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1.
BMC Oral Health ; 20(1): 123, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321490

RESUMO

BACKGROUND: This pilot study was part of a larger study which compared the effect of subgingival air-polishing using trehalose powder with sonic scaling on clinical parameters during supportive periodontal therapy. Within this microbiological part of the investigation subgingival samples were taken from 10 participants to analyze the survival of different bacterial species after the two different treatments as a proof of principle. METHODS: In 10 participants two non-adjacent, single-root teeth requiring treatment (PD =5 mm with bleeding on probing (BOP) or > 5 mm) were selected following a split-mouth design and were treated either with a sonic scaler or air-polishing device and trehalose powder. For persistent pockets (PD =4 mm and BOP or > 4 mm), treatment was repeated after 3 months. Subgingival biofilm samples were taken at baseline (BL), subsequently and three and six months after treatment. After determination of the bacterial counts (TBL), isolated bacteria were identified by MALDI-TOF-MS. If unsuccessful, PCR and 16S rDNA sequencing were performed. RESULTS: In both treatment groups, TBL decreased immediately after treatment remaining at a lower level. This confirms the findings of the larger study regarding clinical parameters showing a comparable effect on PD, BOP and CAL. Immediately after treatment, the diversity of detected species decreased significantly more than in the sonic group (p = 0.03). After 3 months, the proportion of Gram-positive anaerobic rods was lower in the air-polishing group (powder/ sonic 7%/ 25.9%, p = 0.025). Also, there was a greater reduction of Gram-negative aerobic rods for this group at this time (air-polishing/ sonic - 0.91 / -0.23 Log10 cfu/ ml, p = 0.020). CONCLUSION: Within the limitations of this study air-polishing and sonic treatment seem to have a comparable effect on the subgingival oral biofilm during supportive periodontal treatment. TRIAL REGISTRATION: The study was registered in an international trial register (German Clinical Trial Register number DRKS 00006296) on 10th of June 2015. HTML&TRIAL_ID = DRKS00006296.


Assuntos
Biofilmes/efeitos dos fármacos , Placa Dentária/terapia , Raspagem Dentária/instrumentação , Bolsa Periodontal/tratamento farmacológico , Trealose/farmacologia , Adulto , Idoso , Placa Dentária/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Bolsa Periodontal/prevenção & controle , Projetos Piloto , Pós , Trealose/uso terapêutico
2.
J Periodontal Res ; 54(2): 190-197, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30298556

RESUMO

BACKGROUND AND OBJECTIVE: Melatonin is synthesized naturally by pineal gland and responsible for regulation of sleep/waking cycle. It showed appreciated anti-inflammatory and antioxidant properties. The aim of this randomized clinical trial (RCT) was to assess the additive effect of melatonin supplementation in insomniac individuals with generalized chronic periodontitis (gCP) after scaling and root planing (SRP). MATERIAL AND METHODS: Seventy-four gCP patients with primary insomnia participated in this 6-month RCT and randomized into two groups. Melatonin group included 38 patients who were subjected to SRP with a 2-month regimen of 10 mg oral melatonin capsule once daily before bedtime. In the control group, SRP was performed for 36 participants provided with matching placebo capsules. The primary treatment outcome was the measurement of clinical attachment level gain (CAL gain) after 3 and 6 months of therapy, whereas the measurements of pocket depth reduction (PD reduction), bleeding on probing (BOP %), and the changes in salivary TNF-α levels and Athens insomnia scale (AIS) scores represented the secondary endpoints. RESULTS: Melatonin group showed significantly greater CAL gain and PD reduction measurements compared to the control group at 3 and 6 months of therapy, P < 0.01. Likewise, salivary TNF-α levels and AIS scores were significantly lower in the melatonin group compared to placebo group. BOP% improved significantly in both groups without any difference. However, salivary TNF-α levels exhibited no correlation with other clinical variables in both melatonin and placebo groups. CONCLUSION: Daily dietary 10 mg of melatonin supplementation might serve as a viable adjunct to SRP that yielded significantly greater CAL gain and PD reduction and lower salivary TNF-α levels and AIS scores in gCP patients with primary insomnia.


