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1.
J Evid Based Dent Pract ; 20(1): 101403, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32381410

RESUMO

OBJECTIVES: Dental research typically targets multiple outcomes. Interdental cleaning devices such as interdental brushes (IB) and water jet devices (WJ) share a sizable portion of the medical device market. However, recommendations for device selection are limited by the conflicting evidence from multiple outcomes in available studies and the lack of an appropriate synthesis approach to summarize evidences taken from multiple outcomes. In particular, both pairwise meta-analyses and single-outcome network meta-analyses can give discordant results. The purpose of this multioutcome, Bayesian network meta-analysis is to introduce this innovative method to the dental research community using data from interdental cleaning device studies for illustrative purposes. METHODS: We reanalyzed a network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation, which included 22 trials assessing 10 interproximal oral hygiene aids. We focused on the primary outcome of gingival inflammation, which was measured by 2 correlated outcome variables, the Gingival Index (GI) and bleeding on probing (BOP). RESULTS: In our previous single-outcome analysis, we concluded that IB and WJ rank high for reducing gingival inflammation while toothpick and flossing rank last. In this multioutcome Bayesian network meta-analysis with equal weight on GI and BOP, the surface under the cumulative ranking curve was 0.87 for WJ and 0.85 for IB. WJ and IB remained ranked as the 2 best devices across different sets of weightings for the GI and BOP. CONCLUSION: In conclusion, multioutcome Bayesian network meta-analysis naturally takes the correlations among multiple outcomes into account, which in turn can provide more comprehensive evidence.


Assuntos
Dispositivos para o Cuidado Bucal Domiciliar , Placa Dentária , Teorema de Bayes , Pesquisa em Odontologia , Humanos , Metanálise em Rede , Escovação Dentária
2.
Clin Oral Investig ; 23(10): 3811-3819, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30693397

RESUMO

OBJECTIVES: To examine associations between periodontal disease severity and clinical and microbiological measures of caries in adults. MATERIALS AND METHODS: A cross-sectional study of 94 healthy adults ((mean ± SD) 55.4 ± 13.0 years) was conducted. Data were collected by means of questionnaire and a clinical examination that included the Decayed, Missing, Filled teeth Surfaces (DMFS) index, probing depth (PD), clinical attachment level (CAL), and gingival bleeding and plaque scores. Supra- and subgingival plaque samples were collected to assess the presence of Streptococcus mutans and six periodontal pathogens. Participants were subsequently categorized using Center for Disease Control and Prevention/American Academy of Periodontology (CDC-AAP) definitions and tertiles of percentage of sites with CAL ≥ 3mm. RESULTS: Significant positive associations were found between the periodontal disease severity (CDC-AAP) and the DMFS (aOR = 1.03; 95% CI 1.01-1.05) and DS indices (aOR = 1.18; 95% CI 1.05-1.32) as well as between the tertiles of percentage of sites with CAL ≥ 3 mm and DMFS (aOR = 1.03; 95% CI 1.00-1.05) and DS indices (aOR = 1.12; 95% CI 1.00-1.25). A significant positive association was also found between oral levels of F. nucleatum and S. mutans (aOR = 6.03; 95% CI 1.55-23.45). CONCLUSIONS: A small but positive association was found between clinical measures of caries and periodontal disease severity. Further research is warranted to examine the association between these two common oral diseases. CLINICAL RELEVANCE: Periodontal diseases and caries are the two most common oral diseases. There was a positive association between clinical and microbiological markers of both diseases. Therefore, strategies in oral health education should involve both caries and periodontitis prevention.


Assuntos
Cárie Dentária/complicações , Placa Dentária , Doenças Periodontais/complicações , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Índice Periodontal
3.
J Periodontol ; 89(5): 558-570, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29520910

RESUMO

BACKGROUND: A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta-Analysis (BNMA). METHODS: Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding-on-probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random-effects arm-based BNMA model was run for each outcome; posterior medians and 95% credible-intervals (CIs) summarized marginal distributions of parameters. RESULTS: A two-phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water-jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being "best" (64.7% and 27.4%, respectively) for GI reduction, whereas the probability for toothpick and floss being the "best" IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared with control. CONCLUSIONS: BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water-jets ranked high for reducing gingival bleeding, whereas toothpicks and floss ranked last. The patient-perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.


