Association between salivary flow and dental caries in institutionalized adolescents: Cross-sectional study.

Background: Brazil has a larger number of adolescent offenders, but studies evaluating their oral health are still limited. Objective: Assess the association between salivary flow and caries experience in youngsters deprived of liberty. Methodology: Sixty-eight male adolescents in conflict with the law, aged between 15 and 19 years, from a Socio-Educational Assistance Center in Brazil participated in the present study. They answered a structured questionnaire, and oral examination was performed by the Decayed, Missing, and Filled Teeth (DMFT) index. The salivary flow rate was obtained using the mechanically stimulated total saliva method. Adjusted Poisson regression was used for the association with total DMFT and its decayed component, using the salivary flow (continuous fashion) or the hyposalivation (≤1 ml/min) as independent variables. Results: Participants were divided into two groups, those who did not have any decayed teeth at the moment of the examination (n = 39) and those who had at least one decayed tooth (n = 29). Moreover, two groups were formed based on the DMFT: those who had DMFT = 0 (n = 20) and those who had DMFT≥1 (n = 48). In the multivariate analysis, hyposalivation was associated with DMFT≥1 (p = 0.048), but when the salivary flow was included, no significant association with DMFT index was identified (p = 0.178). Conversely, the presence of at least one decayed tooth was significantly associated with the salivary flow (p = 0.004), but not with hyposalivation (p = 0.091). Conclusions: Institutionalized adolescents who present hyposalivation or low salivary flow are associated with DMFT≥1 index or presence of at least one decayed tooth, respectively.

Tratamento de periodontite estágio III localizado grau C em um indivíduo fumante: um relato de caso / Treatment of periodontitis stage III localized grade C in smoker individual: a case report

Objetivo: A periodontite é uma doença infecto-inflamatória que acomete os tecidos de inserção periodontal, e ser fumante representa um risco modificável significativo para todos os graus da doença. Ainda, indivíduos fumantes apresentam uma resposta inflamatória alterada quando comparados a não fumantes. Nesse contexto, o objetivo deste estudo foi reportar um relato de caso de tratamento periodontal de paciente fumante pesado. Relato de caso: O paciente DRS, sexo masculino, 22 anos, foi encaminhado à Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel) com a queixa principal de necessidade de "realização de uma limpeza dentária". Na anamnese, relatou fumar 20 cigarros ao dia, há 7 anos (7 maços-ano). Na consulta inicial, foi encontrado índice de placa visível (IPV) de 100% e índice de sangramento gengival (ISG) de 66,67%. Foi encontrado cálculo supragengival como fator retentivo de placa (FRP) em 46,30% dos sítios. Estabeleceu-se o diagnóstico de periodontite estágio III localizado grau C. Os exames periodontais foram realizados por um único pesquisador calibrado e optou-se pelo tratamento periodontal não cirúrgico. Ao exame de 12 meses, o paciente apresentou IPV de 23,45% e ISG de 22,83%. Houve ausência de FRP. De uma forma geral, foi possível constatar a diminuição significativa das bolsas periodontais, bem como o ganho significativo de inserção clínica periodontal. Considerações finais: Dessa forma, é possível concluir a efetividade da terapia periodontal não cirúrgica, aliada à manutenção periodontal e instruções de higiene para o tratamento de periodontite estágio III, grau C, em paciente fumante.(AU)

Objective: Periodontitis is an infect-inflammatory diseases that affects the periodontal attachment tissues, and being smoker represents a significant modifiable risk for all degrees of the disease. Moreover, smokers have an altered inflammatory response when compared to non-smokers. Therefore, the aim of this study was to report a case report of periodontal treatment of a heavy smoker. Case report: A patient DRS, male, 22 years old, was referred to the School of Dentistry of the Federal University of Pelotas (UFPel) with the main complaint of the need to "perform a dental cleaning". During the anamnesis, he reported smoking 20 cigarettes a day for 7 years (7 pack-years). In the initial appointment, a visible plaque index (VPI) of 100% and a gingival bleeding index (GBI) of 66.67% were found. Supragingival calculus was found as a plaque retentive factor (PRF) in 46.30% of the sites. The diagnosis of periodontitis stage III localized grade C was established. Periodontal examinations were performed by a single calibrated researcher and non-surgical periodontal treatment was chosen. At the 12-month appointment, the patient had an VPI of 23.45% and an GBI of 22.83%. There was absence of PRF. In general, it was possible to observe a significant decrease in periodontal pockets, as well as a significant gain in periodontal clinical attachment. Final considerations: Thus, it is possible to conclude the effectiveness of non-surgical periodontal therapy, combined with periodontal maintenance and hygiene instructions for the treatment of periodontitis stage III localized grade C in a smoker.(AU)

Systemic Profile and Periodontal Condition of Hospitalized Women with High-Risk Pregnancy: A Cross-Sectional Study.

