Aspectos relevantes da síndrome de Sjõgren para o cirurgião-dentista / Sjogren’s syndrome’s relevant aspects for the dental surgeon

A síndrome de Sjõgren (SS), conhecida como síndrome sicca, é uma doença autoimune caracterizada pela hipofunção das glândulas salivares e lacrimais, cuja prevalência na população mundial é de aproximadamente 0,5% a 1%. Por ser uma doença autoimune complexa e de difícil diagnóstico, é sub-diagnosticada e sub-tratada segundo o consenso realizado em 2012 pelo Colégio Americano de Reumatologia (ACR). O Cirurgião-Dentista pode desempenhar papel importante na detecção de possíveis alterações compatíveis com a síndrome, além de auxiliar no tratamento de diversas patologias orais decorrentes da síndrome. Este trabalho tem como objetivo explanar aspectos importantes referentes ao diagnóstico e tratamento da síndrome aqui discutida. A SS apesar de ser considerada uma doença de evolução lenta, em estágios avançados pode ser fatal, principalmente por aumentar as chances dos pacientes virem a desenvolver linfoma não Hodking. O tratamento odontológico dos pacientes com SS deve principalmente ser profilático, com a recomendação do uso de repositores de saliva e controle rígido da higiene bucal.

Sjogren’s syndrome (SS), known as the sicca syndrome, is an autoimmune disease characterized by salivary and lacrimal glands hypofunction which prevalence in the world population is approximatel y around 0,5% to 1%. For being a complex autoimmune disease and with difficult diagnosis, it is sub diagnosed and miss treated according to the consensus occurred in 2012 by the American College of Rheumatology (ACR). The surgeon-dentist (SD) may play a important role on the detection of possible changes compatible to the syndrome, besides can help in the treatment of many oral pathologies caused by the syndrome. This work has the main purpose to explain the important aspects regards to the correct diagnosis and treatment of this syndrome.The SS besides been considered a slow evolution disease, in advanced stages it can be fatal,mainly for increasing the patient’s chances of developing non-Hodking lymphoma. The dental treatment of patients with SS must be prophylactic, with the recomedations of the use of salivary replenishing and careful control of the oral hyigiene.

Expression of protease activated receptor-1 in chronic periodontitis.

BACKGROUND: Protease activated receptor-1 (PAR1) activation by thrombin may play a role in repair and homeostasis of periodontal tissues. The main objective of this study is to investigate PAR1 expression in patients with periodontitis, before and after non-surgical periodontal treatment, and to associate its expression with the presence of inflammatory biomarkers and PAR2 expression. METHODS: Gingival crevicular fluid (GCF) samples and clinical parameters, including probing depth, clinical attachment level, bleeding on probing, and gingival and plaque indices, were collected from periodontally healthy individuals and patients with moderate chronic periodontitis (CP) before and 6 weeks after periodontal non-surgical treatment. PAR1 and PAR2 messenger RNA (mRNA) at the GCF were evaluated by quantitative polymerase chain reaction (qPCR). Flow cytometry analysis identified the GCF PAR1-expressing cells. GCF inflammatory biomarkers were also determined. RESULTS: Clinical parameters were significantly improved after therapy (P <0.01). The qPCR analysis showed that, before therapy, PAR1 mRNA levels in CP were similar to controls. Periodontal treatment led to increased PAR1 expression in CP (P <0.05). PAR1 expression was inversely correlated to PAR2 expression and with interleukins 6 and 8, tumor necrosis factor-α, interferon-γ, and matrix metalloproteinase-2 levels. CONCLUSIONS: Periodontal treatment results in PAR1 overexpression in the GCF, and PAR1 expression is associated with decreased expression of inflammatory biomarkers and inversely correlated to PAR2 expression in the GCF. Therefore, the data suggest the importance of PAR1 mediating the known anabolic actions of thrombin in the periodontium.

Influence of parstatin on experimental periodontal disease and repair in rats.

