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1.
Clin Oral Investig ; 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33179177

RESUMO

OBJECTIVES: Androgenic anabolic steroids (AAS) abuse is a serious health problem associated to several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1ß in men using AAS. MATERIALS AND METHODS: Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1ß, and proportions of 40 bacterial species. RESULTS: Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1ß expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1ß expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1ß or total protein concentrations. CONCLUSIONS: AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites. CLINICAL RELEVANCE: Dental care professionals should perform full mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33023865

RESUMO

INTRODUCTION: Fanconi anemia (FA) is a rare genetic disease characterized by congenital malformations and bone marrow failure. One of the most common oral diseases in individuals with FA is periodontitis and adequate self-perception of periodontal status could contribute to its prevention and early detection. AIM: To compare oral health self-perception, measured by a questionnaire, with the clinical oral condition of patients with FA. METHODS AND RESULTS: Fifty-six patients with FA, over 11 years of age, answered a questionnaire about dental history and self-reported oral health. Decayed, missing, and filled teeth (DMFT), Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI) were measured. The median age of participants was 21 years (min 11, max 44), 31 (55%) were females and 25 (45%) males. Thirty-five (62.5%) participants rated their oral condition as satisfactory and 7 (12.5%) participants reported tooth mobility, 10 (17.9%) exposed roots and 21 (37.5%) gingival bleeding. Clinical examination detected average DMFT = 5.23, VPI = 31.36% and GBI = 33.77%. The gingival bleeding report was more frequent among individuals with higher GBI (p =  0.014). The DMFT was higher in those who had already undergone dental treatments (p =  0.031). There was an association between participants who presented dental caries and who rated their oral health as poor (p =  0.03). The question "Do your gums bleed easily?" had good accuracy in the evaluation of periodontal disease (p =  0.68). CONCLUSION: Oral health self-perception of individuals with FA about gingival inflammation was associated with their gingival bleeding index.

3.
J Int Acad Periodontol ; 22(4): 182-186, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32980831

RESUMO

AIMS: To report the periodontal condition of two siblings (ages 2 and 4) diagnosed with congenital Amegakaryocytic Purpura (AP), who underwent allogeneic hematopoietic stem cell transplant (HSCT) and developed graft-versus-host disease (GVHD) with oral manifestations. METHODS: Clinical history was obtained through physical examination and medical records. Patients received clinical and microbiological assessment at 2 months post-HSCT, when they started to show signs and symptoms of GVHD and were monitored at 8/15-months post-transplant. They were treated by means of prophylaxis and oral hygiene instruction. Two supragingival biofilm samples were collected from each patient and analyzed by Checkerboard DNA-DNA hybridization. RESULTS: Patients developed severe periodontal clinical attachment loss (CAL) in deciduous dentition associated with recession of the periodontal tissues. They also presented GVHD lesions in the oral mucosa, lips and tongue. Caries lesions, gingivitis, and heavy biofilm deposits were identified. The microbiological profile of biofilm samples presented high levels and proportions of periodontal pathogens, such as Aggregatibacter actinomycetemcomitans. CONCLUSION: The cases presented suggested that severe periodontal CAL in children with AP may be an atypical manifestation associated with AP and/or GVHD, which may be aggravated by the presence of a dysbiotic biofilm containing periodontal pathogens, especially A. actinomycetemcomitans.


Assuntos
Doenças Periodontais , Púrpura , Aggregatibacter actinomycetemcomitans , Criança , Pré-Escolar , Humanos , Masculino , Perda da Inserção Periodontal , Irmãos
4.
Oral Health Prev Dent ; 18(1): 427-432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32515412