INTRODUCTION: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. OBJECTIVE: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. METHODS: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). RESULTS: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy.

Association between different dietary patterns and eating disorders and periodontal diseases.

Periodontal diseases is a highly prevalent chronic condition regulated by the host immune response to pathogenic bacterial colonization on the teeth surfaces. Nutrition is a critical component in the modulation of the immune system, hence the importance of a balanced diet. With the understanding of how dietary intake composition affects various health outcomes, nutrient diversity has been reported as a modifiable risk factor for periodontal disease. Eating disorders and different dietary patterns can be associated with periodontal diseases. In this sense, balanced and healthy nutrition plays a major role in maintaining the symbiosis between oral microbiota and periodontal health. Therefore, this review seeks to report the associations found in the literature between high- or low-fat/sodium/sugar, eating disorders and periodontal diseases. It was found that some dietary patterns such as high carbohydrate/sugar, high fat, and low fiber intake may be associated with periodontal disease. In addition, the presence of eating disorders can negatively impact patients' oral health and it is related to the development of several complications, including periodontal diseases. In both situations, nutritional and vitamin deficiencies can aggravate the periodontal condition. However, the relationship between periodontal disease, dietary patterns, and eating disorders still needs more scientific support to be well established, mainly in the sense of pointing out a protective relationship between both.

Poor Quality of Sleep is Associated with Lower Academic Performance in Undergraduate Dental Students: A Cross-Sectional Study.

Purpose: This study aimed to assess the quality of sleep and associated factors among dental students. Methods: All dental students regularly enrolled at the Federal University of Pelotas, Brazil, were invited to participate. A structured online questionnaire was applied to collect the independent variables, including academic performance. Quality of sleep was assessed by the validated version of the Pittsburgh Sleep Quality Index. Sample was dichotomized as good sleep quality (total score: ≤ 4) and at least poor quality (total score: ≥ 5). Adjusted analyses were performed using Poisson regression with robust variance to detect the association between sleep quality and independent variables. Independent adjusted models were performed to the whole-sample, only undergraduate and only graduate dental students. Results: Poor quality of sleep was detected in 266 (65.2%) dental students, of which 228 (68.9%) and 38 (49.4%) were undergraduate and graduate dental students, respectively. Female students presented a prevalence ratio (PR) 19% higher compared to males (95% confidence interval [CI] 1.01-1.41). When only graduate students were considering, those that reported not being the head of the family presented a PR 4.39 higher for poor quality of sleep (95% CI 1.91-10.09). Poor quality of sleep was associated with lower academic performance among undergraduate students (PR: 0.94; 95% CI 0.89-0.99), but not significantly associated when graduate students are considered (PR: 0.99; 95% CI 0.96-1.03). Conclusion: It was concluded that dental students, mainly female ones, have high prevalence of poor quality of sleep, which is associated with undergraduate student's worst academic performance. Supplementary Information: The online version contains supplementary material available at 10.1007/s41782-022-00223-2.

Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up.

INTRODUCTION: Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). CASE PRESENTATION: An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. CONCLUSION: There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Factors associated with poor academic performance among undergraduate dental students: A cross-sectional study.

OBJECTIVE: To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil. METHODS: A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05). RESULTS: In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance. CONCLUSION: A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Higher frequency of specific periodontopathogens in hypertensive patients. A pilot study.

Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.

Higher frequency of specific periodontopathogens in hypertensive patients. A pilot study

Abstract Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.

