time. The primary outcomes included improvements of PD and CAL. Data was statistically analyzed through a repeated-measures analysis of variance (ANOVA) test, multiple least significant difference (LSD) comparisons, Kruskal-Wallis, Friedman, and paired Student t-tests (p<0.05). FMS and QSRP provided similar PD, CAL, GI, PI, and GCF improvements. After treatment, the FMS group displayed lower mean values of total bacterial load and red complex bacterial species in comparison to the QSRP group. FMS and QSRP in conjunction with systemic azithromycin appeared to be an effective and reliable short-term therapeutic approach for the treatment of generalized stage III and IV periodontitis. However, FMD demonstrated superiority in regard to the 6-month antibacterial effects when compared to QSRP.

Resumo A efetividade da azitromicina combinada com a técnica de desinfecção total da boca (DTB) foi comparada a raspagem por quadrante (RQ) utilizando a mesma dosagem de azitromicina no tratamento de indivíduos com periodontite generalizada estágio III e IV, em um período de 6 meses. Trinta e quatro indivíduos foram submetidos aos exames no baseline, 3 e 6 meses pós-tratamento. A população estudada foi alocada aleatoriamente no grupo DTB ou RQ associado a três dias consecutivos de azitromicina (500 mg/dia). Profundidade de sondagem (PS), nível clínico de inserção (NIC), índice gengival (IG) e o índice de placa (IP) foram monitorados, além da quantificação da carga bacteriana total e das espécies bacterianas do complexo vermelho (Porphyromonas gingivalis, Tannerella forsythia e Treponema denticola), em amostras subgengivais, a partir da reação em cadeia da polimerase em tempo real. O volume de fluido crevicular gengival (FCG) também foi monitorado ao longo do tempo. Os resultados primários foram melhorias de PS e NIC. Os dados foram analisados estatisticamente por Análise de variância (ANOVA), comparações múltiplas de diferença menor (LSD), Kruskal-Wallis, Friedman e teste t de Student emparelhado (p<0,05). DTB e RQ forneceram melhorias em PS, NIC, IG, IP e FCG semelhantes. Após o tratamento, o grupo DTB apresentou valores médios mais baixos da carga bacteriana total e de espécies bacterianas do complexo vermelho em comparação com o grupo RQ. DTB e RQ associado a azitromicina sistêmica mostraram ser similarmente uma abordagem terapêutica de curto prazo, eficaz e confiável para o tratamento de periodontite generalizada estágio III e IV. No entanto, DTB demonstrou superioridade sobre os efeitos antibacterianos aos 6 meses em comparação com RQ.

Periodontal condition and levels of bacteria associated with periodontitis in individuals with bipolar affective disorders: A case-control study.

OBJECTIVE: To evaluate the epidemiological and microbiological aspects of the potential association between bipolar affective disorder (BAPD) and periodontitis. METHODOLOGY: The present case-control study comprised 176 individuals with BAPD and 176 controls. All individuals underwent a complete full-mouth periodontal examination and microbiological sampling. Data on bleeding on probing, probing depth, and clinical attachment level in all present teeth were recorded. Quantification of total bacterial load and Aggregatibacter actinomycetemcomitans, Treponema denticola, and Porphyromonas gingivalis counts were performed through qPCR. Data were analyzed using univariate analysis, Spearman correlation and multivariate logistic regression. RESULTS: The prevalence of periodontitis was 39.7% among controls and 58.5% among individuals with BAPD (OR = 2.13; 95% CI 1.39-3.27). A. actinomycetemcomitans and P. gingivalis counts were significantly higher in individuals with BPAD and periodontitis. The final multivariate logistic regression revealed that periodontitis was strongly associated with the total bacterial load (OR = 1.91; 95% IC = 1.0-1.99; P < 0.001) and the depressive phase of BPAD (OR = 28.94; 95% IC = 4.44-177.27; P < 0.001). CONCLUSION: BAPD was associated with increased risk for periodontitis. Individuals with BPAD presented higher levels of A. actinomycetemcomitans and P. gingivalis, suggesting that periodontitis could be a co-morbidity frequently found in individuals with BAPD.