RESUMO

PURPOSE: To analyse the effect of information technologies on improving the frequency of the use of dental floss among adolescents. MATERIALS AND METHODS: A randomised, controlled clinical trial was conducted with 291 adolescents (mean age: 16.1 years) in three phases. Phase I involved the application of a questionnaire and clinical examinations using the simplified Oral Hygiene Index and gingival bleeding index. In phase II, the adolescents were randomly allocated to four groups: oral counseling (OR) and the use of an application (App) for smartphones; OR without the app; video (VD) and app; and VD without app. Messages were set through the app for 30 days. Phase III involved the second administration of the questionnaire and clinical examination. The frequency of dental floss use was evaluated in phases I and III. The groups were categorised into the use of technology (VD and/or App) and non-use of technology (OR alone). RESULTS: Statistically significant reductions in the clinical indices were found with all educational methods (p < 0.005) and improvements were found in the use of dental floss (p < 0.001). Moreover, information technologies were associated with an improvement in the frequency of dental floss use (p < 0.033). CONCLUSION: All methods were effective at improving clinical indicators. The use of information technologies can be considered an effective tool for improving dental floss use among adolescents.


Assuntos
Placa Dentária , Gengivite , Tecnologia da Informação , Adolescente , Dispositivos para o Cuidado Bucal Domiciliar , Índice de Placa Dentária , Humanos , Índice de Higiene Oral
5.
Braz Dent J ; 31(2): 103-108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32556007

RESUMO

Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.


Assuntos
Anti-Infecciosos Locais , Anti-Infecciosos , Antibacterianos , Biofilmes , Cetilpiridínio , Clorexidina
6.
J Int Acad Periodontol ; 22(2): 41-53, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32224549

RESUMO

OBJECTIVE: The selection of proper outcome measures is a critical step in clinical research. Most randomized clinical trials (RCTs) assessing the effects of initial anti-infective periodontal therapies use surrogate outcomes as primary outcome variables, such as mean changes in probing depth (PD) or in clinical attachment. However, these parameters do not reflect disease remission/control at patient level, which has led to subjective interpretations of the data from RCTs and Systematic Reviews. Based on a comprehensive analysis of 724 patients from USA, Germany and Brazil treated for periodontitis, this paper suggests that the clinical endpoint of "≤4 sites with PD≥5mm" is effective in determining disease remission/control after active periodontal treatment and therefore, may represent a pertinent endpoint for applying the treat-to-target concept in RCTs. Furthermore, regression models showed that the presence of >10% and >20% sites with bleeding on probing in the mouth post-treatment increases the risk of a patient leaving the endpoint from 1-2 years (OR=3.5 and 8.7, respectively). Researchers are encouraged to present results on this outcome when reporting their trials, as this will allow for an objective comparison across studies and facilitate systematic reviews, and consequently, the extrapolation of data from research to clinical practice.


Assuntos
Periodontite , Brasil , Alemanha , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
7.
Braz. dent. j ; 31(2): 103-108, Mar.-Apr. 2020. graf
Artigo em Inglês | LILACS-Express | LILACS, BBO - Odontologia | ID: biblio-1132283

RESUMO

Abstract Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.


Resumo O biofilme subgengival periodontopatogênico é o principal agente etiológico da periodontite. Assim, a pesquisa de antimicrobianos como adjuvantes para o tratamento periodontal na literatura é intensa. Cloreto de cetilpiridínio (CPC) é um agente antimicrobiano comumente usado em enxaguatórios bucais. No entanto não foram encontrados na literatura estudos avaliando os efeitos do CPC em um modelo complexo de biofilme. Portanto, o objetivo deste artigo é avaliar as propriedades antimicrobianas do cloreto de cetilpiridinio 0,075% em um modelo de biofilme subgengival multiespécie in vitro. O biofilme subgengival composto por 31 espécies relacionadas à periodontite foi formado por 7 dias, utilizando o dispositivo calgary. Os tratamentos com CPC e clorexidina (CHX) 0,12% (controle positivo) foram realizados 2x/dia, por 1 min, do dia 3 até o final do período experimental, totalizando 8 tratamentos. Após 7 dias de formação do biofilme, a atividade metabólica do biofilme foi avaliada por reação colorimétrica e a composição microbiana dos biofilmes por hibridização DNA-DNA. A análise estatística foi realizada usando ANOVA com dados transformados via BOX-COX seguido do teste de Dunnett. Tanto o CPC como a CHX reduziram a atividade metabólica do biofilme em aproximadamente 60% e apresentaram atividade antimicrobiana contra 13 espécies diferentes. Especificamente, apenas os níveis de F.n. Vicentii e P. gingivalis foram reduzidos somente pelo tratamento com a CHX enquanto apenas o CPC reduziu A. odontolyticus e A. israelli. O CPC foi tão eficaz quanto o CHX como antimicrobiano através de biofilme subgengival complexo multiespecífico in vitro. No entanto, futuros estudos usando modelos in vivo de doença periodontal experimental devem ser realizados para comprovar tal efeito.

