Comparison of gingival inflammatory parameters and pain perception on periodontal probing - a cross sectional study, part II / Comparación de parámetros inflamatorios gingivales y percepción del dolor en el sondaje periodontal - un estudio transversal, parte II

Background: Probing of the periodontal pocket is an essential part of the diagnosis of periodontal disease and 15-77% of untreated periodontal patients experience pain during probing. Therefore, the objective of this study is to evaluate the pain perceived by patients with dental plaque-induced gingivitis and chronic periodontitis during periodontal probing and the main objective includes the evaluation of the relationship between pain perceived during periodontal probing and gingival inflammatory parameters. Material and Methods: A total of 475 participants were recruited into the study. The patients were divided into two groups: Group-A (Gingivitis Group - 275 patients) and Group-B (Chronic Periodontitis Group - 200 patients). Clinical parameters included analysis of bleeding on probing, simplified gingival index, pocket depth on probing, and clinical attachment level. Pain score was recorded using the HP VAS scale and all patients participated in the study after a detailed explanation of the study protocol. Results: A significant difference in pain perception was noted between groups, highlighting the role of the degree of inflammation in the examination of periodontal parameters. Conclusion: Within the limitations of the present study, we can conclude that pain perception is directly correlated with the degree of inflammation in periodontitis rather than plaque-induced gingivitis during periodontal probing. Therefore, some form of adjuvant topical anesthesia may be considered in order to reduce pain levels in severely inflamed patients, to encourage continued acceptance of supportive periodontal therapy.

Antecedentes: El sondaje de la bolsa periodontal es una parte esencial en el diagnóstico de la enfermedad periodontal. 15-77% de los pacientes periodontales no tratados experimentan dolor durante el sondaje. Por lo tanto, el objetivo de este estudio es evaluar el dolor percibido por pacientes con gingivitis inducida por placa dental y periodontitis crónica durante el sondaje periodontal y el objetivo principal incluye la evaluación de la relación entre el dolor percibido durante el sondaje periodontal con parámetros inflamatorios gingivales. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron en 2 grupos: Grupo - A (Grupo de gingivitis - 275 pacientes) y Grupo - B (Grupo de periodontitis crónica - 200 pacientes). Los parámetros clínicos incluyeron el análisis del sangrado al sondaje, el índice gingival simplificado, la profundidad de la bolsa al sondaje y el nivel de inserción clínica. La puntuación del dolor se registró utilizando la escala HP VAS y todos los pacientes participaron en el estudio después de una explicación detallada del protocolo del estudio. Resultados: Se notó una diferencia significativa en la percepción del dolor en el grupo B que en el grupo A, lo que significa el papel del grado de inflamación en el examen de los parámetros periodontales. Conclusión: Dentro de las limitaciones del presente estudio, podemos concluir que la percepción del dolor se correlaciona directamente con el grado de inflamación que se observa en la periodontitis más que con la gingivitis inducida por la placa dental durante el sondaje periodontal. Por lo tanto, se puede considerar alguna forma de anestesia tópica adyuvante para reducir los niveles de dolor en pacientes gravemente inflamados para fomentar la aceptación continua de la terapia periodontal de apoyo.

Evaluation of pain perception on periodontal probing in patients with dental plaque induced gingivitis and chronic periodontitis - a cross sectional study, part I / Evaluación de la percepción del dolor al sondaje periodontal en pacientes con gingivitis inducida por placa dental y periodontitis crónica: un estudio transversal, parte I

Background: Probing of periodontal pockets is an essential part in the diagnosis of periodontal disease. Fifteen to seventy seven percent of untreated periodontal patients experience pain during probing. Hence the aim of this study is to evaluate the pain perceived by patients with gingivitis and periodontitis during periodontal probing. The goals of this study were to compare the patients' pain perception when using a conventional UNC15 probe and a manual pressure sensitive periodontal probe, and to relate the clinical features of gingivitis and periodontitis to the discomfort associated with periodontal probing. Material and Methods: A total of 475 subjects were recruited into the study. The subjects were initially divided into two groups ­ Group ­ A (Gingivitis group - 275 patients) and Group ­ B (Chronic Periodontitis group -200 patients) according to the AAP 1999 Classification. These two groups were further subdivided into two groups each (Gingivitis ­ Conventional Probe ­ GCP, Gingivitis ­ Manual Pressure Sensitive Probe ­ GMPS, Periodontitis - Conventional Probe ­ PCP, Periodontitis ­ Manual Pressure Sensitive Probe ­ PMPS) using a computer generated program of random numbers. Results: A significant difference was noted in pain perception when pressure sensitive probe was used compared to conventional UNC-15 probe. Reduced Bleeding on Probing and Pain scores were noted in Chronic periodontitis subjects with use of pressure sensitive probe, which was statistically significant (p<0.001). Conclusion: Dentistry has changed its focus towards painless dentistry. In this context, the present study presents data towards use of manual pressure sensitive probes, which offers an advantage of low cost when compared to more advanced computerized systems with reduced pain during periodontal examination. It could result in a positive attitude of the patients towards continuous supportive periodontal therapy thereby monitoring periodontal health.

Antecedentes: El sondaje de los sacos periodontales es una parte esencial en el diagnóstico de la enfermedad periodontal. Del quince al setenta y siete por ciento de los pacientes periodontales no tratados experimentan dolor durante el sondaje. De ahí que el objetivo de este estudio fué evaluar el dolor percibido por pacientes con gingivitis y periodontitis durante el sondaje periodontal. Los objetivos de este estudio fueron comparar la percepción del dolor de los pacientes al usar una sonda UNC15 convencional y una sonda periodontal sensible a la presión manual, y relacionar las características clínicas de la gingivitis y la periodontitis con la incomodidad asociada con el sondaje periodontal. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron inicialmente en dos grupos - Grupo - A (grupo de Gingivitis - 275 pacientes) y Grupo - B (grupo de Periodontitis Crónica - 200 pacientes) de acuerdo con la Clasificación AAP 1999. Estos dos grupos se subdividieron en dos grupos cada uno (Gingivitis - Sonda convencional - GCP, Gingivitis - Sonda manual sensible a la presión - GMPS, Periodontitis - Sonda convencional - PCP, Periodontitis - Sonda manual sensible a la presión - PMPS) usando un programa generado por computadora de datos aleatorios. números. Resultados: Se notó una diferencia significativa en la percepción del dolor cuando se usó una sonda sensible a la presión en comparación con la sonda UNC-15 convencional (p<0,001). Conclusion: La odontología ha cambiado su enfoque hacia una odontología sin dolor. En este contexto, el presente estudio presenta datos hacia el uso de sondas manuales sensibles a la presión, que ofrece una ventaja de bajo costo en comparación con sistemas computarizados más avanzados con reducción del dolor durante el examen periodontal. Podría resultar en una actitud positiva de los pacientes hacia la terapia periodontal de apoyo continuo, monitoreando así la salud periodontal.