Assuntos
Gengivite , Higiene Bucal , Teorema de Bayes , Dispositivos para o Cuidado Bucal Domiciliar , Índice de Placa Dentária , Humanos , Inflamação , Escovação Dentária
4.
J Clin Periodontol ; 44(6): 603-611, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28370333

RESUMO

AIM: The recent ADA-commissioned Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis has provided the most exhaustive library of clinical trials on scaling and root planing (SRP) with or without adjuncts. This network meta-analysis (NMA) compared the adjuncts against each other. MATERIALS AND METHODS: A star-shaped NMA was performed based on 36 indirect comparisons of clinical attachment-level (CAL) gains among nine adjuncts in 74 studies from the Clinical Practice Guideline. RESULTS: All pairwise differences were accompanied by wide confidence intervals, and none of the adjuncts were statistically significantly superior to another. Local doxycycline hyclate and photodynamic therapy with a diode laser had the highest probabilities for ranking first and second, respectively. Publication bias was evident, with fewer than expected studies with small effects. The lack of these studies inflated the treatment effects by an estimated by 20%. CONCLUSIONS: Adjuncts improve CAL gain by about a third of a mm over 6-12 months compared with SRP alone, but no significant differences were found among the adjuncts. The patient-perceived benefit of this gain is unclear because CAL is a physical measure made by the clinician and not a patient-oriented outcome. Publication bias inflated the observed treatment effects.


Assuntos
Periodontite Crônica/terapia , Profilaxia Dentária/normas , Anti-Infecciosos/normas , Anti-Infecciosos/uso terapêutico , Bases de Dados Factuais , Profilaxia Dentária/métodos , Raspagem Dentária/métodos , Raspagem Dentária/normas , Doxiciclina/uso terapêutico , Odontologia Baseada em Evidências , Humanos , Terapia a Laser/normas , Lasers Semicondutores , Metanálise em Rede , Fotoquimioterapia/métodos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Aplainamento Radicular/métodos , Aplainamento Radicular/normas
5.
J Periodontol ; 87(8): 900-13, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27108476

RESUMO

BACKGROUND: The present study evaluates effects of non-surgical periodontal treatment on serum biomarkers in patients with type 2 diabetes mellitus (t2DM) and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and associations among diabetes markers, serum biomarkers, and periodontal measures in these patients. METHODS: DPTT participants randomized to receive immediate or delayed non-surgical periodontal therapy were evaluated at baseline and 6 months. Serum samples from 475 participants with 6-month data were analyzed for the following biomarkers: 1) high sensitivity C-reactive protein; 2) E-selectin; 3) tumor necrosis factor (TNF)-α; 4) vascular cell adhesion molecule (VCAM); 5) interleukin (IL)-6; 6) IL-8; 7) intercellular adhesion molecule; and 8) IL-10. Changes in biomarker levels from baseline and correlations among biomarker levels and clinical findings were analyzed. RESULTS: No differences between treatment and control groups were observed for any biomarkers at baseline or 6 months (P >0.05 for all variables). VCAM levels increased by an average (standard deviation) of 17.9 (99.5); ng/mL (P = 0.006) and E-selectin decreased by 2.33 (16.08) ng/mL (P = 0.03) in the treatment group after 6 months. E-selectin levels were significantly correlated with DM-related variables (hemoglobin A1c [HbA1c] and fasting glucose) at baseline and with 6-month change in both groups; no significant correlations were found among periodontal clinical parameters and serum biomarkers or DM-related variables. Neither HbA1c or body mass index varied during the study period in either study group. CONCLUSIONS: Non-surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants during the 6-month follow-up. Correlations among changes in E-selectin, IL-6, and DM-related variables suggest that t2DM may be the primary driver of systemic inflammation in these patients.