Assuntos
Periodontite Crônica/tratamento farmacológico , Suplementos Nutricionais , Melatonina/administração & dosagem , Administração Oral , Adulto , Periodontite Crônica/complicações , Periodontite Crônica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/prevenção & controle , Saliva/metabolismo , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/metabolismo
3.
Periodontol 2000 ; 78(1): 212-226, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30198128

RESUMO

The goal of this review is to summarize the results of randomized trials reported since 2010 that assessed the effect of periodontal interventions on at least one systemic outcome in human subjects of any age, gender or ethnicity. Oral outcome measures included gingivitis, pocket depth, clinical attachment loss and/or radiographic bone loss and oral hygiene indices. Studies were excluded if the trial was not completed or if treatment was not randomized. The results suggest that nonsurgical periodontal intervention provided to pregnant women is safe and improves periodontal status without preventing adverse pregnancy outcomes. Nonsurgical periodontal intervention was also found to provide modest improvement in glycemic control in individuals with type 2 diabetes mellitus and periodontitis. Also, improving oral care through mechanical or chemical control of dental-plaque biofilm formation can contribute to the prevention of respiratory infections in differing clinical settings, including hospitals and nursing homes, and in patients with chronic obstructive pulmonary disease. No clinical trials were reported that tested the effect of periodontal interventions on medical outcomes of atherosclerosis, cardiovascular diseases, stroke, rheumatoid arthritis, Alzheimer's disease, chronic kidney disease or malignant neoplasia.


Assuntos
Assistência Odontológica , Gerenciamento Clínico , Doenças Periodontais/terapia , Perda do Osso Alveolar/terapia , Doença de Alzheimer/complicações , Artrite Reumatoide/complicações , Aterosclerose/complicações , Biofilmes/crescimento & desenvolvimento , Glicemia , Doenças Cardiovasculares/complicações , Bases de Dados Factuais , Placa Dentária/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Feminino , Bolsa Gengival/terapia , Gengivite/terapia , Hospitais , Humanos , Neoplasias/complicações , Casas de Saúde , Índice de Higiene Oral , Perda da Inserção Periodontal/terapia , Doenças Periodontais/etiologia , Doenças Periodontais/prevenção & controle , Índice Periodontal , Bolsa Periodontal/prevenção & controle , Periodontite/etiologia , Gravidez , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Renal Crônica/complicações , Infecções Respiratórias/prevenção & controle , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
5.
J Clin Periodontol ; 45(2): 196-203, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29178189

RESUMO

AIM: To explore the association between toothbrushing behaviour and change in periodontal pocketing among adults. METHODS: We pooled data from 1,025 adults, aged 30-89 years, who participated in two national surveys in Finland (Health 2000 and Health 2011, BRIF8901) and reported their toothbrushing frequency. A cumulative measure of regular toothbrushing was created by counting the number of times participants reported brushing twice or more daily across the two surveys (ranging from 0 to 2). The association between toothbrushing behaviour and the number of teeth with periodontal pocket depth (PPD) ≥4 mm over 11 years was assessed in linear regression models adjusting for confounders. RESULTS: There was a clear dose-response relationship between toothbrushing frequency (either at baseline or follow-up) and change in number of teeth with PPD ≥ 4 mm. There was also evidence of a cumulative effect of regular toothbrushing on change in number of teeth with PPD ≥ 4 mm. Participants who reported brushing twice or more a day in both surveys developed 1.99 (95% CI: 1.02-2.95) fewer teeth with PPD ≥ 4 mm than those who did not report this behaviour in any survey. CONCLUSION: This 11-year prospective study showed that toothbrushing behaviour was associated with smaller increments in the number of teeth with periodontal pocketing.