Condições periodontais e fatores associados a profundidade de sondagem em pacientes de uma faculdade do sul do Brasil / Periodontal conditions and factors associated with the probing depth in patients from a faculty in southern Brazil

RESUMO Objetivos: Verificar os sinais clínicos periodontais e investigar a os níveis de profundidade de sondagem (PS) e fatores associados em pacientes atendidos nas Clínicas da Faculdade IMED, localizada em um município do sul do Brasil. Metodologia: Os dados foram coletados em 193 prontuários de pacientes que buscaram atendimento odontológico, no período de 2017-2018, agrupados em sociodemográficos, hábitos de higiene bucal, hábitos nocivos e doenças crônicas. Os dados clínicos foram índice de placa dental visível (IPV), índice de sangramento gengival (ISG) e PS. Após realizadas análises descritivas foi construído um modelo de Regressão linear simples e múltiplo para verificar relações entre as variáveis ao p-valor<0,05. Resultados: A maioria dos pacientes são do sexo feminino (63,2%) com média de 40,8 anos (±14,58). Os resultados descritivos de IPV, ISG e PS foram 39,11±32,28%, 21,81 ±22,43% e 2,91 ±1,09mm, respectivamente. Após os ajustes no modelo de regressão múltiplo, os portadores de diabetes e a a quantidade de cigarros fumados por dia influenciaram no nível de PS. Conclusões: Os achados desta investigação mostram um alto IPV e de SG. Apesar da média da PS ter sido baixa, portadores de diabetes e fumo foram fatores preditivos de maiores níveis de PS.

ABSTRACT: Objectives: To evaluate periodontal clinical signs and investigate the probing depth levels (PD) and associated factors in patients attending the Dental Clinics of the Faculty IMED, located in a municipality in southern Brazil. Material and Methods: The data were collected of 193 records of patients who demand dental care in the Dental Clinics for periodontal treatment, in the period 2017- 2018: sociodemographic data, oral hygiene habits, tobacco use and chronic diseases. The clinical data were: gingival bleeding index (GBI), visible plaque index (VPI) and PD. The statistical analyzed the relationship between probing depth and exposure variables, using a linear regression linear model (p-value<0.05). Results: The majority of the patients attended were female (63.2%) and 40.8 years old on average (± 14.58). The descriptive results of VPI, GBI e PD were: 39.11 ± 32.28%, 21.81 ± 22.43%, and 2.91 ± 1.09mm, respectively. After adjustments in the multiple regression model, it was observed that diabetes and quantity of cigarettes smoked had an influence on PD. Conclusions: The results obtained in this research allowed to verify a high index of VPI and GBI in the patients. The mean PD of the individuals was low, however, it was possible to verify that having diabetes and smoking a large amount of cigarettes daily were predictive factors of higher levels of PD.

Periodontal disease and its complications in cats from a shelter in the Central Region of Rio Grande do Sul / Doença periodontal e suas complicações em gatos de um abrigo na Região Central do Rio Grande do Sul

Periodontal disease is the most common infectious disease that occurs in feline patients. Although it occurs in both sexes, different age groups, and any breeds, the prevalence and severity seem much higher in cats living in animal shelters. This paper aimed to describe the clinical, radiological, cytopathological, and virological aspects of periodontal disease and its complications in cats, based on these aspects and, consequently, on the importance it brings to cat feline medicine in shelter cats. For this, nine cats with periodontal disease from a single animal shelter were evaluated. These cats demonstrated a disease characterized by halitosis, excessive salivation, and oral discomfort. Lymphadenomegaly of the mandibular and retropharyngeal lymph nodes was observed in 44.4% of the cases. Oral lesions consisted of varying degrees of gingival hyperemia, complete loss of free gingival margins, and consequently gingival retraction, dental calculus deposition, dental mobility, complete exposure of the furcation of premolars and molars, and dental roots of canines and incisors, loss of bone radiopacity due to alveolar bone resorption and tooth loss. Complications included chronic ulcerative paradental stomatitis (22.2%), faucitis (22.2%), and chronic gingivostomatitis (11.1%). None of the cats affected by periodontal disease was positive for FIV or FeLV. In 33.3% of the cases, cats were carriers of feline calicivirus, but not feline herpesvirus.(AU)

Doença periodontal é a mais comum doença infecciosa que ocorre em pacientes felinos. Embora ocorra em gatos de ambos os sexos, diferentes faixas etárias e quaisquer raças, a prevalência e a gravidade parece muito maior em gatos que vivem em abrigos para animais. Baseado nesses aspectos e, consequentemente, na importância que ela traz para a medicina felina de gatos de abrigos, o objetivo desse artigo é descrever os aspectos clínicos, radiológicos, citopatológicos e virológicos da doença periodontal e suas complicações em gatos. Para isso, nove gatos com doença periodontal oriundos de um único abrigo de animais foram avaliados. Esses gatos demonstraram uma doença caracterizada por halitose, salivação excessiva e desconforto oral. Linfadenomegalia dos linfonodos mandibulares e retrofaríngeos foi observada em 44,4% dos casos. As lesões orais consistiam de graus variados de hiperemia gengival, perda completa das margens gengivais livres e, consequentemente, retração gengival, deposição de cálculo dental, mobilidade dentária, exposição completa da furca dos pré-molares e molares e das raízes dentárias dos caninos e incisivos, perda de radiopacidade óssea devido à reabsorção de osso alveolar e perda dentária. Complicações incluíram estomatite paradental ulcerativa crônica (22,2%), faucite (22,2%) e gengivoestomatite crônica (11,1%). Nenhum dos gatos afetados pela doença periodontal foi positivo para FIV ou FeLV. Em 33,3% dos casos, os gatos eram portadores do calicivírus felino, mas não do herpesvírus felino.(AU)