Assuntos
Biomarcadores , Diabetes Mellitus Tipo 2/complicações , Periodontite/complicações , Raspagem Dentária , Hemoglobina A Glicada/análise , Humanos , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue
6.
J Oral Maxillofac Surg ; 74(4): 738-46, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26501428

RESUMO

PURPOSE: To analyze serum markers of bone turnover, angiogenesis, endocrine function, and inflammation in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) who discontinued long-term intravenous bisphosphonate (BP) therapy. PATIENTS AND METHODS: Serum samples were obtained from 25 BRONJ patients who had discontinued long-term intravenous BP therapy for an average of 11.4 ± 8.7 months and 48 non-BRONJ controls who continued receiving intravenous BP therapy. Samples were analyzed for total alkaline phosphatase, bone-specific alkaline phosphatase, osteocalcin, C-telopeptide, vascular endothelial growth factor, triiodothyronine, thyroxine, thyroid-stimulating hormone, 25-hydroxyvitamin D, and C-reactive protein. RESULTS: The mean number of BP infusions was significantly higher in BRONJ patients compared with controls (38.4 ± 26.3 infusions vs 18.8 ± 7.2 infusions, P < .0001); however, the duration of BP therapy was not significantly different between the groups (P = .23). Overall, there were no significant differences in any of the markers between BRONJ patients and controls (all P values ≥ .16). In a subgroup analysis that matched BRONJ patients and controls according to mean age and number of BP infusions (10 BRONJ patients and 48 controls), log10 vascular endothelial growth factor (2.9 ± 0.4 pg/mL vs 2.4 ± 0.4 pg/mL, P < .001) and C-reactive protein (34 ± 26 mg/L vs 13 ± 8 mg/L, P < .01) levels were significantly higher in BRONJ patients compared with controls. Within BRONJ patients, none of the serum markers were correlated with duration of BP discontinuation. CONCLUSIONS: Levels of bone turnover and endocrine markers in BRONJ patients who discontinue long-term intravenous BP therapy are similar to those in non-BRONJ controls receiving intravenous BP therapy. However, levels of angiogenesis and inflammation markers are higher in BRONJ patients who discontinue long-term intravenous BP therapy. The prolonged skeletal half-life of BPs may suppress bone turnover markers in BRONJ patients for several years after discontinuation of intravenous BP therapy, suggesting an extended effect on bone homeostasis.


Assuntos
Proteínas Angiogênicas/sangue , Biomarcadores/sangue , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/sangue , Conservadores da Densidade Óssea/administração & dosagem , Osso e Ossos/metabolismo , Difosfonatos/administração & dosagem , Administração Intravenosa , Idoso , Fosfatase Alcalina/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Colágeno Tipo I/sangue , Feminino , Humanos , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Osteocalcina/sangue , Peptídeos/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Fator A de Crescimento do Endotélio Vascular/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue
7.
J Am Dent Assoc ; 146(7): 508-24.e5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26113099

RESUMO

BACKGROUND: Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS: A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. RESULTS: The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). CONCLUSIONS AND PRACTICAL IMPLICATIONS: With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.


Assuntos
Periodontite Crônica/terapia , Raspagem Dentária , Aplainamento Radicular , Raspagem Dentária/métodos , Humanos , Aplainamento Radicular/métodos , Resultado do Tratamento
8.
J Am Dent Assoc ; 146(7): 525-35, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26113100

RESUMO

BACKGROUND: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS: The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. PRACTICAL IMPLICATIONS AND CONCLUSIONS: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.


