Effect of periodontal treatment on glycated haemoglobin and metabolic syndrome parameters: A randomized clinical trial.

AIM: To assess the effect of periodontal treatment on HbA1c and diagnostic parameters of patients with metabolic syndrome (MetS). MATERIALS AND METHODS: One hundred and fifty-eight patients with MetS and moderate and severe periodontitis were included. They were randomized into a test group (n = 79), which received non-surgical periodontal treatment, and a control group (n = 79), which received no treatment. Medical treatment was delivered to both groups. Clinical periodontal, anthropometric and serological parameters were assessed at baseline, 3 and 6 months. The main outcome was glycated haemoglobin (HbA1c) levels, and the secondary outcomes were changes in the MetS parameters, C-reactive protein (CRP) and HOMA indexes. RESULTS: Significant reductions in all periodontal parameters were observed in the test group, compared with the control group, at 3 and 6 months (p < .001). HbA1c levels, MetS parameters, CRP and HOMA indexes showed no significant differences between the test group and the control group at 3 and 6 months. CONCLUSIONS: Periodontal treatment led to a substantial reduction in periodontal inflammation, although there was no significant effect on the parameters used for MetS diagnosis in patients with early diagnosed and well-controlled MetS.

At least 3 years of self-responsibility for periodontal care after 2 years of supportive periodontal therapy.

OBJECTIVES: This study aimed to investigate the periodontal condition when patients became self-responsible for the continuation of periodontal care, after non-surgical periodontal therapy and 2 years of Supportive Periodontal Therapy (SPT). MATERIALS AND METHODS: Fifty-seven patients completed a previous 2-year SPT study and were afterward advised to seek for dental assistance for maintenance care. After 4.2 ± 0.45 years of self-responsibility for periodontal care (SRPC), 27 patients could be re-examined of which 9 patients had followed the advice to turn to a dental professional for SPT care. Visible Plaque (VPI), Gingival Bleeding (GBI), Periodontal Probing Depth (PPD), Bleeding on probing (BOP), and Clinical Attachment Loss (CAL) were obtained from SPT study: before and after non-surgical treatment, and after 2 years of SPT. The same parameters were reassessed for the present study. General linear models for repeated measures were used for data analysis. RESULTS: At the end of the SRPC period, mean GBI, BOP, and PPD values (43.5%, 55.7%, 2.76 mm, respectively) were back to pre-treatment, whereas VPI (64.3%) and CAL (3.76 mm) became significantly higher. The percentage of sites with PPD ≥5 mm as well as sites with CAL ≥4 or ≥5 mm also returned to pre-treatment values. However, the percentage of sites with PPD ≥4 mm was still significantly lower compared to pre-treatment values but higher than after 2 years of SPT. CONCLUSIONS: Self-responsibility for the continuation of periodontal care after professional treatment should be avoided. CLINICAL RELEVANCE: Clinicians and specialists must be conscious of making all efforts to maintain the patient's frequent recalls.

The use of medium bristle toothbrushes is associated with the incidence of gingival fissures.

OBJECTIVES: The objective of this study was to compare the incidence of gingival fissures (GF) associated with the use of soft and medium bristle toothbrushes over three months. MATERIAL AND METHODS: A blind randomized crossover clinical trial was conducted with 20 high school students (14 females, 14-24 years old) using both toothbrushes type (soft and medium bristle) during 3 months each. Periodontal examinations and photographs of premolars and molars were recorded on days 0, 30, 60, and 90 of 1st phase. Following a 10-day washout period, the 2nd phase was carried out with the participants changing the assigned brush type. Toothbrushing perception was evaluated at the end of study through a questionnaire. A calibrated and blind examiner analyzed the photographs for GF presence. Differences in the GF incidence between toothbrushes type were analyzed by McNemar test, while factors associated with GF incidence were investigated by Poisson regression. RESULTS: Sixty-five percent (n = 13) of participants had at least one GF throughout the study, with 40% (n = 8) of them while using medium brushes only (p = 0.039). GF occurrence was significantly associated with medium brushes (IRR, 3.582; 95% CI 1.459-8.795; p = 0.005). 58.8% of participants reported gingival soreness or bleeding with medium brushes. CONCLUSIONS: Both toothbrushes led to the GF occurrence. Nonetheless, medium bristles toothbrushes determined a 3.58 times greater risk of developing these lesions. Clinical relevance The use of medium bristle brush is associated with greater incidence of gingival fissures. The presence of gingival fissures should be considered by the clinician when evaluating the toothbrushing habits of patients.