Gingivitis influences oral health-related quality of life in adolescents: findings from a cohort study / A gengivite influencia a qualidade de vida relacionada à saúde bucal de adolescentes: achados de um estudo de coorte

ABSTRACT: Introduction: Oral health-related quality of life (OHRQoL) is affected by different clinical conditions. The aim of this study was to evaluate the impact of gingivitis on OHRQoL in adolescents. Methodology: This cohort study consisted of a random sample of 1,134 schoolchildren enrolled during 2012, in Santa Maria, Brazil. After two years, 743 adolescents were follow-up (response rate: 65.5%). Clinical, socioeconomic and OHRQoL data were collected. OHRQoL was assessed by the short Brazilian version of the Child Perceptions Questionnaire 11-14 (CPQ11-14), and gingival bleeding through Community Periodontal Index. Gingivitis was considered with the presence of 15% or more bleeding sites. Poisson regression models were used to evaluate the association between gingivitis and overall and domain-specific CPQ11-14 scores. Prevalence of gingivitis at baseline was considered the main predictor for the OHRQoL at follow-up. Results: Gingivitis at baseline was associated with higher overall CPQ 11-14 score (RR = 1.07; 95%CI 1.01 - 1.14), and emotional well-being (RR = 1.17; 95%CI 1.04 - 1.31), independently of other oral conditions and socioeconomic variables. Conclusions: The findings indicate that gingivitis negatively impacts the adolescents' OHRQoL. Moreover, gender, maternal schooling and household income were also associated with OHRQoL.

RESUMO: Introdução: Qualidade de vida relacionada à saúde bucal (QVRSB) é afetada por diferentes condições clínicas. O objetivo deste estudo foi avaliar o impacto da gengivite na QVRSB de adolescentes. Metodologia: Este estudo de coorte consistiu em uma amostra aleatória de 1.134 escolares iniciado em 2012, na cidade de Santa Maria, Brasil. Após dois anos, 743 adolescentes foram acompanhados (taxa de resposta: 65,5%). Dados clínicos, socioeconômicos e de QVRSB foram coletados. A QVRSB foi avaliada pela versão brasileira curta do Child Perceptions Questionnaire 11-14 (CPQ11-14) e o sangramento gengival foi coletado através do Índice Periodontal Comunitário. Gengivite foi considerada com o indivíduo apresentando 15% ou mais locais de sangramento. Os modelos de regressão de Poisson foram utilizados para avaliar a associação entre gengivite e os escores total e específico do domínio do CPQ11-14. A prevalência de gengivite na primeira avaliação foi considerada o preditor principal para a QVRSB no acompanhamento. Resultados: A gengivite no baseline foi associada à maior pontuação geral do CPQ 11-14 (RR = 1,07; IC95% 1,01 - 1,14) e ao domínio de bem-estar emocional (RR = 1,17; IC95% 1,04 - 1,31), independentemente das outras condições orais e variáveis socioeconômicas. Conclusão: Os achados indicam que a gengivite impacta negativamente a QVRSB de adolescentes. Além disso, sexo, escolaridade materna e renda familiar mensal também foram associados à QVRSB.

Effectiveness of the Mangifera indica L. extract in patients with edematous and fibroedematous chronic gingivitis

Introducción: Las enfermedades periodontales son las afecciones más comunes del género humano y se definen como una reacción inmunoinflamatoria crónica del periodonto de protección o de inserción. Objetivo: Evaluar la eficacia del extracto acuoso tópico de Mangifera indica L. como colutorio en pacientes con gingivitis crónica edematosa y fibroedematosa. Métodos: Se realizó un estudio de intervención terapéutica en 84 pacientes con gingivitis crónica edematosa y fibroedematosa, atendidos en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde noviembre de 2014 hasta igual mes de 2015. La muestra se dividió en 2 grupos (de estudio y control) de 42 integrantes cada uno, tratados con extracto acuoso tópico de Mangifera indica L. y con solución acuosa de clorhexidina al 0,2 %, respectivamente. Los pacientes fueron evaluados al inicio, a los 7, a los 14 y a los 21 días de comenzado el tratamiento. Para la recolección de los datos se aplicó una encuesta y se emplearon las pruebas T de Student, la de homogeneidad y la de Ji al cuadrado para la diferencia de muestras, con p<0,05. Resultados: Predominaron el sexo femenino, el grupo etario de 15-19 años y la gingivitis leve. En el grupo control solo 38,0 % había curado a los 7 días de tratamiento. Conclusiones: El extracto acuoso tópico de la corteza de Mangifera indica L, fue efectivo en el tratamiento de los pacientes con gingivitis crónica edematosa y fibroedematosa y se demostró que por sus poderosas acciones ayuda a la rápida recuperación de los tejidos gingivales.

Introduction: Periodontal diseases are the most common affections of mankind and they are defined as a chronic immunoinflamatory reaction of the protection or insertion periodonto. Objective: To evaluate the effectiveness of the topic watery extract Mangifera indica L. as mouthwash in patients with edematous and fibroedematous chronic gingivitis. Methods: A study of therapeutic intervention was carried out in 84 patients with edematous and fibroedematous chronic gingivitis, assisted in Mártires del Moncada Teaching Provincial Stomatologic Clinic in Santiago de Cuba, from November, 2014 to the same month in 2015. The sample was divided in 2 groups (study and control) of 42 members each one, treated with topic watery extract of Mangifera indica L. and with watery solution of chlorhexidine at 0.2 %, respectively. The patients were evaluated at the beginning, at the 7, 14 and 21 days of having begun the treatment. A survey was applied for gathering the data and the Student T test, homogeneity test and the chi square test were used for the difference of samples, with p <0.05. Results: The female sex, 15-19 years age group and mild gingivitis prevailed. In the control group just 38.0 % got better at 7 days of treatment. Conclusions: The topic watery extract of Mangifera indica L. bark, was effective in the treatment of patients with edematous and fibroedematous chronic gingivitis and it was demonstrated that helps to the quick recovery of gingival tissues due to its powerful actions.