Assuntos
Periodontite Crônica/terapia , Raspagem Dentária , Aplainamento Radicular , Raspagem Dentária/métodos , Raspagem Dentária/normas , Odontologia Baseada em Evidências , Humanos , Aplainamento Radicular/métodos , Aplainamento Radicular/normas
9.
J Clin Periodontol ; 42(4): 333-41, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25683058

RESUMO

AIM: Low-dose aspirin has been hypothesized as being a potential host modulatory agent for periodontitis treatment. We investigated the relationship between low-dose aspirin use and periodontitis prevalence in the continuous National Health and Nutrition Examination Survey, 2011-2012. METHODS: We analysed n = 2335 adult men and women who received a full-mouth periodontal examination and responded to an aspirin use questionnaire. Periodontal disease was defined as severe, moderate or mild according to established case definitions. Mean full-mouth probing depth, attachment loss and tooth loss were also considered. Low-dose aspirin was defined by any self-reported, physician prescribed aspirin use of ≤162 mg/day. RESULTS: Participants had mean age (SE) 55.8 years (0.42). The prevalences of periodontitis and low-dose aspirin use were 49.5% and 25% respectively. In multivariable logistic regression models controlling for age, sex, race, socioeconomic variables and comorbidities, the odds ratios [95%CI] for moderate or severe periodontitis among low-dose aspirin users (versus non-users) were: 0.91 [0.56-1.50] and 1.06 [0.74-1.50] respectively. Results were unchanged among participants without diabetes or coronary heart disease. CONCLUSIONS: Within the limitations of this cross-sectional study we conclude that low-dose aspirin is not associated with prevalent periodontal status in a nationally representative sample of US adults.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Periodontite/epidemiologia , Adulto , Fatores Etários , Estudos Transversais , Diabetes Mellitus/epidemiologia , Escolaridade , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Perda da Inserção Periodontal/epidemiologia , Bolsa Periodontal/epidemiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Perda de Dente/epidemiologia , Estados Unidos/epidemiologia
10.
J Am Dent Assoc ; 145(12): 1227-39, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25429036

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing health problem worldwide. People with T2DM are at risk of experiencing periodontitis and likely require treatment. Using data from the national multicenter Diabetes and Periodontal Therapy Trial (DPTT), the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy. METHODS: The DPTT investigators randomly assigned adults with T2DM (hemoglobin A1c [HbA1c] ≥ 7 percent and < 9 percent) and moderate to advanced periodontitis to receive immediate or delayed therapy (scaling and root planing, oral hygiene instruction, chlorhexidine rinse). The investigators assessed probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and medical conditions at baseline, three months and six months. Six-month changes in mean PD, CAL and BOP defined the treatment response. Complete data were available for 473 of 514 DPTT participants. The authors used multiple regression models to evaluate participant-level factors associated with the response. RESULTS: More severe baseline PD, CAL and BOP were associated with greater improvements in these same measurements (P < .0001). Hispanic participants experienced greater improvements in PD and CAL than did non-Hispanic participants (P < .0001). Obese participants (those with a body mass index > 30 kilograms per square meter) experienced greater reductions in PD and BOP than did participants who were not obese (P < .001). Age, sex, HbA1c values, diabetes duration, and smoking were not associated with change in any outcome (P > .1). CONCLUSIONS: In patients with T2DM, baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy. Body mass index and Hispanic ethnicity-but not glycemic control, diabetes duration or smoking-also may be useful in predicting clinical changes in this population.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Periodontite/terapia , Anti-Infecciosos Locais/uso terapêutico , Índice de Massa Corporal , Clorexidina/uso terapêutico , Raspagem Dentária , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Educação de Pacientes como Assunto , Periodontite/etnologia , Periodontite/patologia , Fatores de Risco , Aplainamento Radicular , Índice de Gravidade de Doença , Resultado do Tratamento
12.
J Periodontol ; 85(2): 226-33, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23786404

