Efectividad de antimicrobianos en el tratamiento del raspado y alisado radicular en el adulto mayor / Effectiveness of antimicrobials in the treatment of scaling and root planing in the elderly

RESUMEN Introducción: La terapia antimicrobiana después del raspado y alisado radicular en el anciano no ha sido evaluada en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba. Objetivo: Evaluar la efectividad de la tetraciclina y azitromicina en el tratamiento del raspado y alisado radicular en el adulto mayor. Método: Estudio cuasiexperimental de intervención terapéutica, realizado entre 2018-2019, en 30 pacientes con 60 y más años y con diagnóstico de periodontitis crónica. Se crearon tres grupos con 10 casos mediante el método aleatorio simple. El Grupo 1 tratado con la técnica convencional y los Grupos 2 y 3, después de la técnica, se aplicó una concentración subgingival de tetraciclina y azitromicina respectivamente y la colocación de cemento quirúrgico por siete días. Se emplearon variables como edad, sexo, cuadro clínico, evolución de signos y síntomas al séptimo día, 1 y 3 meses, y efectividad de curación. La validación estadística fue a través de la prueba Chi-cuadrado, con un 95 % de confiabilidad y la efectividad antimicrobiana, mediante el Análisis de Varianza ANOVA. Resultados: Predominio del grupo 65-69 años y sexo femenino, persistencia de inflamación gingival en el 30,0 % del Grupo 1 al tercer mes, disminuyó la profundidad al sondaje y hubo ganancia de inserción clínica, mejorando sus medias en el tiempo. Se logró un 100,0 % de efectividad de curación en los Grupos 2 y 3. Conclusiones: Elevada efectividad de la aplicación tópica subgingival de tetraciclina y azitromicina con cemento quirúrgico, sobre aquellos tratados con raspado y alisado radicular convencional.

ABSTRACT Introduction: Antimicrobial therapy after scaling and root planing treatment in the elderly has not been evaluated at the "Mártires del Moncada" Provincial Teaching Stomatology Clinic in Santiago de Cuba. Objective: To evaluate the effectiveness of tetracycline and azithromycin in the treatment of scaling and root planing in the elderly. Method: Quasi-experimental study of therapeutic intervention, carried out between 2018 and 2019, on 30 patients with the age of 60 and over and diagnosed with chronic periodontitis. Three groups with 10 cases were created using the simple randomized method. Group 1 treated with the conventional technique and groups 2 and 3, after using the same technique, a subgingival concentration of tetracycline and azithromycin was applied respectively and surgical cement placement for 7 days. Variables such as age, sex, clinical picture, evolution of signs and symptoms at the seventh day, 1 and 3 months, and healing effectiveness were used. The statistical validation was through the Chi-square test, with a 95% reliability and the antimicrobial effectiveness, through the Analysis of Variance ANOVA. Results: Predominance of the group age between 65 and 69 years and female sex, persistent gingival inflammation in 30,0 % of group 1 at the third month, decreased the depth of the catheterization and there was a clinical insertion gain, improving their averages in time. A 100.0% healing effectiveness was achieved in groups 2 and 3. Conclusions: High effectiveness of subgingival topical application of tetracycline and azithromycin with surgical cement, over patients treated with conventional scaling and root planing.

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Relação entre a gravidade clínica do paciente e as horas de cuidados de enfermagem em um serviço hospitalar de emergência / Relations between the severity of patients' clinical situations and the time spent in nursing care in an emergency hospital service