Utilidad del oleozón tópico en la gingivitis crónica fibroedematosa / Usefulness of topic Oleozón® in chronic fibro-edematous gingivitis

RESUMEN Introducción: La constante y diversa disponibilidad de nuevos fármacos, nos ofrece opciones alternativas de tratamiento. El oleozón tópico es un medicamento aun en experimento y validación de sus indicaciones. Existen suficientes evidencias de su efecto antimicrobiano y cicatrizante. Objetivo: evaluar la eficacia del oleozón tópico en el tratamiento de la gingivitis crónica fibroedematosa. Materiales y métodos: se realizó un estudio experimental y aleatorizado. El período de estudio fue de septiembre de 2015 a junio de 2017. Se tomó una muestra de 60 pacientes pertenecientes al municipio de Palmira, entre 18 y 35 años, con diagnóstico de gingivitis crónica fibroedematosa que acudieron a los servicios en el período comprendido, luego de cumplir los criterios de inclusión y consentimiento informado, se dividieron de forma aleatorizada simple en dos grupos: estudio y control. Se utilizaron métodos del nivel teórico, histórico- lógico, documental en la revisión bibliográfica y teórica del tema de investigación, inducción - deducción para el análisis de los propósitos y pasos lógicos de la investigación. Resultados: a pesar de no encontrar diferencias significativas entre los grupos de pacientes tratados con oleozón tópico y clohexidina, recomendamos su inclusión en las Guías Prácticas de Estomatología, como tratamiento alternativo de la gingivitis crónica fibroedematosa. Conclusiones: no se encontraron diferencias significativas respecto a la eficacia del oleozón tópico y clohexidina en el tratamiento de la gingivitis crónica fibroedematosa, ambos tratamientos fueron resolutivos por igual en la mayoría de los casos.

ABSTRACT Introduction: the constant and diverse availability of new drugs offers alternative options of treatment. The topic Oleozón® is a drug that is still being tested and validated. There are evidences enough of its antimicrobial and healing effect. Objective: to evaluate the efficacy of topic Oleozón® in the treatment of chronic fibro-edematous gingivitis. Material and method: an experimental randomized study was carried out. The studied period was September 2015-June 2017. The sample were 60 patients living in the municipality of Palmira, aged 18-35 years old, with diagnosis of chronic fibro-edematous gingivitis who assisted the dental services in the before mentioned period and fulfilled the inclusion criteria and gave their informed consent. They were randomly divided into two groups: the study and the control groups. There were used methods of the theoretic, logic-historical and documental level in the bibliographic and theoretical review of the research theme, the induction-deduction method for the analyses of the purposes and logical steps of the research. Results: although there were not found significant differences between the groups of patients treated with topic Oleozón® and clorhexidine, the authors recommend their inclusion in Guias Prácticas de Estomatología as an alternative treatment of the chronic fibro-edematous gingivitis. Conclusions: there were not found significant differences between the groups of patients treated with topic Oleozón® and clorhexidine in the treatment of chronic fibro-edematous gingivitis; both treatments were decisive at the same level in most of the cases.

Impact of smoking on gingival inflammation in representative samples of three South American cities

Abstract The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

Impacto do tratamento periodontal não cirúrgico nos níveis de biomarcadores do metabolismo ósseo na saliva / Non-surgical periodontal treatment impact on biomarkers levels of bone metabolism in saliva

O objetivo foi avaliar o efeito do tratamento periodontal não cirúrgico, após 1 ano, na expressão salivar dos marcadores do metabolismo ósseo: TNF-α, SOST, PTH, OPG, OPN, OC, Leptina, IL-6, IL-1ß e FGF-23; em pacientes com periodontite crônica generalizada. Participaram deste estudo 15 pacientes com periodontite crônica generalizada (idade média 56,0  DP 9,6 anos). Quinze pacientes com gengivite (idade média 39,7  DP 4,4 anos) foram utilizados como controles. Foram utilizados os seguintes parâmetros clínicos: profundidade de bolsa à sondagem (PBS); nível de inserção clínica (NIC); índice de placa visível (IPV); índice de sangramento gengival (ISG) e índice de sangramento à sondagem (ISS). Foi realizada a coleta de saliva não estimulada (1ml) e congelada à -70°C para posterior análise. Os pacientes de ambos os grupos receberam tratamento periodontal não cirúrgico. Todos os dados foram coletados em 3 visitas no grupo com periodontite (baseline, 6 meses e 1 ano); e em 2 visitas no grupo com gengivite (baseline e 1 ano). Os biomarcadores foram mensurados por meio de um imunoensaio multiplex. No grupo com periodontite, houve redução significativa dos parâmetros % PBS ≥ 6 (p<0,001) e % NIC ≥ 5 (p<0,001), nas visitas 6 meses e 1 ano. Para os dados clínicos do grupo com gengivite, houve diminuição significativa após 1 ano para: % placa (p=0,001), % sangramento marginal (p=0,001), % sangramento sondagem (p=0,001), PBS (média pac.) (p=0,020) e NIC (média pac.) (p=0,001). Após o tratamento no grupo com periodontite, observou-se redução significativa da IL-1ß, IL-6, Leptina e TNF-α, entre a visita baseline e 6 meses (p=0,006; p=0,050; p=0,047; p= 0,014; respectivamente). Entre o baseline e 1 ano, houve diferença significante para a IL-1ß (p=0,010) e OPG (p=0,050). Já a IL-6 e OPG, mostraram uma tendência a redução após 1 ano (p=0,074; p=0,063; respectivamente). No grupo com gengivite, não foram observadas diferenças significativas entre as visitas baseline e 1 ano para todos os biomarcadores. No grupo com periodontite, na visita 1 ano, observamos correlação negativa significativa da OPG com % sangramento sondagem ( τ-b = -0,524 / p=0,006); no grupo com gengivite, na visita baseline, observamos correlação positiva significativa da IL-6 com % placa (τ-b= 0,548 / p= 0,005). Já na visita 1 ano, a Leptina passou a se correlacionar de forma mais forte com % placa (τ-b=0,624 / p=0,010) e com % sangramento marginal (τ-b=0,751 / p= 0,001). Concluindo, a terapia periodontal não cirúrgica levou a uma melhora significativa dos parâmetros clínicos periodontais associada à uma redução significante nos níveis de TNF-α, Leptina e IL-1ß; e uma tendência à redução dos biomarcadores OPG e IL-6. Após 1 ano, verificamos que os níveis dos biomarcadores do grupo com periodontite se aproximaram aos valores do grupo com gengivite, sugerindo que o tratamento periodontal foi capaz de equalizar a resposta imunológica.