RESUMO

BACKGROUND: Previous case reports and animal studies suggest that periodontitis is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ). This case-control study is conducted to evaluate the association between clinical and radiographic measures of periodontal disease and BRONJ. METHODS: Twenty-five patients with BRONJ were matched with 48 controls. Trained examiners measured probing depth, clinical attachment level (CAL), and bleeding on probing on all teeth except third molars and gingival and plaque indices on six index teeth. Alveolar bone height was measured from orthopantomograms. Most patients with BRONJ were using antibiotics (48%) or a chlorhexidine mouthrinse (84%) at enrollment. Adjusted comparisons of patients with BRONJ versus controls used multiple linear regression. RESULTS: The average number of bisphosphonate (BP) infusions was significantly higher in patients with BRONJ compared with controls (38.4 versus 18.8, P = 0.0001). In unadjusted analyses, patients with BRONJ had more missing teeth (7.8 versus 3.1, P = 0.002) and higher average CAL (2.18 versus 1.56 mm, P = 0.047) and percentage of sites with CAL ≥3 mm (39.0 versus 23.3, P = 0.039) than controls. Also, patients with BRONJ had lower average bone height (as a fraction of tooth length, 0.59 versus 0.62, P = 0.004) and more teeth with bone height less than half of tooth length (20% versus 6%, P = 0.001). These differences remained significant after adjusting for age, sex, smoking, and number of BP infusions. CONCLUSIONS: BRONJ patients have fewer teeth, greater CAL, and less alveolar bone support compared with controls after adjusting for number of BP infusions. Group differences in antibiotics and chlorhexidine rinse usage may have masked differences in the other clinical measures.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Periodontite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda do Osso Alveolar/classificação , Perda do Osso Alveolar/diagnóstico por imagem , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Estudos de Casos e Controles , Clorexidina/uso terapêutico , Índice de Placa Dentária , Difosfonatos/administração & dosagem , Feminino , Hemorragia Gengival/classificação , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/uso terapêutico , Perda da Inserção Periodontal/classificação , Índice Periodontal , Bolsa Periodontal/classificação , Periodontite/classificação , Radiografia Panorâmica , Fatores de Risco , Perda de Dente/classificação
13.
JAMA ; 310(23): 2523-32, 2013 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-24346989

RESUMO

IMPORTANCE: Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control. OBJECTIVE: To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis. DESIGN, SETTING, AND PARTICIPANTS: The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA1c levels between 7% and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers. INTERVENTIONS: The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months. MAIN OUTCOMES AND MEASURES: Difference in change in HbA1c level from baseline between groups at 6 months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose level, and Homeostasis Model Assessment (HOMA2) score. RESULTS: Enrollment was stopped early because of futility. At 6 months, mean HbA1c levels in the periodontal therapy group increased 0.17% (SD, 1.0), compared with 0.11% (SD, 1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference, -0.05% [95% CI, -0.23% to 0.12%]; P = .55). Periodontal measures improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28 mm (95% CI, 0.18 to 0.37) for probing depth, 0.25 mm (95% CI, 0.14 to 0.36) for clinical attachment loss, 13.1% (95% CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95% CI, 0.17 to 0.37) for gingival index (P < .001 for all). CONCLUSIONS AND RELEVANCE: Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00997178.


Assuntos
Periodontite Crônica/terapia , Raspagem Dentária , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/análise , Aplainamento Radicular , Idoso , Glicemia , Clorexidina/administração & dosagem , Periodontite Crônica/sangue , Periodontite Crônica/complicações , Complicações do Diabetes/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/administração & dosagem , Método Simples-Cego , Resultado do Tratamento
14.
PLoS One ; 8(10): e77441, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24155956

RESUMO

BACKGROUND: Periodontal infections are hypothesized to increase the risk of adverse systemic outcomes through inflammatory mechanisms. The magnitude of effect, if any, of anti-infective periodontal treatment on systemic inflammation is unknown, as are the patient populations most likely to benefit. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to test the hypothesis that anti-infective periodontal treatment reduces systemic c-reactive protein (CRP). METHODS AND FINDINGS: MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched using sensitivity-enhancing search terms. Eligible RCTs enrolled patients with periodontal infection, compared a clearly defined anti-infective periodontal intervention (experimental group) to an "inactive control" (no periodontal intervention) or to an "active control" (lower treatment intensity than the experimental group). Mean differences in final CRP values at the earliest post-treatment time point (typically 1-3 months) between experimental and control groups were analyzed using random-effects regression. Among 2,753 possible studies 20 were selected, which included 2,561 randomized patients(median=57). Baseline CRP values were >3.0 mg/L in 40% of trials. Among studies with a control group receiving no treatment, the mean difference in CRP final values among experimental treatment vs. control groups was -0.37 mg/L [95%CI=-0.64, -0.11], (P=0.005), favoring experimental treatment. Trials for which the experimental group received antibiotics had stronger effects (P for interaction=0.03) and the mean difference in CRP final values among experimental treatment vs. control was -0.75 mg/L [95%CI=-1.17,-0.33]. No treatment effect was observed among studies using an active treatment comparator. Treatment effects were stronger for studies that included patients with co-morbidities vs. studies that included "systemically healthy" patients, although the interaction was not significant (P=0.48). CONCLUSIONS: Anti-infective periodontal treatment results in short-term modest reductions in systemic CRP.