BACKGROUND: Parstatin is a 41-amino acid peptide, formed by proteolytic cleavage on activation of the protease activated receptor-1, with antiangiogenic properties. The purpose of this study is to evaluate the influence of synthetic parstatin on experimental periodontal disease and repair in rats. METHODS: Ligature-induced periodontitis was established in rats and the influence of parstatin administration was assessed after 8 and 15 days for periodontal disease and 24 hours and 8 days after repair after ligature removal. RESULTS: Parstatin administration significantly inhibited gingival myeloperoxidase activity, interleukin (IL)-1ß, tumor necrosis factor-α, and IL-6 levels and led to suppression of macrophages and collagen degradation. At periodontal tissues under repair, parstatin increased the gingival levels of endostatin and decreased vascular endothelial growth factor expression and blood vessel number but did not influence histologic healing. In addition, the tomographic linear bone loss was significantly reduced at 15 days of periodontitis when the rats were treated with parstatin compared to their respective phosphate-buffered saline-treated controls. CONCLUSIONS: Parstatin suppresses the periodontal tissue breakdown followed by experimental periodontitis in rats and did not impair periodontal tissue repair, despite its antiangiogenic effect. Parstatin may represent a novel approach to modulate host response in chronic periodontal disease.

Diabetes mellitus: o que os periodontistas devem saber / Diabetes Mellitus: what periodontists must know

A doença periodontal, uma doença infecto-inflamatória crônica que pode levar à perda dentária, é considerada a sexta principal complicação que ocorre no paciente diabético, podendo ter sua susceptibilidade aumentada em até três vezes para esse tipo de paciente. Assim como o diabetes aumenta o risco para periodontite, na via contrária, a periodontite dificulta o controle metabólico pelo paciente diabético. O Diabetes do tipo 2 tem se tornado uma epidemia com prevalência crescente em todo o mundo, afetando aproximadamente 382 milhões de pessoas e acredita-se que até 2035 esse número aumente para 592 milhões. O Diabetes Mellitus é uma das principais causas de mortalidade, insuficiência renal, amputação de membros inferiores, cegueira e doença cardiovascular, além de apresentar perda importante de qualidade de vida. Baseados nesses números e na relação bidirecional existente entre essas doenças, nós acreditamos na necessidade do entendimento do diabetes pelo periodontista...

Periodontal disease, a chronic infectious inflammatory disease that can lead to tooth loss, is considered the sixth major complication that occurs in diabetic patients, and may increase susceptibility up to three times for this type of patient. As diabetes increases the risk for periodontitis, periodontitis in the opposite direction complicates metabolic control by the diabetic patient. Type 2 diabetes has become an epidemic with increasing prevalence worldwide affecting approximately 382 million people, and it is believed that by 2035 this number will reach 592 million. Diabetes mellitus is a major cause of mortality, renal failure, lower limb amputation, blindness and cardiovascular disease, as well as significant loss of quality of life. Based on these numbers and the existing bidirectional relationship between these two diseases, we believe the need that periodontists have to understand diabetes mellitus...

Expressão do receptor ativado por protease do tipo 1 (PAR-1) em pacientes com periodontite crônica / Expression of Protease-activated receptor-1 (PAR-1) in chronic periodontitis patients after non-surgical periodontal treatment

A ativação do receptor ativado por protease do tipo 1 (PAR-1) pela trombina desempenha um papel fundamental na deposição de matriz vascular após injúria tecidual, reparação óssea e na homeostase dos tecidos periodontais, assim como na proliferação de fibroblastos gengivais. O principal objetivo deste estudo foi investigar a expressão de PAR-1 em pacientes com periodontite crônica, antes e 45 dias após tratamento periodontal não-cirúrgico. Amostras de fluido gengival (FG), de saliva e parâmetros clínicos, como profundidade de sondagem (PS), perda do nível clínico de inserção (NCI), sangramento à sondagem (SS), índice gengival (IG) e índice de placa (IP) foram coletados de pacientes com saúde periodontal (Controle) e pacientes com periodontite crônica moderada antes (PC) e 45 dias após o tratamento não-cirúrgico periodontal (PCT). A expressão gênica de PAR-1 (mRNA) em FG foram avaliadas por qPCR (Reação de Polimerase em Cadeia em Tempo Real). A análise por citometria de fluxo foi realizada para identificar quais células expressam PAR-1 em FG. Biomarcadores inflamatórios salivares também foram determinados. Os parâmetros clínicos foram significativamente melhorados após terapia periodontal não-cirúrgica (p<0,01). A análise por qPCR mostrou que antes da terapia, níveis de PAR-1 (mRNA) em periodontite crônica foram menores aos controles. O tratamento periodontal levou ao aumento da expressão de PAR-1 em periodontite crônica (p<0,05). A expressão de PAR-1 foi inversamente correlacionada com a expressão dos níveis salivares de IL-6, IL-8, TNF-, IFN-, e MMP-2. Em conclusão, o presente trabalho demonstrou que a expressão de PAR-1 aumentou após o tratamento periodontal em células do FG, e que a expressão de PAR-1 está associada com a diminuição da expressão dos níveis salivares de biomarcadores inflamatórios. Portanto, dentro dos limites do presente estudo, nossos dados sugerem a importância do papel mediador de PAR-1 na reparação do tecido periodontal