Resumo A periodontite e a hipertensão arterial são duas das patologias com maior prevalência global, as evidências relatadas até o momento têm sido favoráveis ​​a uma associação entre elas. Este estudo transversal teve como objetivo avaliar e comparar contagem microbiológicas de pacientes hipertensos e normotensos com periodontite. Dados sociodemográficos, comportamentais, de saúde sistêmica e parâmetros clínicos periodontais foram avaliados. Contagens de A. actinomycetemcomitans, P. intermedia, P. gingivalis e F. nucleatum foram realizadas por reação em cadeia da polimerase em tempo real utilizando amostras de biofilme subgengival. Trinta e oito pacientes foram incluídos nesta análise preliminar, divididos em dois grupos: Grupo Normotenso (GN) (n = 14) e Grupo Hipertenso (GH) (n = 24). Pacientes diagnosticados com periodontite compuseram os dois grupos. A análise dos dados foi realizada com nível de significância de 5%. Não houve diferença significativa entre os grupos para o diagnóstico clínico de periodontite. Além disso, os hipertensos apresentaram maior contagem de P. intermedia, P. gingivalis e F. nucleatum quando comparados aos normotensos. Os parâmetros profundidade de sondagem, sangramento à sondagem e contagem de A. actinomycetemcomitans não apresentaram diferenças estatísticas entre os grupos. Com esses resultados preliminares, pode-se concluir que a presença de hipertensão arterial pode estar associada a uma maior quantidade de bactérias periodontopatogênicas de algumas espécies em indivíduos com periodontite.

Adjuvant therapy with 1% alendronate gel for experimental periodontitis treatment in rats.

PURPOSE: The aim of this study was to evaluate the effects of locally delivered 1% alendronate (ALN) gel used as an adjunct to non-invasive periodontal therapy. METHODS: Ligature-induced periodontitis was performed in 96 rats. The ligature was tied in the cervical area of the mandibular left first molar. The animals were randomly divided into 4 groups: 1) NT, no treatment; 2) SRP, scaling and root planning; 3) SRP/PLA, SRP followed by filling the periodontal pocket with placebo gel (PLA); and 4) SRP/ALN, SRP followed by filling the periodontal pockets with 1% ALN gel. Histomorphometric (percentage of bone in the furcation region [PBF]) and immunohistochemical (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tartrate-resistant acid phosphatase) analyses were performed. Data were statistically analyzed, with the threshold of statistical significance set at P≤0.05. RESULTS: The SRP, SRP/PLA, and SRP/ALN groups presented a higher PBF than the NT group (P≤0.01) at 7, 15, and 30 days. The SRP/ALN group presented a higher PBF than the SRP/PLA group in all experimental periods, as well as a higher PBF than the SRP group at 15 and 30 days. No differences were observed in the immunohistochemical analyses (P>0.05 for all). CONCLUSIONS: Locally delivered 1% ALN gel used as an adjunct to SRP enhanced bone regeneration in the furcation region in a rat model of experimental periodontitis.

Are periodontal diseases associated with sleep duration or sleep quality? A systematic review.

OBJECTIVES: This study aimed to systematically review the associations between periodontal diseases/tooth loss and sleep duration/quality. MATERIAL AND METHODS: PubMed, Scopus, and Embase databases were searched (up to May 2021) to identify studies that assessed the association between periodontal diseases or number of teeth with sleep quality and sleep duration. Two researchers independently selected the studies and extracted the data. Considering the high heterogeneity among the included studies, meta-analysis was deemed unviable. Results are presented descriptively for sleep quality (studies that have used PSQI), self-reported sleep hours, and other tools that assessed sleep patterns. RESULTS: Twenty studies (16 cross-sectional, two case-control, and two cohort) were included. Eight studies used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep. Six of these studies demonstrated that individuals with worse periodontal conditions demonstrated poorer sleep quality. However, most of the included studies that performed adjusted analysis showed no statistically significant association between self-reported hours of sleep and periodontitis. The mean number of present teeth was assessed in four studies; three of them demonstrated lower numbers of present teeth in individuals with inadequate sleep. CONCLUSION: The literature shows conflicting results for the association between sleep hours and periodontitis. However, inadequate sleep may be associated with lower number of present teeth and periodontal diseases. Further studies are necessary in order to confirm these results.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses.

OBJECTIVE: This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults. MATERIAL AND METHODS: Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated. RESULTS: Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI. CONCLUSIONS: Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI. CLINICAL RELEVANCE: Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.

Histomorphometric analysis of implant osseointegration using hydrophilic implants in diabetic rats.