Assuntos
Anti-Infecciosos/uso terapêutico , Proteína C-Reativa/metabolismo , Periodontite/tratamento farmacológico , Periodontite/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Anti-Infecciosos/farmacologia , Humanos , Inflamação/complicações , Inflamação/tratamento farmacológico , Periodontite/complicações , Viés de Publicação
15.
J Periodontol ; 84(4 Suppl): S195-208, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23631579

RESUMO

BACKGROUND: Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity. AIM: To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight. METHODS: Search of databases including PubMed, ISI Web of Science and Cochrane Library. RESULTS: The single RCT identified showed no significant effect of periodontal treatment on birth outcomes. DISCUSSION: All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials--also judged to be high-quality and at low risk of bias--have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes. CONCLUSION: Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.


Assuntos
Raspagem Dentária , Resultado da Gravidez , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro , Aplainamento Radicular
16.
J Clin Periodontol ; 40 Suppl 14: S195-208, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23627329

RESUMO

BACKGROUND: Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity. AIM: To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight. METHODS: Search of databases including PubMed, ISI Web of Science and Cochrane Library. RESULTS: The single RCT identified showed no significant effect of periodontal treatment on birth outcomes. DISCUSSION: All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials - also judged to be high-quality and at low risk of bias - have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes. CONCLUSION: Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.


Assuntos
Raspagem Dentária , Resultado da Gravidez , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro , Aplainamento Radicular
17.
Northwest Dent ; 92(1): 12-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23516715

RESUMO

Bisphosphonates (BP), potent antresorptive agents, play a key role in managing osteolytic bone disorders including osteoporosis, Paget's disease, bone metastasis, and multiple myeloma. However, their long-term administration is associated with increased risk for bisphosphonate-related osteonecrosis of the jaw (BRONJ) development. At present, there is no curative therapy for BRONJ, and patients are often treated palliatively with antibiotics, antimicrobial mouth rinses, and debridement of necrotic bone. This article highlights a new treatment modality that may be beneficial to a subset of osteoporosis patients suffering from BRONJ. Here we report a BRONJ case that was initially unresponsive to conservative treatment, but subsequently responded to teriparatide (recombinant human PTH1-34) therapy.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Teriparatida/uso terapêutico , Alendronato/efeitos adversos , Alendronato/uso terapêutico , Biomarcadores/sangue , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Doenças Ósseas Metabólicas/tratamento farmacológico , Colágeno Tipo I/sangue , Feminino , Seguimentos , Humanos , Doenças Maxilares/tratamento farmacológico , Doenças Maxilares/etiologia , Pessoa de Meia-Idade , Peptídeos/sangue , Extração Dentária
18.
J Am Dent Assoc ; 144(2): 171-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23372133