8.
Odontol. vital ; (30): 31-38, ene.-jun. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1091410

RESUMO

Resumen Objetivo: Describir la incidencia y el puntaje de la mucositis oral (MO) y las morbilidades relacionadas en individuos sometidos a trasplante de células madre hematopoyéticas (TCMH) a lo largo del período de inmunosupresión. Métodos: Los sujetos con enfermedades onco / hematológicas, mayores de 14 años, sometidos a TCMH alogénico fueron evaluados diariamente por la presencia y clasificación de OM, nivel de dolor, disfagia, disgeusia y xerostomía. El examen comenzó dos días antes de la infusión de células madre hematopoyéticas y finalizó veinte días después. La OM se clasificó de acuerdo con la escala de la OMS y se utilizó la escala analógica visual (EVA) para medir el nivel de dolor. Resultados: Se reclutaron 23 individuos, el 83% con enfermedades malignas y el 91% con OM. La mediana del grado máximo de OM fue 3 y el nivel máximo de dolor fue 9. Hubo una mediana de 11 días de uso de medicación opioide. Los sujetos que tuvieron el mayor número de días con dolor en la boca alcanzaron el grado máximo de OM y el mayor número de días y el uso de opioides. Conclusión: Hubo una alta incidencia y puntuaciones más altas de OM, pérdida de masa corporal y dolor en esta muestra.


Abstract Aim: To describe the oral mucositis (OM)` incidence and score, and related morbidities in individuals submitted to Hematopoietic Stem Cell Transplantation (HSCT) throughout the immunosuppression period of time. Methods: Subjects with onco / hematological diseases, older than 14 years, submitted to allogeneic HSCT were daily evaluated by the presence and classification of OM, pain level, dysphagia, dysgeusia and xerostomia. The examination started two days before the infusion of hematopoietic stem cells and ended twenty days later. The OM was classified according to the WHO scale and visual analog scale (VAS) was used to measure pain level. Results: Twenty-three individuals were recruted, 83% with malignant diseases and 91% had OM. The median of maximum OM degree was 3 and the maximum pain level was 9. There was a median of 11 days of opioid medication use. The subjects who had the highest mean number of days with mouth pain reached the maximum degree of OM and higher number of days and opiod use. Conclusion: There was a high incidence and high scores of OM, loss of body mass and pain in this sample.

9.
J Clin Periodontol ; 45(11): 1326-1335, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30076615

RESUMO

AIM: To evaluate if non-diabetic subjects with periodontitis respond better than subjects with type 2 diabetes to the treatment protocol of scaling and root planing (SRP), metronidazole (MTZ) and amoxicillin (AMX). MATERIAL AND METHODS: Diabetic and nondiabetic subjects with severe periodontitis received SRP + MTZ (400 mg/thrice a day [TID]) + AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Subjects were monitored at baseline, 3, 6 and 12 months post-therapy. RESULTS: Twenty-nine type 2 diabetics and 29 non-diabetic subjects participated of this study. Of the non-diabetics and diabetics, 68.9% and 75.9%, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth [PD] ≥5 mm) at 1 year post-therapy (p > 0.05). The diabetic group presented lower mean clinical attachment gain from baseline to 1 year post-therapy and higher mean proportions of the red and orange complexes than the non-diabetic group (p < 0.05). CONCLUSIONS: Non-diabetic subjects with severe periodontitis did not respond better than type 2 diabetic subjects to the treatment protocol of SRP + MTZ + AMX, both in terms of achieving the clinical endpoint for treatment and of PD improvement. Diabetic subjects exhibited a slightly worse microbiological response and showed a healing process more associated with gingival recession than the non-diabetics.