Assuntos
Bolsa Periodontal/prevenção & controle , Escovação Dentária , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia/epidemiologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Escovação Dentária/estatística & dados numéricos
6.
Periodontol 2000 ; 76(1): 180-190, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29239086

RESUMO

Peri-implant and periodontal pockets share a number of anatomical features but also have distinct differences. These differences make peri-implant pockets more susceptible to trauma and infection than periodontal pockets. Inadequate maintenance can lead to infections (defined as peri-implant mucositis and peri-implantitis) within peri-implant pockets. These infections are recognized as inflammatory diseases, which ultimately lead to the loss of supporting bone. Diagnostic and treatment methods conventionally used in periodontics have been adopted to assess and treat these diseases. Controlling infection includes elimination of the biofilm from the implant surface and efficient mechanical debridement. However, the prosthetic supra-structure and implant surface characteristics can complicate treatment. Evidence shows that when appropriately managed, peri-implant mucositis is reversible. Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri-implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated. The major objective of the surgical approach is to provide access and visualize the clinical situation. Hence, a more informed decision can be made regarding whether to use a resective or a regenerative surgical technique. Evidence shows that following successful decontamination, surgical treatment to regenerate the bone can be performed, and a number of regenerative techniques have been proposed. After treatment, regular maintenance and good oral hygiene are essential for a predictable outcome and long-term stability.


Assuntos
Peri-Implantite/terapia , Bolsa Periodontal/terapia , Perda do Osso Alveolar , Anti-Infecciosos/uso terapêutico , Biofilmes/efeitos dos fármacos , Implantes Dentários , Placa Dentária , Profilaxia Dentária , Humanos , Higiene Bucal , Índice de Higiene Oral , Procedimentos Cirúrgicos Bucais/métodos , Peri-Implantite/diagnóstico , Peri-Implantite/prevenção & controle , Peri-Implantite/cirurgia , Desbridamento Periodontal/métodos , Índice Periodontal , Bolsa Periodontal/diagnóstico , Bolsa Periodontal/prevenção & controle , Bolsa Periodontal/cirurgia , Estomatite/diagnóstico , Estomatite/prevenção & controle , Estomatite/terapia , Resultado do Tratamento
7.
J Periodontal Res ; 52(1): 61-73, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26932733

RESUMO

BACKGROUND AND OBJECTIVE: Triclosan/copolymer toothpaste is effective in controlling plaque and gingivitis and in slowing the progression of periodontitis. This study describes its influence on microbiological and clinical outcomes, over a 5-year period, in patients with established cardiovascular disease (CVD). MATERIAL AND METHODS: Four-hundred and thirty-eight patients were recruited from the Cardiovascular Unit at The Prince Charles Hospital, Brisbane, Australia, and randomized to triclosan or placebo groups. Six sites per tooth were examined annually for probing pocket depth and loss of attachment. These outcomes were analysed, using generalized linear modelling, in 381 patients who had measurements from consecutive examinations. Concurrent load of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Tannerella forsythia and Porphyromonas gingivalis was determined, using quantitative real-time PCR, in 437 patients with baseline plaque samples. Group comparisons were expressed as geometric means. The chi-square test was used to test for differences between the two groups of patients with regard to the proportion of patients with different numbers of bacterial species. RESULTS: There was no difference in general health or periodontal status between the groups at baseline. There was a significant reduction in the number of interproximal sites showing loss of attachment between examinations, by 21% on average (p < 0.01), in the triclosan group compared with the placebo group. The prevalence of patients with F. nucleatum and A. actinomycetemcomitans was high and remained relatively constant throughout the 5 years of the study. In contrast, the prevalence of T. forsythia and P. gingivalis showed more variability; however, there was no significant difference between the groups, at any time point, in the prevalence of any organism. A significant difference in the geometric means for P. gingivalis (p = 0.01) was seen at years 1 and 4, and for F. nucleatum (p = 0.01) and in the total bacterial load (p = 0.03) at year 2; however, these differences were not statistically significant following a Bonferroni correction for multiple comparisons. There was no difference between the groups in the geometric means for each organism at year 5. CONCLUSION: Within the limitations of the study, these data suggest that the use of triclosan/copolymer toothpaste significantly slowed the progression of periodontitis in patients with CVD but that it had little influence on key subgingival periodontopathic bacteria in these patients over the 5 years of the study.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Doenças Cardiovasculares/complicações , Periodontite/prevenção & controle , Cremes Dentais/uso terapêutico , Triclosan/uso terapêutico , Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Progressão da Doença , Feminino , Fusobacterium nucleatum/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/complicações , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/prevenção & controle , Bolsa Periodontal/complicações , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/prevenção & controle , Periodontite/complicações , Periodontite/tratamento farmacológico , Periodontite/microbiologia , Porphyromonas gingivalis/efeitos dos fármacos , Reação em Cadeia da Polimerase em Tempo Real , Tannerella forsythia/efeitos dos fármacos
9.
Evid Based Dent ; 17(4): 101-102, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27980329