Transovarial transmission of dengue 1 virus in Aedes aegypti larvae: real-time PCR analysis in a Brazilian city with high mosquito population density.

Transovarial transmission is among the reported factors able to influence environmental maintenance of dengue virus (DENV). Endemic areas with active transmission of dengue are suitable for studying transovarial transmission. Brazil is a country where dengue is endemic and where DENV-1 is the most common disease-related virus serotype. This study aimed to identify transovarial transmission of DENV-1 in Aedes aegypti larvae by reverse-transcriptase nested real-time polymerase chain reaction. Between March and October 2016, Culicidae larvae were collected using traps in 3 locations in Taubaté, São Paulo, Brazil, which has a high occurrence of dengue. The collected larvae were sacrificed in the 3rd or 4th larval stage, classified, and stored at -20 °C. The A. aegypti larvae samples (n = 910) were separated into 91 pools of 10 specimens each from which RNA was extracted, reverse transcribed into cDNA, and analyzed by nested qPCR. None of the pools tested positive for DENV-1. Due to the absence of detectable virus in the evaluated samples, we concluded that transovarial transmission may not be the primary mechanism for maintenance of DENV-1 in this particular environment.

Impact of gingivitis treatment for diabetic patients on quality of life related to periodontal objective parameters: A randomized controlled clinical trial.

OBJECTIVES: Patients with diabetes have a poor oral health-related quality of life (OHRQoL). It is not clear if this situation could be changed with effective periodontal treatment. This study examined both patients with diabetes and systemically healthy individuals to discover the impact of a gingivitis treatment protocol on OHRQoL and its relation to objective periodontal parameters. DESIGN: After ultrasonic debridement, patients were randomly assigned to an essential-oils (EO) or placebo mouthwash group. At baseline and 3 months, OHRQoL was assessed with the Oral Health and Quality of Life-United Kingdom questionnaire (OHQoL-UK) along with clinical, halitometric, microbiological and inflammatory objective parameters. The primary outcome was a change in OHQoL-UK scores. A factor analysis was performed and the impact of the extracted quality of life factor (QLF) and its interactions with diabetes, treatment, and time on the objective parameters, were tested by multiple linear regression models (p < 0.05). Chi-Square test compared questionnaire-answering profiles (p<0.05). RESULTS: Combined treatment with EO provided OHQoL improvements in both systemic conditions. Positive effect of oral health status on quality of life increased in EO groups but not in placebo groups. Question I (self-confidence) showed the greatest factorial weight, while Question A (food intake) showed the lowest factorial weight. All patients who showed OHRQoL improvements and used the EO rinse showed the lowest plaque and gingival indices and lower levels of bacteria and volatile sulfur compounds. CONCLUSIONS: OHRQoL positively changed overtime. Most effective treatment protocols would provide better improvements in OHRQoL which is related to periodontal objective measures.

Nitrito salivar como indicador da condição periodontal: revisão de literatura / Salivary nitrite as periodontal status indicator: a literature review

Vários fatores biológicos têm sido estudados como biomarcadores da condição periodontal. O óxido nítrico (NO) faz parte de uma família de radicais livres envolvidos com a homeostasia, resposta imunológica, atividade cardiovascular e neurotransmissão. O NO pode ser produzido pelo organismo humano via óxido nítrico sintase (NOS) dependente ou via NOS independente. No mecanismo NOS independente a produção de NO envolve um ciclo entero-salivar de redução do nitrato (NO3-) em nitrito (NO2-) e a sua subsequente conversão em NO. Os estímulos inflamatórios presentes na doença periodontal também são capazes de induzir a formação de NO e há relatos na literatura de que o mesmo possa atuar interferindo na progressão da periodontite. No osso, assim como em outros tecidos, a produção de NO pode ser estimulada por lipopolisacarídeos (LPS) bacterianos. Nesse mecanismo tem sido sugerida uma importante participação das bactérias bucais. O objetivo deste trabalho foi avaliar por meio de revisão da literatura a relação do óxido nítrico, nitrato e nitrito com a condição periodontal e se procedimentos terapêuticos periodontais podem interferir com esses fatores. O óxido nítrico é um importante mediador de várias atividades biológicas. Os níveis de NO2- parecem estar aumentados na periodontite, comparativamente à gengivite e saúde gengival. Apesar da produção de NO ter um papel primário bactericida, é provável que essa produção em altas concentrações resulte em danos aos tecidos periodontais do hospedeiro. Nas lesões periodontais quantidades consideráveis de NO são geradas principalmente por macrófagos, neutrófilos polimorfonucleares, linfócitos e fibroblastos induzidos pelas citocinas e por LPS. A oferta dietética de NO3- influencia a síntese de NO e a produção de NO2-. Não está completamente elucidada a real influência do tratamento periodontal sobre os níveis de NO2.(AU)