Effect of Alcohol Consumption on Clinical Attachment Loss Progression in an Urban Population From South Brazil: A 5-Year Longitudinal Study.

BACKGROUND: The aim of this study is to investigate the impact of alcohol consumption on clinical attachment loss (AL) progression over a period of 5 years. METHODS: A multistage probability sampling strategy was used to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. Five hundred thirty-two individuals (209 males and 293 females) aged 18 to 65 years at baseline with no medical history of diabetes and at least six teeth were included in this analysis. Full-mouth periodontal examinations with six sites per tooth were conducted at baseline and after 5 years. Alcohol consumption was assessed at baseline by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: 1) non-drinker; 2) ≤1 glass/week; 3) >1 glass/week and ≤1 glass/day; and 4) >1 glass/day. Individuals showing at least two teeth with proximal (clinical AL) progression ≥3 mm over 5 years were classified as having disease progression. Multiple Poisson regression models adjusted for age, sex, smoking, socioeconomic status, and body mass index were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Overall, individuals who consumed >1 glass/day had 30% higher risk for clinical AL progression (RR = 1.30; 95% CI: 1.07 to 1.58) than non-drinkers. Among males, risk of clinical AL progression for individuals drinking >1 glass/day was 34% higher than non-drinkers (RR = 1.34; 95% CI: 1.09 to 1.64). Never-smoker males drinking ≤1 glass/week had significantly lower risk for clinical AL progression than non-drinkers (RR = 0.52; 95% CI: 0.30 to 0.89), whereas those drinking >1 glass/day had significantly higher risk (RR = 1.50; 95% CI: 1.08 to 1.99). Among females, no association between alcohol consumption and clinical AL progression was observed. CONCLUSIONS: Alcohol consumption increased the risk of clinical AL progression, and this effect was more pronounced in males. Low dosages (≤1.37 g of alcohol/day) of alcohol consumption may be beneficial to prevent periodontal disease progression in males. The impact of alcohol cessation initiatives on periodontal health should be evaluated.

Metabolic syndrome as a risk indicator for periodontal disease and tooth loss.

OBJECTIVES: The aim of the present study was to evaluate the association of metabolic syndrome (MS) with periodontitis (PE) and tooth loss (TL). MATERIALS AND METHODS: A cross-sectional study was conducted with 363 individuals who underwent full-mouth periodontal examination, and the association between MS and PE was evaluated considering three outcomes: severe periodontitis, mean probing depth ≥2.4 mm, and mean clinical attachment loss ≥2.0 mm. The prevalence ratio (PR) between MS and PE was calculated using a model adjusted for gender, age, smoking, years of education, and socioeconomic status. RESULTS: The adjusted model showed a PR for severe periodontitis of 1.17 (95 % CI 0.83-1.65). There was no significant association between MS and PE defined as mean probing depth ≥2.4 mm. MS was significantly associated with PE defined as mean attachment loss ≥2 mm in individuals aged 41-60 years (PR 1.47, 95 % CI 1.05-2.06). In addition, MS was associated with TL (>6 teeth) (PR 1.23, 95 % CI 1.02-1.49) for all ages, both in crude and adjusted analyses. CONCLUSIONS: We concluded that there is a weak association of MS with both attachment loss and TL. CLINICAL RELEVANCE: Patients with MS seem to have a higher risk of attachment loss and tooth loss and should be screened for periodontal disease.

Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis.