RESUMO

Data sourcesMedline, Embase, Cochrane CENTRAL and OpenGREY databases without language restriction until March 2016 plus manual searching of four specific journals and consideration of reference lists.Study selectionStudies evaluating different methods of periodontal treatment in Down syndrome patients measuring at least two periodontal parameters at different periods of assessment. Titles, abstracts and full texts were considered by two independent reviewers and a third where discussion did not reach consensus. Randomised controlled trials were evaluated using the Cochrane risk of bias tool. The observational studies were evaluated using an adapted version of the Newcastle-Ottawa Scale.Data extraction and synthesisData extraction was carried out independently by two reviewers and organised into evidence tables. No meta-analysis was undertaken, however a narrative synthesis was presented.ResultsNine studies met the inclusion criteria; four longitudinal studies, one prospective case series and four clinical trials which included two cross-over studies and a controlled trial. The studies showed marked heterogeneity in terms of methodology, intervention and outcome measures. All studies, however, included assessment of different plaque and gingival indices.Three studies investigated outcomes after scaling and root planing, one of which compared surgical and non-surgical approaches. Periodontal pockets of 1-3 mm were statistically significantly improved with non-surgical treatment in comparison with pockets greater than 4 mm which showed greater reduction with surgical treatment. Six studies investigated different forms and uses of chlorhexidine, three of which investigated its use as an adjuvant to mechanical debridement and one which also included plaque disclosing as an intervention. Chlorhexidine was shown to be most effective when used daily as a 1% gel for toothbrushing. The use of a plaque disclosing tablet and fluoridated tooth paste, however, showed further improved outcomes with regards to plaque control.ConclusionsEight of the nine studies included showed improvement in the primary outcomes of improved plaque and gingival bleeding indices. Professional intervention and periodontal maintenance significantly reduced plaque and gingival indices, irrespective of the treatment performed. Increased frequency of interventions was associated with better outcomes, especially in younger age groups.


Assuntos
Periodontite Crônica/complicações , Periodontite Crônica/terapia , Síndrome de Down/complicações , Clorexidina/uso terapêutico , Periodontite Crônica/prevenção & controle , Raspagem Dentária , Odontologia Baseada em Evidências , Humanos , Antissépticos Bucais/uso terapêutico , Bolsa Periodontal/complicações , Bolsa Periodontal/prevenção & controle , Bolsa Periodontal/terapia , Aplainamento Radicular
10.
Gen Dent ; 64(4): e5-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27367641

RESUMO

Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues.


Assuntos
Assistência Odontológica para Pessoas com Deficiências/métodos , Pessoas com Deficiência/reabilitação , Doenças Periodontais/prevenção & controle , Adulto , Biofilmes , Clínicas Odontológicas , Feminino , Humanos , Masculino , Boca/microbiologia , Higiene Bucal/instrumentação , Higiene Bucal/métodos , Bolsa Periodontal/prevenção & controle , Escovação Dentária/instrumentação , Escovação Dentária/métodos
11.
Expert Rev Anti Infect Ther ; 14(7): 643-55, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27224284

RESUMO

INTRODUCTION: The frequent recolonization of treated sites by periodontopathogens and the emergence of antibiotic resistance have led to a call for new therapeutic approaches for managing periodontal diseases. As probiotics are considered a new tool for combating infectious diseases, we systematically reviewed the evidences for their effectiveness in the management of periodontitis. AREAS COVERED: An electronic search was performed in the MEDLINE, SCOPUS and Cochrane Library databases up to March 2016 using the terms 'periodontitis', 'chronic periodontitis', 'probiotic(s)', 'prebiotic(s)', 'symbiotic(s)', 'Bifidobacterium and 'Lactobacillus'. Only randomized controlled trials (RCTs) were included in the present study. Analysis of 12 RCTs revealed that in general, oral administration of probiotics improved the recognized clinical signs of chronic and aggressive periodontitis such as probing pocket depth, bleeding on probing, and attachment loss, with a concomitant reduction in the levels of major periodontal pathogens. Continuous probiotic administration, laced mainly with Lactobacillus species, was necessary to maintain these benefits. Expert commentary: Oral administration of probiotics is a safe and effective adjunct to conventional mechanical treatment (scaling) in the management of periodontitis, specially the chronic disease entity. Their adjunctive use is likely to improve disease indices and reduce the need for antibiotics.