Several biological factors have been studied as biomarkers of periodontal condition. Nitric oxide (NO) is part of a family of free radicals related to homeostasis, immunological response, cardiovascular activity, and neurotransmission. NO can be produced by human body via nitric oxide synthase (NOS) dependent or an pathway independent of NOS. In the independent pathway NO production involves an enterosalivary cycle by which nitrate (NO3-) is reduced to nitrite (NO2-) followed by its subsequent conversion to NO. The inflammatory stimuli present in periodontal disease are also able to induce the formation of NO and there are reports in the literature that the same may act by interfering on the progression of periodontitis. In bone, like other tissues, NOproduction may be stimulated by lipopolysaccharide (LPS) from bacteria. In this mechanism it has been suggested an important role of oral bacteria. The aim of this study was to evaluate through a literature review the relationship between NO, NO3- and NO2- and periodontal condition. Also whether periodontal therapeutic procedures can interfere in NO, NO3- and NO2- or not. NO is an important mediator in various biological activities. NO2- levels seem to be high in periodontitis when compared to gingivitis and gingival health. Although NOproduction has a bactericidal primary role, probably in high concentrations its production results in damage to host periodontal tissues. In periodontal lesions greater amounts of NO are generated primarily by macrophages, polymorphonuclear neutrophils, lymphocytes and fibroblasts and induced by cytokines and LPS. NO3-from diet influences the synthesis and production of NO and NO2-. It is not completely understood the real influence of periodontal treatment on the levels of NO2- (AU)

Avaliação da eficácia da terapia periodontal não cirúrgica em indivíduos obesos: revisão da literatura / Evaluation of the efficacy of non-surgical periodontal therapy effectiveness in obese individuals: literature review

A obesidade vem sendo considerada um dos maiores problemas de saúde pública da era moderna. A doença influencia negativamente a saúde geral do indivíduo, desencadeando ou agravando inúmeras doenças e comorbidades. Estudos sugerem que a obesidade pode influenciar a severidade e a progressão da doença periodontal, através do aumento de citocinas inflamatórias como o TNF-α, IL-6 e IL-8 secretadas pelo tecido adiposo na corrente sanguínea. Por isso, a presente revisão de literatura objetivou avaliar se a terapia não cirúrgica é eficaz no tratamento da doença periodontal em indivíduos obesos. Utilizando-se Obesity AND Periodontitis AND Periodontal Therapy como palavras chave, foram levantados artigos na base de dados Pubmed, publicados entre os anos de 2011 e 2016, na língua inglesa. A maior parte dos estudos investigou o modelo de tratamento convencional e monitorou parâmetros clínicos. Os resultados demonstraram que clinicamente os obesos respondem favoravelmente a raspagem e alisamento radicular, incluindo diminuição de profundidade de sondagem e melhora na condição gengival. Os estudos que incluíram parâmetros bioquímicos também demonstraram resultados favoráveis. Entretanto, outros parâmetros devem ser monitorados como desfechos e outras modalidades terapêuticas precisam ser testadas para que se possa avaliar melhor a real eficácia do tratamento em obesos. Considerando-se que os dados disponíveis ainda são limitados, a literatura permitiu-nos concluir que a terapia periodontal convencional é efetiva em indivíduos obesos

