Antibacterial, biological, and physicochemical properties of root canal sealers containing chlorhexidine-hexametaphosphate nanoparticles.

OBJECTIVE: The aim of this study was to evaluate the influence of the incorporation of chlorhexidine-hexametaphosphate nanoparticles (CHX-HMP NPs) on antibacterial, cytotoxic and physicochemical properties of AH Plus (AH), MTA Fillapex (MTA) and Pulp Canal Sealer (PCS). METHODS: The NPs were synthesized and characterized by Scanning Electron Microscopy (SEM), Dynamic Light Scattering (DLS), zeta potential, Atomic Force Microscopy (AFM) and Energy-Dispersive X-ray Spectroscopy (EDS). The incorporation was made by weight, 2% and 5% of NPs. The antimicrobial activity, cytotoxicity, flow, radiopacity, setting time, solubility and pH were evaluated. The statistical analysis was performed by two-way analysis of variance test and Tukey post hoc test (P < 0.05). RESULTS: SEM analysis showed the tendency for CHX-HMP NPs to cluster, the effective mean diameter measured by DLS: 169.39 nm and the zeta potential: -10.18 mV. The NPs were individually measured by AFM: 22.99-52.75 nm. EDS analysis identified the presence of C, N, O, Na, P, Cl. After incorporation: The Direct Contact Test showed an increase in the antimicrobial action of AH, PCS and MTA; the sealers showed a decrease in flow and at 24 h of immersion also an increase in solubility, but did not affect the radiopacity of the samples; AH setting time increased and MTA did not reach setting under any of the conditions tested. All samples showed a decrease in pH value as the immersion time progressed. SIGNIFICANCE: The incorporation of NPs can improve the antimicrobial performance of endodontic sealers without impairing other biological and physicochemical properties.

Avaliação de pacientes odontológicos para auxílio no diagnóstico precoce da osteoporose / Evaluation of dental patients to aid in early dignosis of osteoporosis

A osteoporose, doença osteometabólica mais frequente, é caracterizada pela diminuição da massa óssea e deterioração do tecido ósseo. O objetivo deste estudo foi verificar a relevância dos exames clínico e radiográfico no auxílio do diagnóstico precoce da osteoporose. Participaram do estudo 57 pacientes de ambos os gêneros, acima dos 30 anos atendidos na Clínica da FO-UNESA. Após anamnese, os pacientes foram submetidos aos exames radiográficos. As radiografias panorâmicas foram analisadas através dos índices radiomorfométricos quantitativos e qualitativos. Conclui-se que os índices radiomorfométricos, principalmente o IMC, apresentaram maior precisão na detecção da redução da densidade óssea quando associados aos fatores de risco para o desenvolvimento da osteoporose.

Osteoporosis, the most common osteometabolic disease, is characterized by decreased bone mass and deterioration of bone tissue. The aim of this study was to assess the relevance of clinical and radiographic examinations aid in early diagnosis of osteoporosis. The study included 57patients of both sexes over age 30 treated at the Clinic FO-UNESA. After interview, the patients underwent radiographic examinations. Panoramic radiographs were analyzed using quantitative and qualitative radiomorphometric indexes. We concluded that the radiomorphometric indexes, mainly IMC, were more accurate in the detection of low bone density when associated with risk factors for the development of osteoporosis.

Early and late oral features of chronic graft-versus-host disease.

BACKGROUND: Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. OBJECTIVE: The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. METHODS: This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). RESULTS: Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. CONCLUSION: Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation.

Early and late oral features of chronic graft-versus-host disease

Background: Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective: The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods: This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results: Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion: Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation. .

Detection of Sulphate-Reducing Bacteria and Others Cultivable Facultative Bacteria in Dental Tissues.

AIM: To detect for the presence of sulphate-reducing bacteria (SRB) and evaluate the possible association between SRB and cultivable facultative bacterial of oral sites with different periodontal conditions. METHODS: The study was carried out on 9 samples from different oral sites in 8 patients (two samples were collected from the same patient). Material was collected using modified Postgate E culture medium, indicated for the growth and isolation of SRB. In addition, a reducing solution for anaerobic bacteria was used as a transport solution for facultative bacteria and identified by polymerase chain reaction amplification (PCR) and sequencing of the 16S rRNA gene. RESULTS: SRB was found in 3 patient samples: the first in a root fragment, the second in a root fragment and a healthy tooth with vertical bone loss and a mobility degree of 3; and the third in a healthy tooth extracted for orthodontic treatment. In the final patient, the cultivable facultative species Lactobacillus casei was identified. Other facultative bacterial species were identified in patient 5 (Kurthia Gibsonii) and patient 7 (Pseudomonas aeruginosa). CONCLUSIONS: The detection of SRB in different dental tissues with distinct periodontal features demonstrated that new studies need to be developed in order to determine the true role of SRB in the oral microbiota. In addition, it was possible to verify the presence of Lactobacillus casei together with SRB in one sample.