Assuntos
Bifidobacterium , Raspagem Dentária , Lactobacillus , Periodontite/tratamento farmacológico , Probióticos/uso terapêutico , Terapia Combinada , Suplementos Nutricionais , Humanos , Perda da Inserção Periodontal/prevenção & controle , Bolsa Periodontal/prevenção & controle , Periodontite/terapia , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
J Periodontol ; 86(10): 1133-40, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26418666

RESUMO

BACKGROUND: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1ß (IL-1ß) in patients receiving regular periodontal maintenance therapy. METHODS: This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1ß levels were measured immediately before treatment (baseline) and 3 months after treatment. RESULTS: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1ß levels between SRP + L and SRP alone were not statistically significant. CONCLUSION: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.


Assuntos
Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Bolsa Periodontal/radioterapia , Periodontite/radioterapia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Raspagem Dentária/métodos , Feminino , Seguimentos , Líquido do Sulco Gengival/química , Hemorragia Gengival/prevenção & controle , Hemorragia Gengival/radioterapia , Humanos , Interleucina-1beta/análise , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/prevenção & controle , Perda da Inserção Periodontal/radioterapia , Bolsa Periodontal/prevenção & controle , Periodontite/prevenção & controle , Estudos Prospectivos , Aplainamento Radicular/métodos , Método Simples-Cego , Resultado do Tratamento
14.
J Periodontol ; 86(6): 777-87, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25741578

RESUMO

BACKGROUND: Different gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 response patterns were studied among non-smoking and smoking patients with chronic periodontitis (CP) and generalized aggressive periodontitis (GAgP) to test the utility of GCF MMP-8 levels predicting the site-level treatment outcome. METHODS: Data from four independent longitudinal studies were combined. Altogether, the studies included 158 periodontal sites from 67 patients with CP and 32 patients with GAgP, and GCF samples were collected at baseline, after the treatment, and during the 6-month maintenance period. All GCF samples were analyzed by immunofluorometric assay for MMP-8. Different site-level MMP-8 response patterns were explored by the cluster analysis. Most optimal MMP-8 cutoff levels were searched with receiver operating characteristic analyses, and the predictive utility of defined levels was tested. RESULTS: Distinct types of MMP-8 response patterns were found in both smokers and non-smokers. MMP-8 levels exceeding the optimal cutoff levels separately defined for smokers and non-smokers indicated increased risk for compromised treatment outcome at baseline and during the maintenance period. Seventy-one percent of non-smokers (positive likelihood ratio of 4.22) and 88% of smokers (positive likelihood ratio of 5.00) with positive test results at both baseline and the maintenance period had compromised treatment outcome. The double-positive result indicated 46% and 39% point risk increase for the compromised outcome, respectively. CONCLUSION: GCF MMP-8 analysis with defined cutoff levels could be used to predict the site-level treatment outcome and for longitudinal monitoring of the disease status during the maintenance period.


Assuntos
Periodontite Agressiva/terapia , Periodontite Crônica/terapia , Líquido do Sulco Gengival/enzimologia , Metaloproteinase 8 da Matriz/análise , Periodontite Agressiva/enzimologia , Periodontite Agressiva/prevenção & controle , Biomarcadores/análise , Periodontite Crônica/enzimologia , Periodontite Crônica/prevenção & controle , Análise por Conglomerados , Raspagem Dentária/métodos , Seguimentos , Previsões , Retração Gengival/enzimologia , Retração Gengival/prevenção & controle , Retração Gengival/terapia , Humanos , Estudos Longitudinais , Higiene Bucal/educação , Perda da Inserção Periodontal/enzimologia , Perda da Inserção Periodontal/prevenção & controle , Perda da Inserção Periodontal/terapia , Bolsa Periodontal/enzimologia , Bolsa Periodontal/prevenção & controle , Bolsa Periodontal/terapia , Curva ROC , Aplainamento Radicular/métodos , Fumar , Resultado do Tratamento
15.
J Clin Periodontol ; 42(3): 228-35, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25581313