Assuntos
Placa Dentária , Diabetes Mellitus Tipo 2 , Periodontite , Amoxicilina , Antibacterianos , Estudos de Coortes , Terapia Combinada , Raspagem Dentária , Humanos , Metronidazol , Aplainamento Radicular
10.
Int J Paediatr Dent ; 28(4): 410-419, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29756308

RESUMO

BACKGROUND: Adolescence is a decisive period in the construction of new conduits. OBJECTIVE: The influence of an App associated with conventional educational methods in adolescents' oral health. STUDY DESIGN: Randomized controlled trial including 291 participants (mean age = 16.1 years) in baseline. The study consisted of four phases. Interventions were evaluated through the knowledge score (KS) and oral indexes (OHI-S/GBI). KS was obtained through five affirmations about periodontal diseases applied in different moments (pre-test, post-test, and follow-up test). Phase I included pre-test and oral clinical examination. Sample was randomly divided into two groups: oral (OG) and video orientation (VG) and post-test (phase II). Phase III characterized the formation of groups: OG + App/OG without App/VG + App/VG without App. App consisted of reinforcement messages which was sent during 30 days. Phase IV comprised follow-up test and clinical evaluation. RESULTS: There was no significant difference in KS between OG/VG. Overall, App improved KS (P < 0.001). VG + App showed a significant increase in KS in the follow-up test compared to the post-test (P = 0.046). There was a significant reduction in oral indexes for all methods. CONCLUSION: App was effective in increasing knowledge, especially associated with video. The different methods were equally effective for a better standard in oral hygiene.


Assuntos
Aplicativos Móveis , Saúde Bucal/educação , Educação de Pacientes como Assunto/métodos , Doenças Periodontais/prevenção & controle , Adolescente , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Adulto Jovem
11.
Rev. ABENO ; 18(4): 14-20, 2018. graf
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-988273

RESUMO

A avaliação contínua e rotineira mantém o estudante sob constante estudo, leitura e aprendizado, além de suavizar o impacto das avaliações teóricas formais sobre os critérios tradicionais de aprovação. O objetivo deste estudo foi avaliar o impacto da aplicação de quiz semanal sobre a nota da avaliação teórica formal no componente curricular Periodontia I do Curso de Odontologia da Universidade Federal do Paraná. Para este estudo observacional retrospectivo, avaliaram-se os campos "nota quiz" e "nota avaliação" dos diários de classe das turmas do primeiro e segundo semestres de 2016, respectivamente "sem quiz" (n=53) e "com a realização de quiz semanal" (n=55). As avaliações teóricas formais foram idênticas para as duas turmas. Os dados referentes ao número de quizzes realizados e média das notas de quiz foram tabulados. As análises estatísticas utilizadas foram teste t de Student e coeficiente de correlação de Spearman. A aplicação de quiz semanal deslocou a curva referente às notas de avaliação teórica à direita, sendo que as notas foram significativamente maiores neste grupo (p<0.01). Além disso, houve correlação significativa entre a nota da avaliação teórica e o número de quizzes realizados por cada estudante (r=0,39; p<0,01), bem como com a média da nota do quiz (r=0,47; p<0,01). Concluiu-se que a utilização de quiz semanal como instrumento de avaliação da aprendizagem influi positivamente no grau de conhecimento adquirido, provavelmente devido a um maior estímulo à leitura e estudo constante (AU).