AIMS: To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. METHODS: Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with ChP and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. RESULTS: GCF levels of IL-1ß, IL-6, IFN-γ and MCP-1/CCL2 were significantly higher in subjects diagnosed with ChP than periodontally healthy subjects. A significant decrease in GCF levels of IL-1ß and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. CONCLUSION: Evidence for significant differences between periodontal health and ChP was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression.

Clinical attachment loss: estimation by direct and indirect methods.

OBJECTIVE: This observational study aimed to compare the estimation of clinical attachment loss (CAL) as measured by direct (CALD ) and indirect (CALI ) methods. METHODS: Periodontitis patients (n = 75; mean age: 50.9 ± 8.02 years; 72.2% women; 50.6% smokers) received a periodontal examination (six sites/tooth) to determine the presence of visible plaque and calculus, the gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), CALD and gingival recession (GR). CALI values resulted from the sum of PPD and GR values. Statistical analysis considered only data from sites with visible GR (e.g. the gingival margin apical to the cemento-enamel junction; n = 4,757 sites) and determined the mean difference between CALI and CALD measurements. Based on the mean difference, univariate and multivariate analyses were also performed. RESULTS: Mean CALD and CALI values were 3.96 ± 2.07 mm and 4.47 ± 2.03 mm, respectively. The indirect method overestimated CAL compared with the direct method (mean difference: 0.51 ± 1.23 mm; P < 0.001). On uni- and multivariate analyses, absence of GBI and BOP, PPD and proximal site location had significant influences on the overestimation of CAL by the indirect method (all P ≤ 0.01). The indirect method increased the CAL value by 0.38 mm for each additional 1 mm in PPD. CONCLUSIONS: To decrease the number of probing errors in daily practice it is suggested that direct examination is more appropriate than the indirect method for estimating CAL.

Self-reported Use of Dental Floss over 13 Years: Relationship with Family Income, Mother's Age and Educational Level.

PURPOSE: To determine whether family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over a 13-year period in a city in southern Brazil. MATERIALS AND METHODS: A comparison of two household surveys was carried out where mothers of the family were interviewed using a structured questionnaire in order to obtain demographic, behavioural and socioeconomic information. In total, 852 and 984 households were included in 1996 and 2009, respectively. Self-reported use of dental floss was assessed dichotomously (yes/no). Poisson regression models were fitted to study the association between sociodemographic variables with the use of dental floss. Proportion ratios (PR) and 95% confidence intervals (95% CI) were reported. RESULTS: The proportion of dental floss use increased from 48% to 59% over 13 years. The probability of dental floss use increased 1.23 times from 1996 to 2009 (PR = 1.23; 95% CI 1.13-1.34). Households with mothers ≥50 years old presented a 28% lower probability of using dental floss than households with mothers ≤35 years old. In households with higher family income and higher educational level of the mother, probabilities of flossing were 90% and 97% higher. CONCLUSION: Family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over 13 years.

Epidemiology of periodontal diseases in adults from Latin America.

A decade has passed since we first reviewed the epidemiology of periodontal diseases in Latin America. At that time, lack of population-based studies was the norm and our conclusions were based on very limited evidence. The aim of the present comprehensive review was to update and expand our previous work by providing a broad overview of Latin America and its current social, economic and demographic status and by focusing on the epidemiology of periodontal diseases in Latin American adults published in the last 15 years. The amount of periodontal epidemiological data available has increased but is still restricted to a few countries only. The scope of the literature available has also broadened to include oral health-related quality of life and systemic interactions; however, most studies had methodological limitations that might have biased their results. In general, periodontitis was very prevalent, but severe periodontal destruction was localized. Besides being associated with well-established risk factors, periodontitis was associated with demographics and socio-economic factors in Latin American populations. To advance epidemiological knowledge, population-based cross-sectional and longitudinal studies, using appropriate methodologies, should be the future focus of the research agenda of researchers and public health planners in Latin American countries.

Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial was carried out to assess the effect of comprehensive nonsurgical periodontal treatment and strict plaque control performed during pregnancy on the reduction of preterm and/or low birth weight rates (PTLBW). MATERIAL AND METHODS: Three hundred and three women were randomly allocated to receive periodontal treatment either during pregnancy (n = 147, test group) or after delivery (n = 156, control group). During pregnancy, the control group received only one session of supragingival scaling and oral hygiene instruction. In contrast, the test group received comprehensive periodontal treatment including multiple sessions of scaling and root planing, oral hygiene instructions, and frequent maintenance visits. RESULTS: At baseline, periodontal inflammation was observed in approximately 50% of sites and attachment loss affected <15% of sites. Compared to controls, women in the test group had significant reductions in the percentage of sites with plaque (48.5% vs. 10.3%, p < 0.001), gingival bleeding (23.3% vs. 2.5%, p < 0.001), calculus (21.3% vs. 4.1%, p < 0.001), bleeding on probing (38.1% vs. 2.6%, p < 0.001) and probing depth ≥3 mm (19.97% vs. −2.45%, p < 0.001). No significant differences were observed between the groups in the occurrence of PT (11.7% vs. 9.1%, p = 0.57), LBW (5.6 % vs. 4.1%, p = 0.59), and PTLBW (4.15% vs. 2.60%, p = 0.53). CONCLUSIONS: Comprehensive periodontal treatment and strict plaque control significantly improved periodontal health; however, no reduction of PTLBW rates was observed. Thus, remaining periodontal inflammation posttreatment cannot explain the lack of effect of periodontal treatment on PTLBW. Clinical relevance This study demonstrated that periodontal diseases may be successfully treated during pregnancy. Our results do not support a potential beneficial effect of periodontal treatment on PTLBW.

Periodontal response to subgingival restorations in dogs with periodontitis.

The aim of this study was to evaluate the periodontal response to subgingival restorations in dogs with naturally occurring periodontitis. At the baseline, the experimental teeth from three dogs (2nd and 3rd upper premolars and 2nd, 3rd and 4th lower premolars) were randomly assigned to Resin-modified Glass Ionomer Cement (RMGIC) and Amalgam (AM) restorations or controls (CT) at the buccal sites with (SUPRA+) or without mechanical supragingival plaque control (SUPRA) and maintained for 90 days. Clinical [Periodontal Probing Depth (PPD), Clinical Attachment Loss (CAL), and Gingival Margin Recession (GMR)], histological (connective tissue inflammatory and epithelium condition) and histometric evaluation (distance between the apical border of the cavity and the bone level and between the apical extension of the epithelium and the bone level) were performed by a calibrated blinded examiner. Better clinical (especially regarding CAL) and histological results (unaltered epithelium and less severe inflammatory connective tissue) were observed associated with RMGIC sites. Histometric evaluation showed less bone loss associated to RMGIC. Overall, SUPRA+ sites presented less inflammatory response. It could be concluded that in dogs with periodontitis, subgingival RMGIC restorations, especially in the presence of supragingival plaque control, elicited better periodontal response than AM restorations.

Oral health status in elders from South Brazil: a population-based study.

OBJECTIVE: To assess the oral health status of community-dwelling adults aged 60 years and older from southern Brazil and to determine demographics, socioeconomic, behavioural and dental risk indicators. MATERIALS AND METHODS: This cross-sectional study used a multistage, probability sampling method to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. A subsample of 217 subjects was included in this analysis. Oral mucosal lesions, dental caries, tooth loss and periodontal status (full-mouth, six sites per tooth exam) were assessed by calibrated examiners. RESULTS: Prevalence of edentulism was 39.5%, and mean tooth loss was 20.2 (SE = 0.6). Older individuals [Odds Ratio (OR) = 2.2], women (OR = 2.3), white people (OR = 5.9), individuals of lower socioeconomic status (OR = 5.6) and smokers (OR = 3.5) had higher likelihood of being edentulous. Approximately 36% of dentate individuals had caries and/or restoration affecting, in average, 5.0 teeth. Periodontitis affected 79% of subjects, and it was associated with older age (OR = 4.0), men (OR = 3.4) and large amounts of supragingival plaque (OR = 3.0). CONCLUSION: Poor oral health was observed in this elderly population from South Brazil. Sociodemographic disparities accounted for most of the burden of disease and treatment needs.