OBJECTIVES: To evaluate peri-implant bone formation of titanium implants using an in vivo rat model with and without uncontrolled diabetes mellitus (DM) to evaluate osseointegration of hydrophobic (Neoporos®) and hydrophilic (Acqua®) surfaces. MATERIALS AND METHODS: 54 rats were divided into two groups: DM group (DMG) (streptozotocin-induced diabetes) and a control group (CG). Implants with hydrophobic (Neoporos®) and hydrophilic surfaces (Acqua®) were placed in the left or right tibia of animals. Animals were further divided into three groups (n = 9) euthanized after 7, 14, or 28 days. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed in total, cortical, and medullary areas. RESULTS: The DMG group, after a 7-day healing period, yielded with the Acqua implants presented significantly higher total BIC (+37.9%; p=0.03) and trabecular BIC (%) (+46.3%; p=0.02) values in comparison to the Neoporos implants. After 28 days of healing, the CG yielded that the cortical BAFO of Acqua implants to be significantly, 14%, higher (p=0.04) than Neoporos implants. CONCLUSION: The positive effects of the Acqua surface were able to counteract the adverse impact of uncontrolled DM at early osseointegration periods. After 28 days in vivo, the metabolic systemic impairment caused by DM overcame the surface treatment effect, leading to impaired osseointegration in both hydrophilic and hydrophobic implants. CLINICAL RELEVANCE: The adverse effects of diabetes mellitus with respect to bone healing may be minimized by deploying implants with strategically modified surfaces. This study evaluated the effects of implants with Acqua® and Neoporos® surfaces in both diabetic and healthy animals. During the initial healing period in diabetic animals, the hydrophilic surface was demonstrated to have beneficial effect on osseointegration in comparison to the hydrophobic surface. The results provide an insight into early healing, but the authors suggest that a future short-term and long-term clinical study is needed to assess the possible benefit of the Acqua® implant as well as in increasing the predictability of implant osseointegration.

Condição bucal de mulheres com diabetes mellitus gestacional internadas em um hospital escola no sul do Brasil / Oral condition of women with gestational diabetes mellitus admitted in a school hospital in southern Brazil

Objetivo: avaliar a condição bucal de mulheres com diabetes mellitus gestacional (DMG) internadas no Hospital Escola (HE) da Universidade Federal de Pelotas (UFPel). Métodos: trata-se de um estudo transversal retrospectivo de base hospitalar, em que dois residentes treinados realizaram a coleta dos dados por meio da avaliação dos prontuários médicos e odontológicos, no período de setembro de 2019 a março de 2020. Os dados socioeconômicos e demográficos e o diagnóstico de DMG foram coletados dos prontuários médicos, enquanto hábitos e condição bucal, dos prontuários odontológicos. A análise dos dados foi realizada no programa Stata 11.0, usando os testes Exato de Fisher e Regressão de Poisson. Resultados: foram avaliados os prontuários de 83 gestantes, destas, 37 (44,6%) apresentavam DMG. A presença de DMG esteve asso-ciada com as gestantes de maior faixa etária (62,2%) e no terceiro trimestre de gestação. Em sua maioria, tinham renda de até dois salários mínimos, eram solteiras, tinham filhos e realizaram pré-natal. Em relação à avaliação bucal, apenas a presença de cálculo dental e inflamação gengival foi estatisticamente associada à presença de DMG (p= 0,030 e 0,014 respectivamente). A autopercepção do sorriso foi considerada ruim por 40,5%, e a maioria teve dentes perdidos por cárie (64,9%). Conclusões: a prevalência de DMG foi alta entre as gestantes internadas, sendo maior em mulheres de mais idade. Presença de cálculo dental e inflamação gengival foram fortemente associadas à presença de DMG, enquanto hábitos bucais e presença de cárie não apresentaram associação. Novas pesquisas, com exames periodontais completos, são necessárias para verifi-car as condições periodontais dessas mulheres.(AU)