Continuous and routine evaluation keeps the student studying, reading and learning permanently, as well as lightens the impact of formal theoretical exams on the traditional criteria for passing a course. The aim of this study was to evaluate the impact of weekly quiz application on the formal theoretical exam score in the course of Periodontics I ­ a theoreticalpractical course ­ at the School of Dentistry at Federal University of Paraná, Brazil. For this retrospective observational study, the fields "quiz score" and "exam score" of the register book from students of the first and second term of 2016, "no quiz" (n=53) and "weekly quiz application" (n=55), respectively, were analyzed. Formal theoretical exams were identical for both students groups. Data related to the number of quizzes taken by each student and quiz scores were tabulated. Student's t-test and Spearman correlation coefficient test were used for statistical analyses. Weekly quiz application moved the theoretical exam scores curve to the right and scores were significantly greater in this group (p<0.01). Besides, there was a significant correlation between theoretical exam score and the number of quizzes taken by each student (r=0.39; p<0.01), as well as with mean quiz score (r=0.47; p<0.01). We concluded that weekly application of quiz as an evaluation instrument in Periodontics positively influences acquired knowledge, probably due to stimulating permanent studying (AU).


Assuntos
Humanos , Periodontia/educação , Estudantes de Odontologia , Aprendizagem Baseada em Problemas/métodos , Educação em Odontologia , Avaliação Educacional/métodos , Brasil , Estatísticas não Paramétricas , Estudos Observacionais como Assunto/métodos
12.
J Clin Periodontol ; 39(12): 1149-58, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23016867

RESUMO

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ + amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). A secondary aim was to examine a possible added effect of chlorhexidine to these therapies. METHODS: One hundred and eighteen subjects received scaling and root planing (SRP) only or with MTZ [400 mg/thrice a day (TID)] or MTZ+AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% chlorhexidine twice a day (BID) for 2 months. Subjects were clinically monitored at baseline, 3, 6 and 12-months post-therapy. RESULTS: The two antibiotic groups showed lower mean number of sites with probing depth (PD) ≥5 mm and fewer subjects exhibiting ≥9 of these sites at 1-year post-treatment. Logistic regression analysis showed that antibiotics were the only significant predictors of subjects presenting ≤4 sites with PD ≥5 mm at 1 year (MTZ+AMX: OR, 13.33; 95%CI, 3.75-47.39/p = 0.0000; MTZ: OR, 7.26; 95%CI, 2.26-23.30/p = 0.0004). The frequency of adverse events did not differ between the two antibiotic treatments (p > 0.05). The chlorhexidine subgroups showed a trend (p > 0.05) to present fewer residual sites ≥5 mm compared with the placebo subgroups at 1 year. CONCLUSION: Treatment of generalized ChP is significantly improved by the adjunctive use of MTZ+AMX and MTZ.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Periodontite Crônica/tratamento farmacológico , Metronidazol/uso terapêutico , Adulto , Amoxicilina/efeitos adversos , Análise de Variância , Antibacterianos/efeitos adversos , Quimioterapia Adjuvante , Clorexidina/uso terapêutico , Raspagem Dentária , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/uso terapêutico , Índice Periodontal , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/patologia , Estatísticas não Paramétricas , Resultado do Tratamento
13.
J Appl Oral Sci ; 20(3): 295-309, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22858695

RESUMO

Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of ß-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/fisiologia , Doenças Periodontais/tratamento farmacológico , Antibacterianos/farmacocinética , Bactérias/efeitos dos fármacos , Permeabilidade da Membrana Celular , Humanos , Macrolídeos/farmacocinética , Macrolídeos/farmacologia , Metronidazol/farmacocinética , Metronidazol/farmacologia , Resistência às Penicilinas/fisiologia , Doenças Periodontais/metabolismo , Resistência a Tetraciclina/fisiologia
14.
J. appl. oral sci ; 20(3): 295-309, May-June 2012.
Artigo em Inglês | LILACS | ID: lil-643725

RESUMO

Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.