Daily biofilm control and oral health: an epidemiological challenge consensus – brazilian advisory panel in oral health

Dental plaque is known as the primary etiological factor for the periodontal diseases. Knowledge about dental plaque has extensively evolved being recognized, not only as a simple bacterial conglomerate adhering to the tooth surface, but also defined as biofilm. Adequate oral hygiene is the most effective way to prevent periodontal disease and caries, which are caused by specific microorganisms found in the oral biofilm. Disorganization and constant removal of this biofilm represents the major strategy utilized in the prevention and treatment of such diseases. The inclusion of oral antiseptics, in daily home care, provides a more effective recommendation for prevention by dental professionals. It is possible to establish a hierarchical order of effectiveness. Chlorhexidine (CHX) promotes the highest anti-plaque effects followed by the essential oils (EOs), cetylpyridinium chloride (CPC) and finally triclosan. For anti-gingivitis action the EOs are equivalent to CHX being both superior agents when compared with CPC and triclosan. Based on the available scientific evidence this group of experts in oral care is favorable to recommending the daily use of an essential oil-containing mouthwash as the active principle, for the majority of the population, excluding children under 6 year of age, individuals with sensitivity to the formula components and those who present adequate oral hygiene using only mechanical methods (brushing and flossing) and dentifrice.

Periodontal response to subgingival restorations in dogs with periodontitis

The aim of this study was to evaluate the periodontal response to subgingival restorations in dogs with naturally occurring periodontitis. At the baseline, the experimental teeth from three dogs (2nd and 3rd upper premolars and 2nd, 3rd and 4th lower premolars) were randomly assigned to Resin-modified Glass Ionomer Cement (RMGIC) and Amalgam (AM) restorations or controls (CT) at the buccal sites with (SUPRA+) or without mechanical supragingival plaque control (SUPRA-) and maintained for 90 days. Clinical [Periodontal Probing Depth (PPD), Clinical Attachment Loss (CAL), and Gingival Margin Recession (GMR)], histological (connective tissue inflammatory and epithelium condition) and histometric evaluation (distance between the apical border of the cavity and the bone level and between the apical extension of the epithelium and the bone level) were performed by a calibrated blinded examiner. Better clinical (especially regarding CAL) and histological results (unaltered epithelium and less severe inflammatory connective tissue) were observed associated with RMGIC sites. Histometric evaluation showed less bone loss associated to RMGIC. Overall, SUPRA+ sites presented less inflammatory response. It could be concluded that in dogs with periodontitis, subgingival RMGIC restorations, especially in the presence of supragingival plaque control, elicited better periodontal response than AM restorations.

O objetivo do presente estudo foi avaliar a resposta do periodonto a restaurações subgengivais em cães com diagnóstico de periodontite. No início do estudo, os dentes experimentais de três cães (2o e 3o molares superiores e 2o, 3o e 4o premolares inferiores) foram randomicamente designados para restauração com cimento de ionômero de vidro modificado por resina (CIVMR), amálgama (AM) ou Controle (CT) nos sítios vestibulares submetidos (SUPRA+) ou não (SUPRA-) a controle mecânico de placa supragengival e mantidos por 90 dias. Avaliações clínicas [Profundidade de Sondagem (PS), Nível de Inserção Clínica (NIC), Recessão Gengival (RG)], histológicas (condições inflamatórias do tecido epitelial e conjuntivo) e histométricas (distância entre a margem apical da cavidade e o nível ósseo e entre a extensão apical do epitélio e o nível ósseo) foram realizadas por examinador calibrado e cego. Melhores resultados clínicos (especialmente quanto à PI) e histológicos (epitélio sem alterações e tecido conjuntivo com menor severidade de infiltrado inflamatório) foram observados em associação a sítios restaurados com CIVMR. A avaliação histométrica mostrou menor perda óssea associada a restauração com CIVMR. Todos os sítios SUPRA+ exibiram menor resposta inflamatória. Pode ser concluído que, em cães com periodontite, restaurações subgengivais realizadas com CIVMR, especialmente na presença de controle mecânico de placa supragengival, apresentaram melhor resposta do periodonto quando comparadas com restaurações de amálgama.