RESUMO

AIM: To assess an approach to improving behavioural and glycaemic outcomes in dental patients who present with diabetes risk factors and previously unrecognized hyperglycaemia. METHODS: We randomized 101 individuals identified with potential diabetes or pre-diabetes into two interventions. In the basic/control intervention, participants were informed about their diabetes risk factors and blood test result, and advised to see a physician. In the enhanced/test intervention, patients received a detailed explanation of findings and their implications, a written report for the physician, and were contacted at 2 and 4 months to inquire whether medical follow-up had occurred. At a 6-month re-evaluation, outcome measures included visit to physician, positive lifestyle changes and reduction in HbA1c. RESULTS: Seventy-three subjects returned for the 6-month visit. The two intervention groups did not significantly differ in any of the outcome variables. Eighty-four percent of subjects reported having visited a physician post-randomization, and 49% reported at least one positive lifestyle change as a result of our intervention. In subjects identified with potential diabetes (baseline HbA1c ≥ 6.5%), HbA1c was reduced 1.46 ± 0.28% compared to baseline (p < 0.01). CONCLUSION: Diabetes risk assessment and education by dental professionals of affected individuals unaware of their status may contribute to improved patient outcomes.


Assuntos
Assistência Odontológica , Hiperglicemia/diagnóstico , Programas de Rastreamento , Adulto , Idoso , Glicemia/análise , Peso Corporal , Informação de Saúde ao Consumidor , Exercício Físico , Comportamento Alimentar , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Comportamentos Relacionados com a Saúde , Humanos , Hiperglicemia/prevenção & controle , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Índice Periodontal , Bolsa Periodontal/diagnóstico , Bolsa Periodontal/prevenção & controle , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/prevenção & controle , Encaminhamento e Consulta , Medição de Risco , Fatores de Risco , Perda de Dente/diagnóstico , Resultado do Tratamento
16.
J Periodontol ; 86(4): 507-15, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25597411

RESUMO

BACKGROUND: Currently, there is an increased prevalence of diabetes mellitus among the aging adult population. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in patients with diabetes are essential. The objective of this study is to assess the effectiveness of the lifestyle change plus dental care (LCDC) program to improve glycemic and periodontal status in aging patients with diabetes. METHODS: A cluster, randomized, controlled trial was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to April 2014. Sixty-six patients with diabetes per health center were included. At baseline, the intervention group attended 20-minute lifestyle and oral health education, individual lifestyle counseling, application of a self-regulation manual, and individual oral hygiene instruction. At month 3, the intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-minute educational video. The control group received a routine program. Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status. Data were analyzed by using descriptive statistic, χ(2) test, Fisher exact test, t test, and repeated-measures analysis of variance. RESULTS: After the 6-month follow-up, participants in the intervention group had significantly lower glycated hemoglobin, fasting plasma glucose, plaque index, gingival index, probing depth, and attachment loss when compared with the control group. CONCLUSION: The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes.


Assuntos
Assistência Odontológica , Diabetes Mellitus Tipo 2/terapia , Estilo de Vida , Doenças Periodontais/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Aconselhamento , Índice de Placa Dentária , Diabetes Mellitus Tipo 2/sangue , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Educação em Saúde Bucal , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Higiene Bucal/educação , Perda da Inserção Periodontal/prevenção & controle , Índice Periodontal , Bolsa Periodontal/prevenção & controle , Resultado do Tratamento
17.
Sangyo Eiseigaku Zasshi ; 57(1): 1-8, 2015.
Artigo em Japonês | MEDLINE | ID: mdl-25365972