Activation of protease-activated receptor type 1 (PAR-1) thrombin plays a key role in matrix deposition after vascular tissue injury, bone repair and homeostasis of periodontal tissues, as well as the proliferation of gingival fibroblasts. The main objective of this study was to investigate the expression of PAR-1 in patients with chronic periodontitis before and 45 days after non-surgical periodontal treatment. Samples of gingival fluid (GF), saliva and clinical parameters such as probing depth (PD), loss of clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were collected from patients with periodontal health (Control) and patients with moderate chronic periodontitis before (PC) and 45 days after non-surgical periodontal treatment (PCT). The gene expression of PAR-1 (mRNA) in GF were assessed by qPCR (Polymerase Chain Reaction in Real Time). The flow cytometry analysis was performed to identify cells which express PAR-1 in GF. Salivary inflammatory biomarkers were also determined. Clinical parameters were significantly improved after therapy (p<0,01). The qPCR analysis showed that before therapy, PAR-1 (mRNA) levels in chronic periodontitis were smallest to controls. Periodontal treatment led to increased PAR-1 expression in chronic periodontitis (p<0,05). PAR-1 expression was inversely correlated to IL-6, IL-8, TNF-, IFN-, and MMP-2 salivary levels. In conclusion, the present study showed that the expression of PAR-1 increased after periodontal treatment in FG cells, and that expression of PAR-1 is associated with decreased expression of salivary levels of inflammatory biomarkers. Therefore, within the limits of this study, our data suggest the importance of the mediating role of PAR-1 in the repair of periodontal tissue

Aspectos relacionados ao câncer oral de interesse na periodontia / Oral cancer related aspects of interest in periodontics

Dentre as doenças mais comuns que afetam a cavidade oral, o câncer é a terceira condição mais frequente, ficando logo após a cárie e a doença periodontal. A etiologia do câncer está associada principalmente a mutações genéticas que proporcionam mudanças nas funções celulares. Fatores comportamentais como uso do álcool e tabaco constituem os principais fatores de risco para o câncer da cavidade oral. A importância do conhecimento sobre os tipos e a etiopatogenia das neoplasias da cavidade oral implica principalmente no correto diagnóstico e na detecção de pacientes de alto risco, bem como na utilização de medidas preventivas no controle dessa doença. O planejamento e o tratamento odontológico prévio e posteriores às intervenções das neoplasias orais são de fundamental importância e nesse aspecto, a detecção de patologias, como a doença periodontal, que possam estar associadas direta ou indiretamente a essas lesões podem interferir na complexidade dessa doença e no seu tratamento.

Within the most common diseases that occur in the oral cavity, cancer is the third most frequent condition, right after tooth decay and periodontal disease. The etiology of cancer is mainly associated with genetic mutations which provide changes in cellular functions. Behavioral factors such as alcohol and tobacco consumption are the major risk factors for oral cancer. The importance of knowledge about the types and pathogenesis of tumors of the oral cavity involves primarily the correct diagnosis and detection of patients at high risk as well as the use of preventive measures for the control of this disease. The planning and dental treatment prior and subsequent to the therapeutic interventions of oral cancer are essential and in this respect, the detection of pathologies such as periodontal disease, which direct or indirectly interfere with the complexity of this disease and its treatment