Assuntos
Humanos , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/fisiologia , Doenças Periodontais/tratamento farmacológico , Antibacterianos/farmacocinética , Bactérias/efeitos dos fármacos , Permeabilidade da Membrana Celular , Macrolídeos/farmacocinética , Macrolídeos/farmacologia , Metronidazol/farmacocinética , Metronidazol/farmacologia , Resistência às Penicilinas/fisiologia , Doenças Periodontais/metabolismo , Resistência a Tetraciclina/fisiologia
15.
J Clin Periodontol ; 38(9): 828-37, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21762197

RESUMO

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ+amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). MATERIALS AND METHODS: Fifty-one subjects (n=17/group) were randomly assigned to receive scaling and root planing (SRP) only or combined with MTZ (400 mg t.i.d.) or MTZ+AMX (500 mg t.i.d.) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-SRP. Nine plaque samples/subject were analysed by checkerboard DNA-DNA hybridization for 40 bacterial species. RESULTS: Subjects receiving MTZ+AMX exhibited a greater mean gain of clinical attachment, reduction in probing depth (PD) in intermediate and deep sites and a lower percentage of sites with PD5 mm at 3 months, in comparison with those treated with SRP only (p<0.05). The major benefit from the adjunctive use of MTZ was a greater reduction in PD in deep sites. SRP+MTZ+AMX was the only treatment that significantly reduced the levels and proportions of all red complex pathogens and elicited a significantly greater beneficial change in the microbial profile in comparison with SRP only. CONCLUSION: The adjunctive use of MTZ+AMX offers short-term clinical and microbiological benefits, over SRP alone, in the treatment of non-smokers subjects with generalized ChP. The added benefits of MTZ were less evident.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Periodontite Crônica/tratamento farmacológico , Metronidazol/uso terapêutico , Adulto , Amoxicilina/farmacologia , Antibacterianos/farmacologia , Carga Bacteriana/efeitos dos fármacos , Quimioterapia Adjuvante , Periodontite Crônica/microbiologia , Periodontite Crônica/terapia , DNA Bacteriano/análise , Placa Dentária/microbiologia , Raspagem Dentária , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Metronidazol/farmacologia , Pessoa de Meia-Idade , Números Necessários para Tratar , Variações Dependentes do Observador , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/microbiologia , Bolsa Periodontal/terapia , Estatísticas não Paramétricas
16.
RSBO (Impr.) ; 8(2): 211-218, jun. 2011.
Artigo em Português | LILACS-Express | LILACS | ID: lil-591754

RESUMO

INTRODUÇÃO: Atualmente se aceita que a doença periodontal (DP) é mais prevalente e mais severa em pessoas portadoras de diabete melito (DM) do que nas não diabéticas. Por outro lado, indivíduos com periodontite severa podem apresentar dificuldade em realizar o controle glicêmico. OBJETIVO: Por meio de uma revisão da literatura, determinar a influência da DP no controle metabólico dos pacientes diabéticos. REVISÃO DE LITERATURA: Mediante pesquisa na base de dados PubMed entre os meses de novembro e dezembro de 2008 foram relacionados diversos artigos da bibliografia atual e clássica, utilizando unitermos como periodontite e diabete melito. Dos 44 trabalhos encontrados, metade (n = 22) referia-se a estudos em humanos após tratamento periodontal mecânico somente ou associado a uma terapia antimicrobiana tópica ou sistêmica. Destes, dez apresentaram resultados benéficos quanto ao controle glicêmico. Três artigos (n = 3) traziam pesquisas simulando a periodontite em ratos pré-dispostos ou portadores de DM. Os resultados para as investigações epidemiológicas (n = 5), de revisão de literatura e meta-análise (n = 14) mostraram-se positivamente similares aos estudos em humanos após tratamento periodontal para quatro e 11 artigos, nessa ordem. As possíveis trajetórias patofisiológicas comuns entre DP e DM avaliadas pelos autores foram relacionadas a marcadores inflamatórios, à resposta do hospedeiro alterada e à resistência a insulina. CONCLUSÃO: A periodontite pode influenciar no controle glicêmico do diabete. No entanto a padronização das pesquisas no tocante à terapia periodontal e ao grupo testado torna-se necessária para consolidar a relação bidirecional entre DP e DM e auxiliar no tratamento multiprofissional dos pacientes acometidos por tais patologias.