RESUMO

OBJECTIVE: Periodontal disease is a chronic disease caused by bacterial infection, and frequently develops in adulthood. As the disease is closely related to lifestyle, it is important to clarify its relationship with health-related behaviors to provide effective health instructions targeting its prevention. In this study, we focused on periodontal pockets with advanced periodontal disease to clarify the health-related behaviors associated with the presence or absence of periodontal pockets. METHODS: The subjects were 3,142 employees (male: N=2,429, female: N=713; 42.4 ± 10.5 years, Range 20-59 years) of one company, which had provided all employees with an oral health program in 2002. Participants with a Community Periodontal Index code of ≤2 and ≥3 were classified as those without and with periodontal pockets, respectively. To clarify the health-related behaviors associated with the presence or absence of periodontal pockets, we conducted multivariate logistic regression analysis, with presence/absence of periodontal pockets as the dependent variable, and items of health-related behavior investigated in 2002 as independent variables, and calculated the odds ratios (OR) and 95% confidence intervals (95%CI) adjusted for sex, age group and occupation. RESULTS: The factor most strongly correlated with the presence of periodontal pockets was non-use of dental floss (OR=1.95 (95%CI: 1.57-2.41)), followed by smoking (OR=1.71 (95%CI: 1.44-2.03)), and tooth-brushing habits (≤once a day: OR=1.33 (95%CI: 1.10-1.61)). CONCLUSIONS: Our results suggest that, to promote oral health program at the worksite, it is important to provide health education and instructions to encourage the use of dental floss, a daily tooth-brushing habit, and smoking cessation.


Assuntos
Dispositivos para o Cuidado Bucal Domiciliar/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Saúde do Trabalhador , Saúde Bucal , Bolsa Periodontal/epidemiologia , Bolsa Periodontal/prevenção & controle , Escovação Dentária/estatística & dados numéricos , Local de Trabalho , Adulto , Feminino , Educação em Saúde , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/etiologia , Fatores de Risco , Fumar/efeitos adversos , Abandono do Hábito de Fumar , Inquéritos e Questionários , Adulto Jovem
18.
J Clin Periodontol ; 42(2): 150-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25469634

RESUMO

AIM: To relate the mean percentage of bleeding on probing (BOP) to smoking status in patients enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Retrospective data on BOP from 8'741 SPT visits were related to smoking status among categories of both periodontal disease severity and progression (instability) in patients undergoing dental hygiene treatment at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland 1985-2011. RESULTS: A total of 445 patients were identified with 27.2% (n = 121) being smokers, 27.6% (n = 123) former smokers and 45.2% (n = 201) non-smokers. Mean BOP statistically significantly increased with disease severity (p = 0.0001) and periodontal instability (p = 0.0115) irrespective of the smoking status. Periodontally stable smokers (n = 30) categorized with advanced periodontal disease demonstrated a mean BOP of 16.2% compared to unstable smokers (n = 15) with a mean BOP of 22.4% (p = 0.0291). Assessments of BOP in relation to the percentage of sites with periodontal probing depths (PPD) ≥ 4 mm at patient-level yielded a statistically significantly decreased proportion of BOP in smokers compared to non-smokers and former smokers (p = 0.0137). CONCLUSIONS: Irrespective of the smoking status, increased mean BOP in SPT patients relates to disease severity and periodontal instability while smokers demonstrate lower mean BOP concomitantly with an increased prevalence of residual PPDs.


Assuntos
Doenças Periodontais/prevenção & controle , Índice Periodontal , Fumar , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Desbridamento Periodontal/métodos , Doenças Periodontais/classificação , Bolsa Periodontal/classificação , Bolsa Periodontal/prevenção & controle , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
19.
J Clin Periodontol ; 41(9): 883-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25041441