Aim: to assess the oral condition of women with Gestacional Diabetes Mellitus (GDM) admitted in a School Hospital (HE)/UFPel. Methods: medical and dental records, from September 2019 to March 2020, were evaluated in this hospital-based retrospective cross-sectional study. Socioeconomic and demographic data were collected from medical records, while oral condition and habits were obtained from the dental records. Statistical analysis was performed with Stata 11.0 software using Fisher's exact test and Poisson regression. Results: the medical records of 83 pregnant women were evaluated, of which 37 (44.6%) had GDM. The presence of GDM was associated with pregnant women of older age (62.2%) and most in the third trimester of pregnancy. Most of them had an income of up to two minimum wages, were single, had children and underwent prenatal care. Regarding the oral evaluation, only the presence of dental calculus and gingival inflammation was statistically associated with the presence of GDM (p = 0.030 and 0.014 respectively). The self-perception of the smile was considered bad to 40.5% and many of them had lost teeth due to caries (64.9%). Conclusions: the prevalence of GDM was high in hospitalized pregnant women, being higher in older women. Presence of dental calculus and gingival inflammation were strongly associated with the presence of GDM, while oral habits and the presence of caries were not associated. Further research, with complete periodontal examinations is necessary to verify the periodontal conditions of these women.(AU)

Osteonecrosis of the jaw as a late complication of herpes zoster infection: a case report.

Occurrences of rare oral complications following herpes zoster (HZ) infection have been reported. In the present case, a 57-year-old man was referred for periodontal evaluation due to gingival bleeding. His medical history included diagnoses of chronic lymphocytic leukemia and HZ infection. Intraoral examination revealed necrosis and alveolar bone exposure around the mandibular left lateral incisor, and the patient reported spontaneous exfoliation of the maxillary and mandibular left central incisors. Conservative surgical and antibiotic therapies were provided to the patient, and a diagnosis of osteonecrosis of the jaw following HZ infection was established. There were no signs of recurrence in 17 months of follow-up. Clinicians should be aware of unusual complications related to a previous HZ infection.

Treatment of experimental periodontitis with chlorhexidine as adjuvant to scaling and root planing.

OBJECTIVES: To assess whether subgingival irrigation with 0.12 % or 0.2 % chlorhexidine (CHX) immediately after scaling and root planing (SRP) enhances periodontal tissue repair compared to irrigation with saline solution (control). MATERIALS AND METHODS: Periodontitis was ligature-induced in rat molars for 7 days. Animals were distributed into three groups: 1) SRP group, SRP and irrigation with 0.9 % saline (n = 30); 2) SRP + 0.12 % CHX group, SRP and irrigation with 0.12 % CHX (n = 30); 3) SRP + 0.2 % CHX group, SRP and irrigation with 0.2 % CHX (n = 30). Animals were killed at 7, 15, and 30 days after treatment. Furcation region was histometrically analyzed to determine the bone area. Immunohistochemical reactions were performed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP). RESULTS: Both chlorhexidine groups presented less inflammation and improved tissue repair along the entire experiment when compared with the SRP group. In the histometric analysis at 7, 15 and 30 days, SRP group (4.58 ±â€¯2.51 mm2, 4.21 ±â€¯1.25 mm2, 3.49 ±â€¯1.48 mm2), showed statistically less bone area than groups SRP + 0.12 % CHX (1.86 ±â€¯1.11 mm2; 0.79 ±â€¯0.27 mm2; 0.34 ±â€¯0.14 mm2) and SRP + 0.2 % CHX (1.14 ±â€¯0.51 mm2; 0.98 ±â€¯0.40 mm2; 0.41 ±â€¯0.21 mm2). Both chlorhexidine concentrations modulated the expression of TRAP, RANKL and OPG. CONCLUSIONS: Subgingival irrigation with chlorhexidine contributed for a quicker shift from a proinflammatory destructive profile to healing of periodontal tissues.

Enxerto de tecido conjuntivo subepitelial e retalho coronal em recessões gengivais múltiplas / Subepithelial connective tissue graft and coronal fl ap in multiple gingival recessions

Algumas das principais indicações para o recobrimento de superfícies radiculares expostas por recessão gengival compreendem a hipersensibilidade dentinária cervical e o tratamento de defeitos estéticos. Este trabalho descreveu o tratamento de recessão gengival múltipla classe III de Miller em um periodonto delgado, após 36 meses de uma intervenção cirúrgica com enxerto gengival livre. O tratamento cirúrgico periodontal proposto foi o recobrimento radicular por meio de enxerto de tecido conjuntivo subepitelial associado a retalho reposicionado coronalmente na região vestibular dos elementos 31, 41 e 42. Após 90 dias, foi possível observar o recobrimento parcial da recessão, aumento da espessura tecidual e o controle do biofi lme pelo paciente, promovendo maior proteção da região e redução do risco de recidiva das recessões. Diante da resolução do caso clínico apresentado, pôde-se concluir que a técnica do enxerto de tecido conjuntivo subepitelial associado ao retalho reposicionado coronalmente, quando bem indicada e realizada, pode ser empregada com sucesso em áreas de recessões múltiplas e periodonto com espessura reduzida.