RESUMO

BACKGROUND: Clinicians and researchers need a measure for monitoring the periodontal condition of their patients or study participants. The authors explored the utility of change in probing depth (PD) for predicting change in clinical attachment loss (CAL). METHODS: The authors used clinical trial data from 363 participants who had received nonsurgical treatment to describe associations between PD and CAL changes. They computed the association between PD and CAL changes-correlation, sensitivity, specificity, and positive and negative predictive values-according to tooth type, tooth site and initial PD. RESULTS: Depending on the subset of tooth sites, sensitivity of PD change to predict CAL change ranged from 18 to 74 percent; the highest sensitivity was at initially deep sites. Specificity and negative predictive value were higher than sensitivity and positive predictive value. Correlations between person-level mean PD and CAL changes ranged from 0.60 to 0.79 and were highest at initially deep sites. CONCLUSIONS: Except at initially deep sites, PD change did not reliably predict CAL change. Clinicians and researchers who measure only PD may fail to identify teeth that lose or gain attachment. CLINICAL IMPLICATIONS: Clinicians should consider monitoring CAL to detect changes in periodontal status more reliably. It is unknown if these findings apply to patients treated surgically or to prediction of tooth loss.


Assuntos
Perda da Inserção Periodontal/classificação , Bolsa Periodontal/classificação , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Periodontite Crônica/classificação , Periodontite Crônica/terapia , Raspagem Dentária/métodos , Doxiciclina/uso terapêutico , Feminino , Seguimentos , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/terapia , Desbridamento Periodontal/métodos , Bolsa Periodontal/terapia , Placebos , Valor Preditivo dos Testes , Aplainamento Radicular/métodos , Sensibilidade e Especificidade
19.
J Am Dent Assoc ; 143(11): 1190-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23115147

RESUMO

BACKGROUND: Practice guidelines historically have recommended postponing dental care after ischemic vascular events. The authors examined an administrative data set to determine whether dental procedures increased patients' risk of experiencing a second vascular event. METHODS: The authors examined a data set of 50,329 participants in the Medicare Current Beneficiary Survey to identify those who had had a vascular event (n = 2,035) and a second event (n = 445) while in the survey. They used Cox proportional hazards regression to study associations between dental procedures performed within 30, 60, 90 or 180 days after a first event and the risk of experiencing a second vascular event. RESULTS: Dental procedures of any kind, and invasive procedures considered separately, were not associated with patients' risk of experiencing second vascular events across all periods examined. Most hazard ratios associated with dental procedures were less than 1.0, although none differed significantly from 1.0. CONCLUSIONS: The authors found that community-dwelling Medicare beneficiaries who underwent dental procedures within 30 to 180 days after an ischemic vascular event, including those that produce a bacteremia consistently, were not at an increased risk of experiencing a second event. CLINICAL IMPLICATIONS: The results of this study suggest that clinicians should reassess historical recommendations that dental care in this population be postponed for as long as six months after an ischemic vascular event.


Assuntos
Isquemia Encefálica/epidemiologia , Assistência Odontológica/estatística & dados numéricos , Medicare/estatística & dados numéricos , Isquemia Miocárdica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Estudos de Coortes , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Profilaxia Dentária/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Nível de Saúde , Humanos , Hipertensão/epidemiologia , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Tratamento do Canal Radicular/estatística & dados numéricos , Autorrelato , Fumar/epidemiologia , Extração Dentária/estatística & dados numéricos , Estados Unidos/epidemiologia
20.
J Am Dent Assoc ; 142(12): 1343-51, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22130434

RESUMO

BACKGROUND: The publication of the 2009 American Academy of Orthopedic Surgeons' (AAOS') guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs). METHODS: Using data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs). RESULTS: Control participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18-3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18-1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results. CONCLUSIONS: Dental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned. CLINICAL IMPLICATIONS: These results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care.


Assuntos
Artroplastia de Substituição/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Infecções Relacionadas à Prótese/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/estatística & dados numéricos , Bacteriemia/epidemiologia , Estudos de Casos e Controles , Doença Crônica , Estudos de Coortes , Profilaxia Dentária/estatística & dados numéricos , Escolaridade , Feminino , Nível de Saúde , Humanos , Renda , Masculino , Estado Civil , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Fatores de Risco , Tratamento do Canal Radicular/estatística & dados numéricos , Fatores de Tempo , Extração Dentária/estatística & dados numéricos , Estados Unidos/epidemiologia
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