Seladores coronários temporários: determinação da atividade antimicrobiana in vitro / Temporary coronary dental sealers: determination of in vitro antimicrobial activity

O objetivo do trabalho foi comparar a atividade antimicrobiana in vitro de 6 seladores coronários temporários. Foram testados: Vitro Molar®, IRM®, Coltosol®, Citodur, Maxxion R® e Cavit®. O método utilizado foi o teste de determinação da ação antimicrobiana de difusão em ágar inoculado com amostras de saliva humana de 30 indivíduos. Os testes ANOVA e Mann-Whitney foram utilizados para a análise estatística da medida dos halos de inibição do crescimento bacteriano. A correção de Bonferroni foi aplicada para as comparações múltiplas. Coltosol® foi selador coronário que apresentou a maior média de halo de inibição do crescimento microbiano in vitro, sendo estatisticamente superior ao IRM® (p<0,001) e Citodur® (p<0,001). As demais comparações dos pares dos outros seladores não demonstraram significância.

The purpose of this study was to compare the in vitro antimicrobial activity of six temperary coronary sealers. The materiais tested were: Vitro Molar®, IRM®, Coltosol®, Citodur®, Maxxion R® and Cavit®. The method used for determining antimicrobial activity was the agar diffusion test with human saliva samples from 30 individuals. The ANOVA and Mann-Whitney test were used for statistical analysis of measurements of the halos of bacterial growth inhibition. The Bouferroni correction was applied for multiple comparisons. Coltoso® was the sealer with the highest average of bacterial growth inhibition, statistically superior to IRM® (p<0.001) and Citodu® (p<0.001). The comparisons of pairs of other sealers showed no significant differences concerning to bacterial growth inhibition.

Necrotizing periodontal diseases in HIV-infected Brazilian patients: a clinical and microbiologic descriptive study.

OBJECTIVE: Nowadays, necrotizing periodontal diseases have a low prevalence; however, a better understanding of the etiopathogenesis of these diseases is necessary for determining more adequate preventive and therapeutic strategies. METHOD AND MATERIALS: From a pool of 1,232 HIV-infected patients, 15 presented with necrotizing periodontal diseases, which were evaluated by full-mouth periodontal clinical measurements. Subgingival biofilm samples were collected from necrotizing lesions of six of these individuals. The presence and levels of 47 bacterial species were determined by checkerboard DNA-DNA hybridization. RESULTS: All 15 patients (10 had severe immunodeficiency) had been infected sexually. Thirteen patients were taking antiretroviral medication (66.7% undergoing highly active antiretroviral therapy). Regarding necrotizing periodontal diseases, necrotizing ulcerative gingivitis (60%) was more prevalent than necrotizing ulcerative periodontitis (40%). The frequency of supragingival biofilm and bleeding on probing ranged from 11.5% to 59.2% and 3.0% to 54.0%, respectively, whereas the mean probing depth and clinical attachment level were between 1.48 and 2.61 mm and 1.30 and 2.62 mm, respectively. Species detected in high prevalence and/or counts in necrotizing lesions included Treponema denticola, Eikenella corrodens, Dialister pneumosintes, Enterococcus faecalis, Streptococcus intermedius, Aggregatibacter actinomycetemcomitans, and Campylobacter rectus. In contrast, Parvimonas micra, Prevotella melaninogenica, Fusobacterium nucleatum, Eubacterium nodatum, and Helicobacter pylori were observed in the lowest mean prevalence and/or counts. CONCLUSION: Necrotizing periodontal disease lesions in HIV-infected patients present a microbiota with high prevalence and/or counts of classical periodontal pathogens, in particular T denticola, as well as species not commonly considered as periodontal pathogens, such as E faecalis and D pneumosintes. In addition, these individuals with necrotizing periodontal disease frequently display severe immunodeficiency and AIDS-defining diseases such as tuberculosis.