Some of the main indications for the root coverage of gingival recessions include cervical dentin hypersensitivity and treatment of aesthetic defects. This manuscript describes the treatment of a Miller's Class III multiple gingival recession 36 months after a free gingival graft surgical procedure. The periodontal surgical treatment proposed was the subepithelial connective tissue graft associated with a coronally repositioned fl ap at vestibular region of elements 31, 41 and 42. After 90 postoperative days, it was possible to observe an increase on tissue thickness and biofi lm control by the patient, promoting a greater protection of the region and reducing the risk of recession recurrence. It can be concluded that the subepithelial connective tissue graft technique associated with the coronal repositioned fl ap, when well indicated and performed, can be successfully used in multiple recessions and periodontal regions with reduced thickness.

O cálculo dental e a doença periodontal / Dental calculus and periodontal disease ­ a literature review

A doença periodontal (DP) é uma infecção crônica em resposta à presença de bactérias nos tecidos ao redor do dente, sendo definida como uma doença sujeito e sítio-específica, que evolui continuamente com períodos de exacerbação e de remissão. É uma patologia fortemente associada à presença de cálculo dentário em superfícies radiculares, porém, a superfície áspera do cálculo dental por si só não é suficiente para induzir à inflamação nos tecidos periodontais adjacentes. O cálculo dental atua como um substrato ideal para a colonização microbiana subgengival, e seu papel no desenvolvimento da doença periodontal tem sido investigado em vários estudos. Esta revisão buscou encontrar na literatura disponível estudos recentes sobre a relação existente entre o cálculo dental e a doença periodontal. Diante dos artigos encontrados, concluiu-se que a superfície porosa do cálculo dental abriga um biofilme viável, que propicia o crescimento e o desenvolvimento de periodontopatógenos. Ainda, pôde-se concluir que o papel do cálculo dental na etiologia da DP é secundário e que sua remoção da superfície dentária é essencial na fase inicial da terapia periodontal. Entretanto, nenhum método utilizado para o debridamento da superfície dental é eficaz na eliminação total do cálculo.

Periodontal disease (PD) is a site-specific, chronic infection in response to bacteria surrounding teeth, with periods of exacerbation and remission. It has been strongly associated to dental calculus (DC) at root surfaces; however, the rough nature of radicular tissues is not enough to trigger soft tissue adjacent infl ammation. The dental calculus act as an ideal substrate for subgingival colonization and its role on the development of periodontal disease has been investigated in several articles. The review aimed to identify recent studies on the relationship between PD and dental calculus. Based on the available data, it can be stated that the porous nature of dental calculus harbors an active biofi lm allowing for growth and development of periodontopathogenic microorganisms. Also, it can be said that DC has a secondary role on the PD etiology, and that its removal remains essential in the early phase of periodontal therapy. Nevertheless, no actual debridement method is effective for complete elimination of DC.

Root coverage of adjacent gingival recessions with a combination of two surgical techniques

Introduction: The dentin hypersensitivity associated with gingival recession is an occurrence of high prevalence in the clinical routine of dentists. Coverage of exposed root surfaces represents a challenge for periodontal treatment. Objective: The purpose of the present study is to describe an approach for adjacent gingival recession treatment using a combination of two surgical techniques: the subepithelial connective tissue graft (SCTG) with a laterally positioned double flap. Case report: This surgical treatment was conducted in a 45-yearold female patient who complained of sensitivity when brushing the lower right teeth. Clinical and radiographic examinations showed gingival recessions (Miller Class III) with traumatic origin promoted for tooth brushing and the presence of thin periodontium in the region. In addition, interproximal bone loss was noted on vestibular face of the right mandibular second premolar and mesial root of the right mandibular first molar. At 12 postoperative months, it was observed that the association of the two surgical techniques promoted an almost complete coverage of the gingival recessions, an increased keratinized gingival band and the elimination of initial dentin hypersensitivity. Conclusion: The appropriate choice of techniques and patient compliance to the periodontal support therapy led to treatment success and periodontal health maintenance in the region during the whole follow-up period.