Obesity has been considered one of the greatest public health problems of the modern era. The disease adversely affects the overall health of the individual, triggering or worsening numerous diseases and comorbidities. Studies suggest that obesity can influence the severity and progression of periodontal disease by the increase of inflammatory cytokines such as TNF-α, IL-6 and IL-8 secreted by adipose tissue in the bloodstream. Therefore, the aim of this literature review is to assess the efficacy of non-surgical periodontal therapy in obese individuals. Using Obesity AND Periodontitis AND Periodontal Therapy as keywords, articles published between 2011 and 2016 in the English language were searched in Pubmed database. Most studies had focused on conventional treatment and monitored clinical parameters. Obese showed good clinical response to scaling and root planing, including a decrease in pocket depth and improvement in the gingival condition. Studies that included biochemical parameters also showed favorable results. However, other parameters should be monitored as outcomes and other therapeutic modalities need to be tested so that the real effectiveness of treatment in obese patients can be better evaluated. Considering the limitation of available data, the literature enabled us to conclude that periodontal therapy is effective in obese individuals

Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines.

BACKGROUND: There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals not or occasionally using alcohol and those with alcohol dependence. The aim of this study is to determine the effect of alcohol consumption on the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]-1ß and tumor necrosis factor [TNF]-α) in the gingival fluid among individuals with and without periodontitis. METHODS: This observational analytic study includes 88 volunteers allocated in four groups (n = 22): individuals with alcohol dependence and periodontitis (ADP), individuals with alcohol dependence and without periodontitis (ADNP), individuals not or occasionally using alcohol with periodontitis (NAP), and individuals not or occasionally using alcohol without periodontitis (NANP). Levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum were determined by real-time polymerase chain reaction on the basis of the subgingival biofilm, and IL-1ß and TNF-α were quantified by enzyme-linked immunosorbent assay in gingival fluid samples. RESULTS: Individuals with alcohol dependence showed worse periodontal status and higher levels of P. intermedia, E. corrodens, F. nucleatum, and IL-1ß than non-users. No significant correlations between TNF-α and bacterial levels were observed. However, in the ADP group, higher levels of E. corrodens were correlated with higher levels of IL-1ß. CONCLUSION: A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies.

Periodontal Therapy Effects on Nitrite Related to Oral Bacteria: A 6-Month Randomized Clinical Trial.

BACKGROUND: Nitrite is a biologic factor relevant to oral and systemic homeostasis. Through an oral bacteria reduction process, it was suggested that periodontal therapy and chlorhexidine (CHX) rinse could affect nitrite levels, leading to negative effects, such as an increase in blood pressure. This 6-month randomized clinical trial evaluated the effects of periodontal therapeutic protocols on salivary nitrite and its relation to subgingival bacteria. METHODS: One hundred patients with periodontitis were allocated randomly to debridement procedures in four weekly sections (quadrant scaling [QS]) or within 24 hours (full-mouth scaling [FMS]) in conjunction with a 60-day CHX (QS + CHX and FMS + CHX), placebo (QS + placebo and FMS + placebo), or no mouthrinse (QS + none and FMS + none) use. Real-time polymerase chain reaction determined total bacterial, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Streptococcus oralis, and Actinomyces naeslundii levels. Salivary nitrite concentration was determined with Griess reagent. Data were analyzed statistically at baseline and 3 and 6 months by analysis of variance, Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests (P <0.05). RESULTS: Nitrite concentrations did not tend to change over time. Regarding CHX use, there was a negative correlation between nitrite and total bacterial load at 6 months (FMS + CHX) and one positive correlation between P. gingivalis and nitrite at baseline (QS + CHX). Independently of rinse type, in the FMS group, nitrite correlated negatively with several microbial parameters and also with a higher percentage of deep periodontal pockets. CONCLUSIONS: The relationship between nitrite and bacterial levels appears weak. Short-term scaling exhibited a greater influence on nitrite concentrations then long-term CHX use.

Clinical, microbial, and immune responses observed in patients with diabetes after treatment for gingivitis: a three-month randomized clinical trial.