Avaliação estereomicroscópica de limas endodônticas tipo K / Stereomicroscope evaluation of endodontics files K-type

As superfícies metálicas de dezesseis limas endodônticas tipo Kerr, novas, foram avaliadas através do uso de um microscópio esterioscópico. Todas as limas estudadas revelaram a existência de defeitos superficiais oriundos do processo de fabricação: partículas ao longo de todo o instrumento e/ou ranhuras de usinagem. A importância de caracterizar estes defeitos se reflete como um risco estrutural resultando em uma fratura inesperada do instrumento, obstrução do conduto radicular e o transporte destes fragmentos para a região perirradicular devido ao deslocamento das partículas presentes sobre a superfície metálica da lima.

The metallic surfaces of sixteen new Kerr-type endodontics files were evaluated through use of a stereomicroscope. All studied files showed surface defects from the manufacturing process: particles throughout the instrument and / or machining grooves. The importance of characterizing these defects is reflected as a structural risk resulting in an unexpected fracture of the instrument, obstruction of the root canal and transport of these fragments into the periradicular region due to displacement of the particles on the surface of the metal file.

Influence of IL-1 gene polymorphism on the periodontal microbiota of HIV-infected Brazilian individuals.

This study investigated the association of IL-1A (+4845) and IL-1B (+3954) gene polymorphism with the subgingival microbiota and periodontal status of HIV-infected Brazilian individuals on highly active antiretroviral therapy (HAART). One hundred and five subjects were included in the study, distributed into 2 HIV groups [29 chronic periodontitis (CP+) and 30 periodontally healthy (H+)]; and 2 non-HIV groups (29 CP- and 17 H- patients). IL-1A and B were genotyped by PCR and restriction enzyme digestion. Thirty-three bacterial species were detected by checkerboard. Overall, we observed a prevalence of the allele 2 in the IL1-A and IL-1B polymorphism at 30.5% and 25.7%, respectively. Only 11.4% of all patients were composite genotype-positive, and 75% of those were HIV-infected. No significant associations between polymorphism of the IL-1 gene and periodontitis or HIV infection were observed. Likewise, no significant differences in the frequency and counts of any bacterial species were found between individuals with and without allele 2 (IL-1A or IL-1B). The data indicated that the IL-1 gene polymorphism is neither associated with periodontal destruction nor with high levels of subgingival species, including putative periodontal pathogens in HIV Brazilian individuals on HAART.

Influence of IL-1 gene polymorphism on the periodontal microbiota of HIV-infected Brazilian individuals

This study investigated the association of IL-1A (+4845) and IL-1B (+3954) gene polymorphism with the subgingival microbiota and periodontal status of HIV-infected Brazilian individuals on highly active antiretroviral therapy (HAART). One hundred and five subjects were included in the study, distributed into 2 HIV groups [29 chronic periodontitis (CP+) and 30 periodontally healthy (H+)]; and 2 non-HIV groups (29 CP- and 17 H- patients). IL-1A and B were genotyped by PCR and restriction enzyme digestion. Thirty-three bacterial species were detected by checkerboard. Overall, we observed a prevalence of the allele 2 in the IL1-A and IL-1B polymorphism at 30.5 percent and 25.7 percent, respectively. Only 11.4 percent of all patients were composite genotype-positive, and 75 percent of those were HIV-infected. No significant associations between polymorphism of the IL-1 gene and periodontitis or HIV infection were observed. Likewise, no significant differences in the frequency and counts of any bacterial species were found between individuals with and without allele 2 (IL-1A or IL-1B). The data indicated that the IL-1 gene polymorphism is neither associated with periodontal destruction nor with high levels of subgingival species, including putative periodontal pathogens in HIV Brazilian individuals on HAART.

Processos fisiológicos e patológicos das bactérias redutoras de sulfato do gênero desulfovibrio sp / Physiologic and pathological processes of the sulphate-reducing bacteria of the genus desulfovobrio sp

As bactérias redutoras de sulfato do gênero Desulfovibrio sp. podem ser encontradas normalmente formando parte da biota intestinal e oral de seres humanos saudáveis, participando, direta ou indiretamente, com seus produtos metabólicos, de diversas afecções como: periodontites, câncer colorretal, infecções e sepsemias. Propõe-se com esta revisão avaliar os aspectos normais e as possíveis alterações patológicas correlacionadas com as bactérias redutoras de sulfato no organismo humano. As conclusões levam a crer que o desequilíbrio na biota oral e intestinal pode levar a aumento no número de bactérias redutoras de sulfato e na produção de sulfeto, como produto metabólico final, podendo representar um fator adicional no desenvolvimento daquelas afecções. Além disso, por haver forte propensão para formar associações bacterianas, aumentando seu potencial patológico, pode ser difícil a identificação do seu verdadeiro papel nas morbidades em que estão envolvidas assim como o seu potencial virulento.