The aim of this study was to evaluate the effect of non-surgical periodontal therapy, after 1 year, on the salivar expression of bone metabolism markers: TNF-α, SOST, PTH, OPG, OPN, OC, Leptin, IL-6, IL-1ß and FGF-23; in patients with generalized chronic periodontitis. Fifteen patients with generalized chronic periodontitis (mean age 56.0 ± SD 9.6 years) were included in this study. Fifteen patients with gingivitis (mean age 39.7 ± SD 4.4 years) were used as controls. Clinical evaluation parameters including probing pocket depth (PD), clinical attachment level (CAL), visible plaque index (VPI), gingival index bleeding (GI) and bleeding on probing (BOP) were used. Non-stimulated whole saliva was collected (1ml) and frozen at -70°C for further analysis. Patients from both groups received non-surgical periodontal treatment. All data were collected in 3 visits in the group with periodontitis (baseline, 6 months and 1 year); and in 2 visits in the group with gingivitis (baseline and 1 year). The biomarkers expression were evaluated through multiplex technology. In the group with periodontitis, there was a significant reduction of the parameters % PD ≥ 6 (p <0,001) and % CAL ≥ 5 (p <0,001), at 6 months and 1 year visits. For the clinical data of the group with gingivitis, there was a significant decrease after 1 year for: plaque (p=0,001), sulcus bleeding (p=0,001), bleeding on probing (p=0,001), PD (p=0,020) and CAL (p=0,001). After treatment in the group with periodontitis, a significant reduction of IL-1ß, IL-6, Leptin and TNF-α was observed between baseline and 6 months visit (p=0,006; p=0,050; p=0,047; p=0,014; respectively). Between baseline and 1 year, there was significant difference for IL-1ß (p=0,010) and OPG (p=0,050). On the other hand, IL-6 and OPG showed a tendency to decrease after 1 year (p=0,074; p=0,063; respectively). In the group with gingivitis, no significant differences were observed between the baseline visits and 1 year for all biomarkers. In the group with periodontitis, at the 1-year visit, we observed a significant negative correlation of OPG with bleeding on probing (τ-b=-0,524 / p=0,006); in the group with gingivitis, at the baseline visit, we observed a significant positive correlation of IL-6 with plaque (τ-b=0,548 / p=0,005). At the 1-year visit, Leptin correlated more strongly with plaque (τ-b=0,624 / p=0,010) and with sulcus bleeding (τ-b=0,751 / p=0,001). In conclusion, non-surgical periodontal therapy led to a significant improvement in periodontal clinical parameters associated with a significant reduction in levels of TNF-α, Leptin and IL-1ß; the OPG and IL-6 showed a tendency to reduce. After 1 year, we observed that the biomarkers levels in the group with periodontitis approximate the values of the group with gingivitis, suggesting that the periodontal treatment was able to equalize the immune response.

Occurrence and predictors of gingivitis and supragingival calculus in a population of Brazilian adults

Abstract: The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by ∼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.

Manifestaciones clínicas de la enfermedad periodontal en gestantes de un área de salud en Pinar del Río / Clinical signs of periodontal disease in pregnant women of a health area in Pinar del Río

Se realizó un estudio observacional, descriptivo, de corte transversal, de 63 embarazadas que acudieron a la Clínica Estomatológica Docente Ormani Arenado Llonch de Pinar del Río, de enero a julio de 2015, a fin de caracterizarles y determinar la manifestación de algunas enfermedades periodontales (gingivitis crónica edematosa, gingivitis crónica fibroedematosa y estomatitis aftosa) en ellas. En la investigación se obtuvo una preponderancia del grupo etario de 21-26 años (32,0 por ciento), cuyas pacientes estuvieron mayormente afectadas por estomatitis aftosa (34,4 por ciento), y como principales factores de riesgo figuraron la dieta cariogénica (79,4 por ciento) y la mala higiene bucal (71,4 por ciento). De igual modo, resultaron más frecuentes el cálculo dental (71,4 por ciento) y el dolor (66,7 por ciento) entre los síntomas y signos de las enfermedades periodontales, con predominio del último en todas las gestantes que presentaban estomatitis aftosa

An observational, descriptive, cross-sectional study, of 63 pregnant women, that went to Ormani Arenado Llonch Teaching Stomatological Clinic was carried out in Pinar del Río, from January to July, 2015, in order to characterize them and determine the manifestation of some periodontal diseases (chronic edematous gingivitis, chronic fibroedematous gingivitis and aphthous stomatitis). In the investigation there was a prevalence of the 21-26 age group (32.0 percent) whose patients were mostly affected by aphthous stomatitis (34.4 percent), and as main risk factors we can mention the cariogenic diet (79.4%) and poor oral hygiene (71.4 percent). Likewise, dental calculus (71.4 percent) and pain (66.7 percent) were more frequent among the symptoms and signs of periodontal diseases, with prevalence of the latter in all the pregnant women that presented aphthous stomatitis

Caracterización clinicoepidemiológica de pacientes especiales con gingivitis crónica / Clinical and epidemiological characterization of special patients with chronic gingivitis

Se realizó un estudio descriptivo y transversal de 59 pacientes especiales con gingivitis crónica, atendidos en el Policlínico Docente Julián Grimau García de Santiago de Cuba, desde marzo de 2016 hasta enero de 2017, con vistas a caracterizarles según variables clínicas y epidemiológicas de interés. Entre los resultados principales prevalecieron el sexo masculino (72,9 por ciento), el grupo etario de 10-14 años (64,4 por ciento), la primaria terminada como nivel escolar (40,7 por ciento), así como la higiene bucal deficiente (81,3 por ciento) como factor de riesgo; entre estos últimos, la mayoría presentaron gingivitis crónica edematosa (79,2 por ciento) e inflamación severa (76,2 por ciento). La práctica inadecuada del cepillado dental, dada por la incapacidad intelectual de este tipo de paciente, favoreció la aparición de esta enfermedad.