O aumento no número de atendimentos nos serviços hospitalares de urgência e emergência (SHE) resulta em superlotação desses serviços, afetando o resultado do tratamento dos pacientes e contribuindo para aumento da mortalidade. Este estudo objetivou avaliar a relação entre a gravidade clínica dos pacientes internados em um SHE e as horas de cuidados dos profissionais de enfermagem. Trata-se de um estudo de abordagem quantitativa, do tipo retrospectiva e correlacional, realizado no pronto socorro adulto (PSA) do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro em Minas Gerais (HC-UFTM) no qual foram analisados os prontuários dos pacientes internados no PSA entre os meses de janeiro a dezembro de 2017. Para avaliação da gravidade clínica foi utilizado o Acute Physiology and Chronic Health Evaluation II (APACHE II) e para avaliação das horas de cuidados de enfermagem foi utilizado o Nursing Activities Score (NAS), além disso, foi utilizado um formulário para coleta das variáveis sociodemográficas e clínicas. Foram incluídos 338 prontuários de pacientes. Os resultados mostraram mais óbitos entre os pacientes com idade mais elevada (65,3%) e nos pacientes do sexo feminino (63,3%). A maioria dos pacientes era proveniente das cidades de referência da Macrorregião Triângulo Sul (42,3%) e grande parte dos pacientes entraram no SHE por vaga zero (75,1%). Ainda, verificou-se que os diagnósticos mais frequentes no momento da admissão foram o IAM (22,2%), AVC (20,1%) e TCE (7,1%). A classificação de risco predominante entre os pacientes que internaram no SHE foi a cor laranja (68,6%), no entanto, observou-se a associação entre a classificação vermelha e a ocorrência de óbito. Em relação à gravidade clínica, a média do APACHE II para amostra foi 13,4 (DP=10,2), sendo maior nos pacientes que foram a óbito 22,0 (DP=10,0) do que nos pacientes que tiveram alta 11,3 (DP=9,1). A pontuação obtida no NAS para a amostra foi 46,9 (DP=30,3), sugerindo 11,2 horas de cuidados de enfermagem para cada paciente. A pontuação do NAS foi maior nos pacientes que foram a óbito 56,9 (DP=12,1) do que nos pacientes que tiveram alta 44,5 (DP=32,8). Foi observada correlação fraca entre o APACHE II e o NAS. Este estudo mostrou que os pacientes internados no PSA do HC-UFTM apresentam quadro clínico grave e necessitam de muitas horas de cuidados de enfermagem

The increased number of patients in urgency and emergency hospital services (EHS) leads to an overload of these services, affecting the result of patient treatment and contributing to an increased mortality. This study aimed at evaluating the relation between the severity of the clinical situation of the patients hospitalized in an EHS and the time spent by nursing professionals treating these patients. This is a quantitative study, a correlational retrospective conducted in the adult medical center (PSA) of the General Hospital at the Universidade Federal do Triângulo Mineiro, in Minas Gerais (GH-UFTMK). The study analyzed the records of patients hospitalized in the PSA from January to December 2017. The Acute Physiology and Chronic Health Evaluation II (APACHE II) was used to evaluate the clinical severity of the conditions of the patients, and the Nursing Activities Score (NAS) was used to evaluate the time under nursing care. In addition, a form was used to collect sociodemographic and clinical variables. The investigation included 338 patient records. The results showed a higher number of deaths among older (65.3%) and female (63.3%) patients. Most of them were from the cities that are references of the Macro-region Triângulo Sul (42.3%), and a high number of patients entered in the EHS through the zero vacancy method, that is, were admitted due to an emergency, despite the lack of vacancies in the hospital (75.1%). Additionally, the most commonly performed diagnoses in the moment of patient arrival were AMI (22.2%), Stroke (20.1%), and TBI (7.1%). The most common risk classification among patients entering in the EHS was orange (68.6%), while the red classification was associated to death. Regarding the clinical severity of the cases, the APACHE II mean for the sample was 13.4 (SD=10.2). The result was higher among patients who died, 22.0 (SD=10.0), than among those who were discharged 11.3 (SD=9.1). The score of the NAS in the sample was 46.9 (DP=30.3), suggesting that 11.2 hours of nursing care were needed for each patient. The NAS score was higher among patients who did not survive, 56.9 (SD=12.1) than among those who were discharged, 44.5 (SD=32.8). A weak correlation was found between APACHE II and NAS. This study showed that patients hospitalized in the GH-UFTM PSA have severe clinical conditions and require many hours of nursing care

Work-Related Flow Inventory: Evidence of Validity of the Brazilian Version / Inventário de Flow no Trabalho: Evidências de Validade da Versão Brasileira / Inventario de Flow en Trabajo: Evidencia de Validez de la Versión Brasileña