Sulfate-reducing bacteria of the genus Desulfovibrio spp. can be routinely detected as member of the normal intestinal and oral microbiota in health individuals. This bacterial group produces metabolic byproducts, which participate, direct or indirect, in several diseases, such as periodontitis, colorectal cancer, infections and sepsis. The purpose of the present study was to assess the association between sulfate-reducing bacteria and normal conditions and pathology alterations in human. In conclusion, it is possible that alteration of the oral and intestinal flora can result in increase of sulfate-reducing bacteria levels and products of sulfide as final metabolic. Therefore, these conditions can represent an important fact associated with those diseases. In addition, this bacterial group presents a great tendency in to associate with other microorganisms. Like that, it can increase the pathologic potential and can difficult the identification of the true involvement with several diseases as well as its virulent potential.

Clinical and microbiological profiles of human immunodeficiency virus (HIV)-seropositive Brazilians undergoing highly active antiretroviral therapy and HIV-seronegative Brazilians with chronic periodontitis.

BACKGROUND: This study compares the periodontal clinical profile and the composition of the subgingival microbiota of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative subjects with chronic periodontitis. METHODS: A total of 172 subjects were distributed into two HIV-seropositive groups (37 chronic periodontitis [H+CP+] and 35 periodontally healthy [H+CP-] individuals) and two HIV-seronegative groups (49 chronic periodontitis [H-CP+] and 51 periodontally healthy [H-CP-] subjects). Subgingival samples were collected from six sites with the deepest probing depth in the periodontitis groups and six random sites in the groups with periodontal health. All HIV-infected patients had undergone highly active antiretroviral therapy (HAART) for at least 2 years. The presence and levels of 33 bacterial species were detected by DNA probes and the checkerboard method. Kruskal-Wallis and Mann-Whitney tests were used to seek for significant differences among and between groups. RESULTS: H-CP+ patients showed significantly more periodontal destruction and inflammation than H+CP+ patients, whereas H+CP- subjects presented a greater percentage of sites with bleeding than H-CP- subjects (P <0.01). Patients who were HIV seronegative showed higher prevalence and levels of most bacterial species than HIV seropositive patients. Periodontal pathogens including Tannerella forsythensis, Porphyromonas gingivalis, Prevotella nigrescens, Eubacterium nodatum, Fusobacterium nucleatum, and Selenomonas noxia were more frequently detected in H-CP+ subjects compared to H+CP+ and controls. In contrast, Enterococcus faecalis and Acinetobacter baumannii were more commonly found in HIV-infected than in non-HIV-infected subjects (P <0.05). CONCLUSION: Putative periodontal pathogens are more prevalent in the subgingival microbiota of HIV-seronegative patients with chronic periodontitis, whereas species not usually associated with periodontitis are detected in higher frequency in HIV-seropositive subjects under HAART.

Periodontite crônica e a infecção pelo HIV. II. Resposta do hospedeiro / Chroni periodontitis and HIV infection. II. Host response

Apesar de a terapia anti-retroviral altamente intensiva (HAART) ter diminuído a incidência e severidade das formas atípicas de doença periodontal û eritema gengival linear (EGL) e doenças periodontais necrosantes (DPN) û em pacientes HIV+, a periodontite crônica ainda parece demonstrar um quadro clínico mais severo e extenso e uma progressão mais rápida quando comparada à de pacientes não infectados pelo HIV.

Association of T CD4 lymphocyte levels and chronic periodontitis in HIV-infected brazilian patients undergoing highly active anti-retroviral therapy: clinical results.