A descriptive and cross-sectional study of 59 special patients with chronic gingivitis, assisted in Julián Grimau García Teaching Polyclinic was carried out in Santiago de Cuba, from March, 2016 to January, 2017, aimed at characterizing them according to clinical and epidemiologic variables of interest. Among the main results, there was a prevalence of the male sex (72.9 percen), 10-14 age group (64.4 percen), primary school level (40.7 percent), as well as the inadequate oral hygiene (81.3 percen) as risk factor; among the latter, most of them presented chronic edematous gingivitis (79.2 percen) and severe inflammation (76.2 percen). The inadequate practice of dental brushing, due to the intellectual incapacity of this type of patient, favored the emergence of this disease.

Enfermedades gingivales en niños y adolescentes: primera parte / Gingival diseases in children and adolescents: first part

Las características de los tejidos gingivales y periodontales son diferentes en niños y adolescentes. La clasificación actual de enfermedades gingivales incluye a las gingivitis producidas por el biofilm y a las no producidas por el biofilm de placa. Las gingivitis son reversibles. Las condiciones de riesgo individuales, de origen externo o de origen sistémico, influyen en el agravamiento. La prevención de la gingivitis está enfocada en el control de los factores de riesgo.

Las enfermedades periodontales como enfermedades crónicas no transmisibles: cambios en los paradigmas / Periodontal disease as a chronic non transmissible diseases: paradigm shift

Las enfermedades periodontales (gingivitis y periodontitis) son un problema de salud pública debido a su alta prevalencia, su impacto en la calidad de vida y los altos costos que implica su tratamiento. Sus principales factores e indicadores de riesgo son compartidos con las enfermedades crónicas no transmisibles (ECNT). Además, la presencia de enfermedad periodontal en un paciente con ECNT puede contribuir a su exacerbación y/o desarrollo, a través de diversos mecanismos patogénicos, y el tratamiento de la condición periodontal genera una reducción de la inflamación sistémica. Debido a lo anterior, las enfermedades periodontales deben considerarse como una ECNT, y se debe trabajar en la creación, desarrollo e implementación de medidas de promoción de la salud y de prevención de ellas y participar activamente de las propuestas ya emanadas desde aquellas ECNT que tienen como objetivo a los mismos indicadores/factores de riesgo de las enfermedades periodontales.

Periodontal diseases (gingivitis and periodontitis) are a public health problem. They are highly prevalent, they affect life quality and their treament is expensive. Their principal risk factors and indicators are shared with chronic non transsmisible diseases (NTCD). Also, the presence of periodontal disease could exacerbate or initiate the development of a NTCD. Furthemore, Periodontal treatment results in systemic inflammation reduction. According to above explained, periodontal diseases should be considered as NTCD. It is highly advisible to focus on development, building and its implementation of periodontal prevention practices and communications. Moreover, it is advisible to participate in NTCD prevention programs, which targets same periodontal diseases risk factors and indicators.

Uso de sessões múltiplas de terapia fotodinâmica antimicrobiana como adjuvante ao retratamento de gengivite crônica em paciente com alto nível de estresse / Use of multiple sessions of antimicrobial photodynamic therapy as an adjunct to the re-treatment of chronic gingivitis in patients with high stress levels ­ a case report

O objetivo desse relato de caso foi abordar o uso de sessões múltiplas de terapia fotodinâmica antimicrobiana (TFD) como adjuvante ao tratamento periodontal convencional. Paciente com 23 anos, leucoderma, compareceu à clínica de Periodontia da FOB/USP com a queixa de halitose e sangramento espontâneo, com profundidade de sondagem (PS) de 2-3 mm e sangramento a sondagem (SS) em 90% dos sítios. A paciente já havia realizado tratamento periodontal, porém, sem sucesso. Durante a anamnese, constatou-se boa instrução de higiene bucal pela paciente, sem alteração sistêmica, porém, sob forte estresse psicológico (estudante de concurso). Foi realizada a remoção do biofilme dentário por meios mecânicos e, concomitantemente, aplicada a terapia fotodinâmica antimicrobiana (TFDa). Para a TFDa, foi utilizado o corante azul de metileno a 50 µ g/ml e laser vermelho, com comprimento de onda de 660 nm. O corante ficou três minutos em pré-irradiação e, em seguida, a ponteira do laser foi posicionada na embocadura do sulco gengival, sendo ativados três pontos por vestibular e por palatino, com uma dose final de 6 J de energia por dente. Tal procedimento foi repetido após quatro, sete e 14 dias. Após um mês, verificou-se a melhora de todos os parâmetros periodontais, com redução da PS (1-2 mm) e do SS para 15% dos sítios. Portanto, a TFD mostrou-se viável como um meio adjuvante ao tratamento da gengivite crônica em paciente com episódios recorrentes e sem resposta aos tratamentos anteriores.

This case report aims at addressing the use of multiple antimicrobial photodynamic therapy (aPDT) sessions, as an adjunct to conventional periodontal treatment. A 23 years-old Caucasian patient was referred to the Periodontics Clinic of FOB/USP, with the complaint of halitosis and spontaneous bleeding with probing depth (PD) of 2-3 mm and bleeding on probing (BOP) in 90% of the sites. The patient had already undergone periodontal treatment, with no success. The anamnesis showed that she had good oral hygiene instructions, with no systemic change, however, presenting severe psychological stress (public service exams and testing), and being monitored but a psychologist. The dental biofilm was removed mechanically and the antimicrobial photodynamic therapy (aPDT) applied concomitantly. Methylene blue dye at 50 µ g/ml and red laser with a 660 nm wavelength were used for aPDT. The dye was kept 3 minutes in pre-irradiation and then the laser tip was positioned at gingival sulcus, three points being activated buccally and palatally, with a final dose of 6 J energy per tooth. This procedure was repeated after 4, 7 and 14 days. Improvement of all periodontal parameters was seen after a month, with a reduction of PD (1-2 mm) and BOP in 15% of the sites. Therefore, aPDT showed to be feasible as an adjunct means in the treatment of chronic gingivitis in patients with recurrent episodes, unresponsiv e to previous treatments.