BACKGROUND: Although patients with diabetes are frequently affected by periodontitis, only a few investigations have focused on gingivitis in this at-risk population. This randomized placebo-controlled clinical trial compared the response to a gingivitis treatment protocol that combined mechanical procedures and daily use of an essential oil (EO) mouthrinse between patients with and without diabetes. METHODS: The whole-mouth periodontal probing depth (PD), gingival index (GI), and plaque index (PI) were monitored in gingivitis cases among systemically healthy patients (n = 60) or those with diabetes (n = 60) at baseline and 3 months after treatment. Levels of Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and total bacterial load were determined by a real-time polymerase chain reaction in intrasulci plaque samples. The volume of gingival crevicular fluid (GCF) was quantified, and interleukin-1ß (IL-1ß) levels were determined in GCF samples. After a full-mouth ultrasonic debridement, patients were randomly assigned to an EO or a placebo rinse for 90 days (40 mL/day). The data were analyzed through repeated-measures analysis of variance and multiple comparisons Tukey tests (P <0.05). RESULTS: GI was more severe in the diabetes group. Diabetes impaired GI and reduced GCF volume. PD, bacterial levels, and IL-1ß improved similarly in both systemic conditions. The adjunctive use of EO provided greater reductions of PI, GI, total bacterial load, T. forsythia, A. actinomycetemcomitans, and GCF volume. CONCLUSIONS: Response to gingivitis treatment in patients with diabetes can slightly differ from that in patients without diabetes. Daily use of an EO mouthrinse after ultrasonic debridement benefited patients with and without diabetes.

Associations of duration of smoking cessation and cumulative smoking exposure with periodontitis.

This cross-sectional study investigated associations of cumulative smoking exposure and duration of smoking cessation with periodontitis and evaluated the effects of biological, behavioral, and social risk variables on these associations. The sample comprised 705 adults of both sexes (age, 35-65 years) who underwent a full-mouth periodontal examination. Subjects were classified according to smoking status as nonsmokers, former smokers, and current smokers, and univariate and multivariate analysis was used to evaluate associations between periodontitis prevalence and potential risk variables. The rates of periodontitis among nonsmokers, former smokers, and current smokers were 25.6%, 29.3%, and 45.1% respectively. After adjusting for other periodontal risk variables the odds ratio (95% confidence interval) for periodontitis was 3.09 (1.98-4.92) for former smokers and 5.24 (2.61-8.97) for current smokers. A significant dose-response relationship between pack-years of smoking and periodontitis prevalence was observed, as was a significant decrease in the risk of periodontitis as years of smoking cessation increased. Cumulative smoking exposure and duration of smoking cessation were significantly associated with periodontitis.

Gingival overgrowth in renal transplant subjects: a 44-month follow-up study.

BACKGROUND: To assess changes in gingival status of renal transplant subjects under immunosuppressive regimens based on cyclosporine (CsA), tacrolimus (Tcr), and sirolimus (Sir). METHODS: From a sample of 135 subjects (baseline examination [BE]), 89 without periodontal treatment, who maintained the immunosuppressive regimen based on the same main agent (CsA=23, Tcr=31, and Sir=35), were reexamined after 44 months (follow-up examination [FE]). Demographic, pharmacologic, and periodontal variables were collected and gingival overgrowth (GO) was assessed by visual examination. RESULTS: In Tcr and CsA groups, although not significant, occurrence of GO decreased (CsA [BE=56.5% and FE=34.8%; P=0.063] and Tcr [BE=19.4% and FE=12.9%; P=0.500]). In addition, the severity of GO decreased significantly in CsA group (mean score BE=10.29 ± 7.70 and mean score FE=0.78 ± 1.38; P=0.003). In Sir group, GO decreased from 17.1% (BE) to 0.0% (FE) (P=not applicable). In total sample, GO was associated with papillary bleeding index (P=0.001) and concomitant use of calcium channel blockers (P=0.029); in CsA and Tcr groups, GO was associated with papillary bleeding index (P=0.029 and 0.033, respectively). CONCLUSIONS: There was no incidence of GO, and a decrease in the occurrence and severity of GO was significant in total sample. This decrease can be attributed to changes in pharmacologic and periodontal variables over this period of time.