BACKGROUND: Controversial data regarding the association between immunosuppression and prevalence/ severity of periodontal diseases in HIV infection have been reported. Thus, the aim of this study was to test the hypothesis that lower T CD4 lymphocyte levels are not related to a higher prevalence of chronic periodontitis in HIV-infected Brazilians undergoing highly active anti-retroviral therapy (HAART). METHODS: Sixty-four HIV-infected patients under HAART were classified as having chronic periodontitis; i.e., > or = three sites with probing depth (PD) and/or clinical attachment level (CAL) > or = 5 mm or periodontal healthy (no sites with PD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Bleeding on probing, plaque accumulation, PD, and CAL were registered at six sites/tooth at baseline and 4 months after therapy. Epidemiological features and levels of T CD4 lymphocytes were obtained from medical records. Significance of differences in periodontal clinical parameters within and between groups were determined using Wilcoxon signed-rank and Mann-Whitney or independent sample t tests. Associations between T CD4 levels and clinical parameters were determined using the chi square test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The overall T CD4 lymphocyte mean levels was 333 +/- 254 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet the prevalence of chronic periodontitis was relatively low (36%). In addition, patients with periodontitis presented a moderate disease (mean PD = 2.2 +/- 0.10; mean CAL = 2.6 +/- 0.13) and responded successfully to periodontal therapy. These subjects showed higher levels of T CD4 cells, but lower counts of neutrophils than periodontally healthy patients. Among periodontally healthy and chronic periodontitis patients, 41.7% and 22.9%, respectively, had low levels of T CD4 lymphocytes. No significant differences between periodontal status and epidemiological and immunological parameters were observed. CONCLUSION: Based on these results, the hypothesis that lower T CD4 lymphocyte levels are not associated with higher prevalence of chronic periodontitis in HIV-infected Brazilians under HAART cannot be rejected.

Periodontite crônica e a infecção pelo HIV. I. Aspectos microbiológicos / Chronic periodontitis and HW infection. I. Microbiologic features

A microbiologia da periodontite crônica em pacientes HIV+ apresenta uma semelhança na prevalência de periodontopatógenos clássicos quando comparada com a de indivíduos HIV negativo. Contudo, em função da imunossupressão, microrganismos, atípicos, tais como Staphylococcus epidermidis, Candida albicans. Enterococcus faecalis. Clastridium clastridiforme. Clastridium difficile e Mycoplasma salivarium, podem ser encontrados na microbiota subgengival. Além disso, os tecidos periodontais podem ser invadidos po Candida spp em periodontites severas. Essa característica particular pode justificar a maior severidade das periodontites nos pacientes HIV. Alguns vírus, incluindo o herpesvírus e o próprio HIV, também podem desempenhar um papel importante na patogênese de doenças periodontais nessa população.

Association of T CD4 lymphocyte levels and subgingival microbiota of chronic periodontitis in HIV-infected Brazilians under HAART.

OBJECTIVE: The aim of this study was to determine the subgingival microbiota of HIV-infected patients with chronic periodontitis and different T CD4 lymphocyte levels under HAART. STUDY DESIGN: 64 HIV+ patients (mean age 34.5 +/- 7.3; 75% males) were distributed into Group I: chronic periodontitis (> or = 3 sites with probing pocket depth (PPD) and/or clinical attachment level (CAL) > or = 5 mm); and Group II: periodontal health (no sites with PPD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Periodontal clinical parameters were evaluated at 6 sites/tooth in all teeth at baseline and 4 months after therapy. The levels of T CD4 were obtained from the patient's medical record. Subgingival plaque samples were taken from the 6 sites with the largest pocket depth in each subject of Group I, and 6 randomly selected sites in subjects of Group II. The presence of 22 subgingival species was determined using the checkerboard DNA-DNA hybridization method. Significant microbiological differences within and among groups were sought using Wilcoxon signed-rank and Mann-Whitney tests, respectively. Relationships between T CD4 levels and microbiological parameters were determined using Kruskal-Wallis test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The T CD4 lymphocyte mean level was 333 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet, the prevalence of chronic periodontitis was relatively low (36%). Several periodontal pathogens, in particular T. forsythensis (P < .05), were more prevalent in HIV-positive patients with periodontitis than in HIV-positive subjects with periodontal health. Most of the species decreased in frequency after therapy, particularly P. gingivalis (P < .05). E. faecalis and F. nucleatum were significantly more prevalent in the subgingival microbiota of patients with chronic periodontitis and lower levels of T CD4 (P < .05), while beneficial species tended to be more frequently detected in individuals with T CD4 counts over 500 cells/mm3. CONCLUSION: The subgingival microbiota of HIV-infected patients with chronic periodontitis include a high prevalence of classical periodontal pathogens observed in non-infected individuals. Furthermore, the severe immunosuppression seems to favor the colonization by these species, as well as by species not commonly found in the subgingival microbiota.