INTRODUCTION: Currently, it is accepted that the periodontal disease is more prevalent and severe in people with diabetes mellitus glycemic index. compared to non-diabetic people. On the other hand, patients with severe periodontitis may present difficulty in performing glycemic control. OBJECTIVE: The objective of the present study is to determine, through a literature review, the influence of the periodontal disease on the metabolic control of diabetic patients. LITERATURE REVIEW: PubMed database was searched, from November to December of 2008, and several studies comprising the current and classic literature were listed, using the following uniterms: periodontitis and diabetes mellitus. Forty and four reports were found. Half of them (n = 22) was conducted in humans after the mechanic periodontal treatment alone or associated with a topic or systemic antimicrobial therapy. Ten of these studies presented beneficial results regarding to the glycemic control. Three studies (n = 3) were conducted in animals, simulating periodontitis in pre-diabetic or diabetic rats. The results of epidemiologic (n = 5), literature review, and meta-analysis (n = 14) studies were positively similar to the studies in humans after the periodontal treatment, in 4 and 11 articles, respectively. The most common possible patho-physiological paths between periodontal disease (DP) and diabetes mellitus (DM) evaluated by the authors were related to the inflammatory markers, the host's modified response, and the resistance to insulin. CONCLUSION: Periodontitis may influence on the glycemic control of diabetes. However, the study's standardization in relation to both the periodontal therapy and the studied groups are necessary to consolidate the bidirectional relationship between DP and DM and to help in the multidisciplinary treatment of the patients suffering of these diseases.

17.
Rev. Assoc. Paul. Cir. Dent ; 63(6): 468-473, nov.-dez. 2009.
Artigo em Português | LILACS, BBO - Odontologia | ID: lil-590313

RESUMO

O objetivo deste estudo foi avaliar os efeitos clínicos e microbiológicos da terapia de raspagem e alisamento radicular (RAR) isoladamente ou em combinação com o controle profissional da placa supragengival (CPP). Foram selecionados 30 indivíduos com periodontite crônica e, posteriormente, distribuídos aleatoriamente em dois grupos terapêuticos: controle (RAR) e teste (RAR + CPP). Os exames clínicos (índice de placa, índice gengival, profundidade de sondagem, nível clínico de inserção, sangramento à sondagem e supuração) e microbiológico (Teste BANA) foram realizados no momento inicial, 40 e 60 dias após a terapia de RAR. A terapia de RAR foi realizada em 21 dias e o CPP foi iniciado juntamente com a RAR, duas vezes semanais, e prosseguiu durante 40 dias após o término desta. Os parâmetros clínicos foram reduzidos significativamente aos 60 dias pós-terapia em ambos os grupos terapêuticos (p6 mm) no grupo CPP tiveram melhores resultados em relação à redução do acúmulo de placa e na profundidade de sondagem em comparação ao grupo controle. Ambas as terapias levaram a melhora microbiológica durante o período experimental (p0,05). Em conclusão, a combinação do CPP com a RAR promove benefícios clínicos em comparação com a RAR isolada.


The purpose of the present study was to evaluate the clinical and microbiological effects of scaling and root planing (RAR) alone or in combination with professional supragingival pla- que control (CPP). Thirty subjects with chronic periodontitis were assigned into two therapeutic groups: Control (RAR) and Test (RAR + CPP). Clinical (visible plaque, gingival bleeding, probing depth, clinical attachment levei, bleeding on probing and suppuration) and microbiological (BANA Test] examinations were performed at baseline, 40 and 60 days post-SRP. The CPP treatment was made twice a week and began with SRP and was continued for 40 days post-SRP. The clinical pa- rameters were significantly reduced at 60 days post-therapy in both treatment groups (p6mm) in the PPC group also had a better reduction in the percentage of sites with bleeding on probing and in probing depth and in the gain of clinical attachment compared to the control group. Both therapies led to a microbiological improvement overtime (p0.05). In conclusion, the combination of CPP and RAR leads to clinical benefits in comparison to RAR alone.


Assuntos
Humanos , Masculino , Feminino , Placa Dentária , Doenças Periodontais/patologia , Microbiologia , Profilaxia Dentária/métodos , Raspagem Dentária/métodos
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