Avaliação do perfil periodontal dos pacientes atendidos na Faculdade de Odontologia da Unievangélica / Periodontal assessment profile of patients treated in the College of Dentistry UniEVANGÉLICA / Periodontal assessment profile of patients treated in the College of Dentistry UniEVANGÉLICA

INTRODUÇÃO: A Doença Periodontal é caracterizada por uma doença infecciosa resultante da inflamação dos tecidos de suporte e do tecido de revestimento dos dentes. Esta pode ser classificada em: gengivite quando compromete o periodonto de proteção e periodontite que acomete os tecidos de inserção. OBJETIVO: Este estudo teve como objetivo verificar o perfil periodontal dos pacientes atendidos na Faculdade de Odontologia da UniEVANGÉLICA, Anápolis- GO. MATERIAL E MÉTODO: Esta pesquisa documental descritiva retrospectiva avaliou prontuários de pacientes atendidos na clínica da Faculdade de Odontologia da UniEVANGÉLICA no período de 2009 a 2014. Nos prontuários foram analisados principalmente o Registro Periodontal Simplificado (PSR), a classificação da doença periodontal e o periograma dos pacientes que apresentaram periodontite. RESULTADOS: Dentre os 233 prontuários, 68% (n = 158) eram mulheres, 33,05% (n = 77) tinham entre 40 e 50 anos e 21% (n = 51) eram fumantes. Destes, 55 % (n = 129) possuíam gengivite e 45% (n=104) periodontite. Dos pacientes com periodontite, a Crônica Localizada foi constatada em 48% (n = 50), a Crônica Generalizada em 40% (n = 42), enquanto as Agressivas Localizada e Generalizada foram encontradas em 7% (n = 7) e 5% (n = 5) respectivamente. Pelos dados do PSR, pode-se observar que 49% (n = 114) apresentaram o código asterisco. CONCLUSÃO: De acordo com os resultados obtidos nesta pesquisa, pode-se notar uma prevalência de pacientes do gênero feminino e a gengivite foi a doença periodontal mais prevalente seguida pela periodontite crônica localizada.

INTRODUCTION: The Periodontal Disease is characterized by an infectious disease resulted from the inflammation of covering tissues (gingivitis) and/or of the support tissue (periodontitis) of teeth. OBJECTIVE: The objective of this study was to verify the periodontal profile of the patients attended at UniEVANGÉLICA'S Dental School. MATERIAL AND METHOD: This is a descriptive documental and retrospective research that evaluated the records of the patients that were attended at UniEvangélica's Dental School clinic from 2009 to 2014. The Periodontal Screening and Record (PSR), the periodontal disease's classification and the periodontal chart of the patients that presented periodontitis were the main analysis performed from the records. RESULTS: Among the 233 records, 68% (n=158) were women, 33,05% (n=77) among 40 to 50 years old and 21% (n=51) were smokers. Among these, 55% (n=129) presented gingivitis, from the patients with periodontitis, 48% (n=50) were diagnosed with the Localized Chronic periodontitis, 40% (n=42) with the Generalized Chronic, while 7% (n=7) and 5% (n=5) had the Aggressive Localized and the Generalized Periodontitis, respectively. Through the PSR data, it was noticed that 49% (n=114) presented the asterisk code. CONCLUSION: According to the results of this research, a female prevalence could be noticed and the gingivitis was the most prevalent periodontal disease, followed by the Localized Chronic Periodontitis

Gingivitis and oral health-related quality of life: a systematic literature review / Gengivite e qualidade de vida relacionada à saúde bucal: uma revisão sistemática da literatura

O objetivo deste estudo foi revisar sistematicamente a literatura sobre a relação entre gengivite e qualidade de vida relacionada à saúde bucal (QVRSB). Material e Métodos: Bases de dados relevantes foram utilizadas para busca de artigos em Inglês, publicados entre Outubro de 1990 a Fevereiro de 2014. Dois examinadores independentes selecionaram os artigos relevantes, avaliando inicialmente os resumos e posteriormente os artigos completos. Os estudos selecionados foram agrupados de acordo com os intrumentos clínicos e de QVRSB e foram submetidos à análise qualitativa. Resultados: Das 184 referências, dez foram selecionadas para análise. Todos os estudos eram transversais e reportavam dados de quatro países: Índia (n = 1), Brasil (n = 3), Tailândia (n = 5) e Sudão (n = 1). O número e idade dos sujeitos avaliados variaram de 53 a 1874 e de oito a 106 anos, respectivamente. Os seguintes instrumentos de QVRSB foram utilizados: Oral Health Impact Profile (OHIP-14), Child Perceptions Questionnaire (CPQ), Oral Impacts on Daily Performance (OIDP), Child-OIDP e Geriatric Oral Health Assessment Index (GOHAI). Os diferentes métodos para avaliar a presença de gengivite foram: Índice Gengival (n = 2), Índice Periodontal Comunitário (n = 7) e sangramento gengival após escovação dentária (n = 1). Conclusão: A presente revisão sistemática da literatura sugere que a gengivite está associada com o comprometimento da QVRSB...

The aim of this study was to review systematically the literature about the relationship between gingivitis and oral health-related quality of life (OHRQoL). Material and Methods: Relevant databases were searched for articles in English, which had been published from October 1990 to February 2014. Two independent examiners selected relevant papers, by initially assessing the abstracts and subsequently the full-text articles. Selected studies were grouped based on clinical and OHRQoL instruments and submitted to qualitative analyses. Results: Out of 184 references, ten were eligible for synthesis. All studies were cross-sectional and reported data from the following four different countries: India (n = 1), Brazil (n = 3), Thailand (n = 5) and Sudan (n = 1). The number and age of subjects included ranged from 53 to 1874 and from eight to 106 years, respectively. The following five OHRQoL instruments were used: Oral Health Impact Profile (OHIP-14), Child Perceptions Questionnaire (CPQ), Oral Impacts on Daily Performance (OIDP), Child-OIDP and Geriatric Oral Health Assessment Index (GOHAI). The different methods to evaluate the presence of gingivitis were: Gingival Index (n = 2), Community Periodontal Index (n = 7) and gingival bleeding after tooth brushing (n = 1). Conclusion: This systematic literature review suggests that gingivitis is associated with impairment of OHRQoL...