Effect of the topical application of triclosan in periodontally treated patients.

The aim of this clinical parallel, double-blind study was to evaluate the effect of irrigating, with 0.6% triclosan, periodontal pockets 2 4 mm showing persisting signs of inflammation 90 days after sub-gingival scaling and root planing. 14 patients, aged 35-61 years, were randomly assigned to test group (TG) or placebo group (PG). In TG, pockets were rinsed with 10 ml of triclosan while in PG, pockets were rinsed with placebo. Irrigations were repeated fort-nightly for 70 days (total 6 rinses). Clinical examinations consisted of Plaque Index (PlI), Gingival Index (GI), Bleeding on Probing (BOP), Periodontal Probing Depth (PPD) and Clinical Attachment Level (CAL). Median values of PlI, GI and BOP were analyzed over time with the Friedman test and for the multiple comparisons with Wilcoxon and Mann-Whitney tests. Means for PPD, and CAL were analyzed with repeated measurements ANOVA (p<0.05). There were no statistically significant differences in the PlI and GI between groups. BOP was reduced significantly in both groups in a similar fashion. Significant reductions in PPD were observed for both groups. TG showed a PPD reduction of 0.8 mm whereas PG reduced 0.4 mm. No difference was found among groups for PPD. CAL gain for the TG group was 0.7 mm and for the PG of 0.5 mm. Only the gains observed for the TG group were significant. It can be concluded that 0.6% triclosan or placebo irrigation, 3 months after non-surgical treatment, of sites with persistent signs of inflammation, produced similar results.

Prevalence and risk indicators for chronic periodontitis in adolescents and young adults in south Brazil.

AIM: To describe the distribution of clinical attachment loss (CAL) and to study risk indicators for chronic periodontitis in a large population-based sample of adolescents and young adults from south Brazil. MATERIAL AND METHODS: This cross-sectional study used a subset of data from a larger survey representative of Porto Alegre, Brazil. The sample consisted of 612 individuals (291 males/321 females) aged 14-29 years. Full-mouth, six sites per tooth clinical examinations were performed by calibrated periodontists. Chronic periodontitis was defined as CAL 3mm affecting two or more teeth. Aggressive periodontitis cases were excluded from the analysis. RESULTS: CAL 3 and 5mm affected 50.4% and 17.4% of subjects and 9.7% and 1.1% of teeth, respectively. Prevalence of chronic periodontitis ranged between 18.2% and 72.0% among subjects 14-19 and 24-29 years old, respectively. In the multivariable logistic regression analysis, older age [odds ratio (OR)=2.6, 95% confidence interval (CI)=1.7-3.9 and OR=7.2, 95% CI=3.7-14.0 for 20-24 and 25-29 years old, respectively], low socioeconomic status (OR=1.9, 95% CI=1.4-2.7), heavy smoking (OR=1.7, 95% CI=1.1-2.7) and larger amounts of calculus (OR=2.0, 95% CI=1.2-3.2) were significantly associated with chronic periodontitis. CONCLUSION: This population of adolescents and young adults had a high prevalence of chronic periodontitis, and its presence was associated with age, socioeconomic status, smoking and calculus.

Association among menopause, hormone replacement therapy, and periodontal attachment loss in southern Brazilian women.