RESUMO

OBJECTIVES: To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder containing 0.3% chlorhexidine. MATERIAL AND METHODS: Single-centre, examiner masked, randomized clinical trial of 12 months with a two-arm, within-subject parallel design. Fifty patients in periodontal maintenance were monitored in 3-month intervals. At months 0, 3, 6 and 9, all sites presenting with a probing depth (PD) >4 mm were subject to subgingival air-polishing (test side) or ultrasonic debridement (control side). The primary endpoint was presence/absence of PD >4 mm after 12 months. RESULTS: Totally 6918 sites were monitored at baseline, 457 of them had a PD >4 mm (range 5-9 mm). The number of pockets >4 mm per subject, PD and bleeding on probing were significantly lower at month 12. Differences between test and control were not significant. There was a significant difference in favour of air-polishing for the perception of pain/discomfort. Differences of frequencies at >1000 and >100,000 cells/ml of six microorganisms between baseline and month 12 were not significant. At month 12, test sites were less frequently positive for Aggregatibacter actinomycetemcomitans at >1000 cells/ml than controls, and counts never exceeded 100,000 cells/ml. CONCLUSIONS: Repeated subgingival air-polishing reduced the number of pockets >4 mm similar to ultrasonic debridement. It was safe and induced less pain.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Raspagem Dentária/métodos , Eritritol/uso terapêutico , Doenças Periodontais/prevenção & controle , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Anti-Infecciosos Locais/administração & dosagem , Carga Bacteriana , Clorexidina/administração & dosagem , Índice de Placa Dentária , Raspagem Dentária/instrumentação , Sensibilidade da Dentina/classificação , Eritritol/administração & dosagem , Feminino , Seguimentos , Hemorragia Gengival/prevenção & controle , Retração Gengival/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Percepção da Dor/fisiologia , Desbridamento Periodontal/métodos , Doenças Periodontais/microbiologia , Índice Periodontal , Bolsa Periodontal/microbiologia , Bolsa Periodontal/prevenção & controle , Método Simples-Cego , Ultrassom/instrumentação
20.
J Dent Res ; 93(8): 767-73, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24970858

RESUMO

Periodontitis is a common chronic inflammatory disease initiated by bacteria, resulting in bone resorption, tooth loss, and systemic inflammation. Long-chain omega-3 fatty acids such as docosahexaenoic acid (DHA) reduce periodontitis in animals. We aimed to determine whether DHA supplementation with low-dose aspirin would reduce periodontitis in humans. We conducted a double-blind placebo-controlled parallel trial lasting 3 mo. Fifty-five adults with moderate periodontitis were randomized to 2,000 mg of DHA or identical soy/corn oil capsules. All participants received 81 mg of aspirin but received no other treatments. We analyzed the primary outcome of per-pocket change in pocket depth using mixed models among teeth with pocket depth ≥5 mm. Secondary outcomes assessed with generalized estimating equations included gingival index, plaque index, and bleeding on probing. Gingival crevicular fluid samples were analyzed for changes in high-sensitivity C-reactive protein (hsCRP) and interleukins 6 and 1ß (IL-6 and IL-1ß). Plasma was analyzed for changes in systemic inflammatory markers, including hsCRP. We confirmed adherence with erythrocyte fatty acid measurement. Forty-six participants completed the trial. While similar at baseline, the proportion of DHA in red blood cell plasma membranes increased from 3.6% ± 0.9% to 6.2% ± 1.6% in the intervention group but did not change among controls. DHA supplementation decreased mean pocket depth (-0.29 ± 0.13; p = .03) and gingival index (-0.26 ± 0.13; p = .04). Plaque index and bleeding on probing did not change. Significant adjusted differences were found between DHA and control for both gingival crevicular fluid hsCRP (-5.3 ng/mL, standard error [SE] = 2.4, p = .03) and IL-1ß (-20.1 pg/mL, SE = 8.2, p = .02) but not IL-6 (0.02 pg/mL, SE = 0.71, p = .98) or systemic hsCRP (-1.19 mg/L, SE = 0.90, p = .20). In this randomized controlled trial, aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy (clinicaltrials.gov NCT01976806).


Assuntos
Anti-Inflamatórios/uso terapêutico , Ácidos Docosa-Hexaenoicos/uso terapêutico , Periodontite/prevenção & controle , Adulto , Anti-Inflamatórios/análise , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Proteína C-Reativa/análise , Membrana Celular/química , Índice de Placa Dentária , Ácidos Docosa-Hexaenoicos/análise , Método Duplo-Cego , Eritrócitos/química , Feminino , Seguimentos , Líquido do Sulco Gengival/química , Humanos , Mediadores da Inflamação/análise , Mediadores da Inflamação/sangue , Interleucina-1beta/análise , Interleucina-6/análise , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Bolsa Periodontal/prevenção & controle , Periodontite/sangue , Placebos , Resultado do Tratamento
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