Avaliação da condição gengivalde escolares / Evaluation of the gingival condition of school children

Verificar a condição periodontal e fatores associados de crianças e adolescentes matriculados em escola pública e privada de Caruaru-PE. Material e Métodos: A amostra foi composta por 121 escolares, de ambos os sexos, na faixa etária de sete a catorze anos. Para a coleta de dados foram utilizados o índice gengival (IG) e o índice de placa (IP). Também foi aplicado um questionário aos pais e responsáveis para avaliação da renda familiar e da escolaridade materna. Foram aplicados o teste do qui-quadrado e/ou Exato de Fischer; t-Student e Anova (α<0,05). Resultados: A maioria dos escolares tinha entre sete e dez anos de idade (57,9%), era do sexo feminino (55,4%), de escola pública (61,2%), com renda familiar abaixo de um salário-mínimo (51,2%) cujas mães tinham menos de 12 anos de estudo (62,8%). A prevalência de gengivite e índice de placa não aceitável foi de 18,2% e 79,3%, respectivamente. Verificou-se associação significativa entre o índice gengival e mães sem instrução(p=0,025) . Com exceção da variável sexo, houve associação significativa entre o índice de placa e as demais variáveis (p<0,05). Conclusão: A maioria dos pesquisados não apresentou alterações gengivais e dentre os que apresentaram gengivite, a inflamação leve foi predominante. Faz-se necessário uma melhor atenção à saúde bucal no serviço público, bem como o aumento da informação aos pais, em especial aqueles em situação de deprivação social...

To verify the periodontal condition and associated factors of children and adolescents enrolled in public and private schools in Caruaru-PE. Materials and Methods: The sample consisted of 121 students of both sexes, aged from seven to fourteen years old. Data was collected according to the gingival index (GI) and the plaque index (PI). Parents were asked to answer a questionnaire in order to assess family income and maternal education. We applied the Chi-Square and / or Fisher's Exact, Student t test and ANOVA (α<0,05). Results: Of the 121 respondents, the majority (57.9%) was between seven and ten years old, were females (55.4%), from public school (61.2%), with family income lower than one minimum salary (51.2%), whose mothers had less than 12 years of education (62.8%). The prevalence of gingivitis and plaque index was not acceptable by 18.2% and 79.3%, respectively. There was a significant association between the gingival index and illiterate mothers(p=0,025). With the exception of gender, there was a significant association between the plaque index and the other variables (p <0.05). Conclusion: It's necessary to pay more attention to oral health in the public service, as well as to increase the amount of information given to parents, specially to those in situations of social deprivation...

Avaliação da associação entre os indicadores de saúde bucal, os aspectos socioeconômicos e crianças com sinais clínicos orofaciais indicativos de respiração oral crônica / Evaluation of the association between indicators of oral health and sociodemographic variables in children with orofacial clinical signs of chronic mouth breathing

Objetivo Avaliar se os indicadores clínicos de saúde bucal e sociodemográficos de crianças em idade escolar (8 a 12 anos), em fase de dentição mista, estão associados com a respiração oral. Métodos Foram avaliadas 55 crianças, selecionadas em uma escola estadual do município de Cachoeira do Sul (RS). Após a autorização dos responsáveis, foram realizados exames por uma fonoaudióloga treinada, para a identificação de crianças com sinais clínicos orofaciais, indicativos de respiração oral. Para a realização dos exames de saúde bucal, os estudantes de odontologia foram treinados e calibrados, de acordo com os critérios para levantamentos epidemiológicos da Organização Mundial de Saúde. Além dos exames intrabucais, foram coletadas informações socioeconômicas e demográficas com os responsáveis pelas crianças, por meio de um questionário. Resultados A prevalência de crianças com sinais de respiração oral foi relevante, porém, menor do que descreve a literatura. Não houve diferença entre os grupos (respiradores orais e respiradores nasais), tanto em relação às variáveis socioeconômicas, como em relação aos aspectos odontológicos testados. Conclusão Não houve associação da respiração oral com nenhum indicador clínico de saúde bucal (cárie, placa visível e sangramento gengival). Também não foi encontrada associação entre as variáveis sociodemográficas e a respiração oral. .

Purpose To evaluate whether clinical and sociodemographic indicators of oral health in school-age children (from 8 to 12 years) with mixed dentition are associated with oral breathing. Methods Fifity-five children selected from a public school in the city of Cachoeira do Sul (RS) were evaluated. After obtaining parental consent, a trained speech pathologist performed examinations to identify children with orofacial clinical signs indicative of oral breathing. For the oral health exams, dental students underwent training and calibration according to the criteria of the World Health Organization for epidemiological surveys. In addition to the intra-oral examinations, socioeconomic and demographic data were collected from the parents of the children using a questionnaire. Results Although the prevalence of children with mouth breathing symptoms was notable, it was lower than that reported in the literature. No difference was observed between the groups (mouth breathers and nose breathers) regarding socioeconomic variables associated with the tested dental aspects. Conclusion Oral breathing was not associated with clinical indicators of oral health such as caries, visible plaque, and gingival bleeding. Further, no association was found between sociodemographic variables and oral breathing. .

Doença periodontal em doenças reumáticas pediátricas / Periodontal disease in pediatric rheumatic diseases

Gengivite e periodontite são doenças periodontais imunoinflamatórias caracterizadas por infecções localizadas crônicas geralmente associadas a uma inflamação insidiosa. Essa revisão narrativa discute doenças periodontais e mecanismos que influenciam a resposta imune e a autoimunidade na área das doenças reumáticas pediátricas (DRP), particularmente a artrite idiopática juvenil (AIJ), lúpus eritematoso sistêmico juvenil (LESJ) e dermatomiosite juvenil (DMJ). Foi notada maior frequência de gengivite nessas doenças em comparação com controles sadios, enquanto casos de periodontite foram achados raros. Em pacientes com AIJ, a gengivite e a periodontite estavam relacionadas a fatores mecânicos, artrite crônica com incapacitação funcional, desregulação da resposta imunoinflamatória, dieta e medicamentos, principalmente corticosteroides e ciclosporina. Em pacientes com LESJ, a gengivite estava associada a períodos mais longos da doença, doses elevadas de corticosteroides, hiperativação dos linfócitos B e elevação da imunoglobulina G. São escassos os dados sobre doenças periodontais na população com DMJ; nos pacientes ativos, foi observado um padrão gengival singular, caracterizado por eritema gengival, dilatação dos capilares e formação arbustiforme. Em conclusão, gengivite foi a doença periodontal mais comum em pacientes com DRP. A associação observada com a atividade da doença reforça a necessidade de futuros estudos, com o intuito de determinar se a resolução dessa complicação irá influenciar o curso ou a gravidade da doença.

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation. This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.