BACKGROUND: The aim of the present study was to evaluate the association among menopause, hormone replacement therapy (HRT), and periodontal attachment loss (PAL). METHODS: Three hundred twenty-eight women (40 to 69 years old) who participated in a previous oral survey in South Brazil were included. Women who reported not having their monthly menstrual cycles for >or=12 months were classified as postmenopausal. Postmenopausal women were categorized according to HRT. Women with >or=30% teeth with PAL >or=5 mm were classified as having periodontitis. The data were analyzed using a multivariable logistic regression model and adjusted for age, smoking, socioeconomic status, and dental care. RESULTS: The prevalence of periodontitis was significantly greater among postmenopausal women not using HRT (HRT-) than among premenopausal women (64.4% versus 46.3%; P = 0.005). Similarly, the multivariable analysis demonstrated a significantly higher chance of having periodontitis in postmenopausal HRT- women than in premenopausal women (odds ratio [OR], 2.1; 95% confidence interval [CI]: 1.1 to 4.0). In contrast, no significant differences were observed in the prevalence of periodontitis between postmenopausal women using HRT (HRT+) and premenopausal women (48.8% versus 46.3%; P = 0.77). After adjusting for cofactors, postmenopausal HRT+ women did not have a greater likelihood of having periodontitis than premenopausal women (OR, 1.2; 95% CI: 0.6 to 2.5). No significant differences in tooth loss were observed among the study groups after adjusting for confounders. CONCLUSIONS: Postmenopausal HRT- women had a greater chance of having periodontitis than premenopausal women. In contrast, postmenopausal HRT+ women and premenopausal women had similar periodontal status. HRT may have a beneficial effect on periodontal health.

Effect of chewing gums on the production of volatile sulfur compounds (VSC) in vivo.

The aim of the present study was to evaluate the effect of two chewing gums on the production of volatile sulfur-containing compounds (VSC) in vivo. Fourteen periodontally healthy participants (20-35 years old) were included in the test panel. Test gum 1 (TG1) contained sucrose and Test gum 2 (TG2) contained xylitol and zinc citrate. Two series of tests were conducted with a double-blind cross-over design. Following an overnight refrain from oral hygiene, VSC was measured before and at 5, 15, 30, 45 and 60 minutes of chewing the test gums. In the second series, VSC production was monitored prior to and up to 30 minutes after a rinse with cysteine 6 mM alone or after a rinse followed by chewing the test gums. For the first test, the results were analyzed by repeated measurements ANOVA for intra-group and paired sample t test for intergroup comparisons. In the second series, percent reduction of VSC was compared by Friedman and Wilcoxon tests (p < .05). The test gums did not differ in terms of VSC production, with values ranging from 146 ppb after 5 minutes to 86 ppb after 60 minutes. Similar reductions in VSC production following cysteine were observed for both test gums, with the largest reductions (71% to 52%) observed after 5 and 15 minutes. It can be concluded that VSC production is diminished after chewing gum and that the use of chewing gums reduces temporarily the VSC production enhanced by cysteine rinses.

The effect of smoking on gingival crevicular fluid volume during the treatment of gingivitis.

Smoking is detrimental to periodontal tissues, and periodontal destruction is greater among smokers. Paradoxically, smokers seem to have less gingival bleeding than never-smokers with comparable supragingival plaque. There is scarce information about the impact of smoking on gingival crevicular fluid (GCF) volume. This single-arm study clinical trial assessed the effect of smoking on GCF volume during the treatment of gingivitis. The sample included 24 never-smokers (47.3 +/-6.7years old, 41.7% males) and 21 smokers (45.8 +/- 5.1 years old; 55% males; 19.6 +/- 11.8 cigarettes/day; 24.1 +/- 8.7 years of smoking) with gingivitis and chronic periodontitis. After baseline supragingival scaling, patients received oral hygiene instructions weekly for 180 days. Particqants were examined at baseline, 30, 90 and 180 days, and gingival bleeding index (GBI), bleeding on prob-ing (BOP), periodontal probing depth (PPD) and GCF volume were recorded. Statistical analysis was performed using linear models (Wald test, p<0.05%). Smokers had significantly smaller GCF volumes than never-smokers. This finding was not attributed to GBI, BOP or PPD. Higher volumes of GCF were significantly associated with deeper pockets. GCF was significantly reduced throughout the study for both smokers and never-smokers, and the largest reductions were seen at 30 days. Smoking affected the GCF crevicular fluid volume independently of the presence of gingival bleeding, BOP and PPD. Smoking status and PPD should be taken into account when GCG volume and components are under investigation.