Abstract Flow in work is constituted by the positive experiences and mental state experienced during the day-to-day occupational activities. This study aims to adapt and assess the psychometric properties of the Brazilian Version of the Work Related Flow Inventory (WOLF). Participants were a nationwide sample of 640 professional (74% women), aged 19 to 73 years (M = 35.9, SD = 10.5). Confirmatory factor analyses (CFA) supported the oblique three-factor structure (absorption, work enjoyment and intrinsic work motivation) as being the most reliable to the data. Multigroup CFA achieved full measurement invariance for the gender and employment status (autonomous and non-autonomous). Flow dimensions were positively related to occupational self-efficacy and job satisfaction. WOLF presented adequate psychometric properties, suggesting its usefulness in evaluating flow at work in the Brazilian context.

Resumo Flow no trabalho constitui-se pelas experiências positivas e estado mental vivenciados durante as atividades ocupacionais do dia a dia. Este estudo tem como objetivo adaptar e avaliar as propriedades psicométricas da versão Brasileira do Inventário de Flow no Trabalho (WOLF). Os participantes desta pesquisa foram uma amostra nacional de 640 profissionais (74% mulheres), idades entre 19 a 73 anos (M = 35,9, DP = 10,5). A análise fatorial confirmatória (AFC) evidenciou a estrutura de três fatores oblíquos (absorção, envolvimento e motivação intrínseca) como a mais adequada aos dados. A AFC Multigrupo demonstrou a invariância da escala para sexo e situação de trabalho (autônomo e não-autônomo). As dimensões de flow estiveram positivamente relacionadas à autoeficácia ocupacional e satisfação no trabalho. WOLF apresentou propriedades psicométricas satisfatórias, sugerindo a sua utilidade para avaliar flow no contexto brasileiro.

Resumen El flow en trabajo comprende una experiencia positiva y estado mental que pueden ocurrir durante las actividades laborales. Este estudio pretende adaptar y evaluar las propiedades psicométricas de la versión brasilera del Inventario de Flow en trabajo (WOLF). Los participantes fueron una muestra nacional de 640 profesionales (74% mujeres) con edades entre 19 a 73 años (M = 35,9, DE = 10,5). El análisis factorial confirmatorio (AFC) respaldó que la estructura oblicua de tres factores (absorción, implicación y motivación intrínseca) es la más confiable. El AFC multigrupo alcanzó invariancia de medida completa para sexo y status de empleo (autónomo y no autónomo). Las dimensiones del flow se relacionaron positivamente con autoeficacia ocupacional y satisfacción laboral. El WOLF presentó propiedades psicométricas adecuadas, lo que sugiere su utilidad en evaluar flow en el contexto brasilero.

Comparison of full-mouth scaling and quadrant-wise scaling in the treatment of adult chronic periodontitis

Abstract In the search for the ideal treatment of periodontal disease various non-surgical techniques should be considered. The objective of this study was to evaluate the efficacy of full-mouth scaling (FMS) by clinical and microbiological parameters. 670 individuals were evaluated with 230 subjects meeting the selection criteria and were divided into two groups; 115 subjects treated with FMS and 115 treated with weekly sessions of scaling and root planning (SRP). The patient population had a mean age of 51.67 years, with moderate chronic periodontitis. Subjects were evaluated prior to treatment (T1) and 90 days after execution of therapy (T2), with regards to: probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and microbial detection for the presence of Porphyromonas gingivalis (P.g.) and Prevotella intermedia (P.i.) by culture method and confirmed by biochemical tests. Subjects treated in the FMS group also rinsed with 0.12% chlorhexidine mouthwash for seven days following treatment. The results were analyzed using statistical Student's t-test and chi-square test. No statistically significant differences were observed for PD and CAL between T1 and T2 in both groups. For GI and PI significant difference was observed between the groups. For the evaluated microbial parameters was observed reduction of P.g. and P.i., but only for P.g. with a significant reduction in both groups. The full mouth scaling technique with the methodology used in this study provided improved clinical conditions and reduction of P.g. in subjects with moderate periodontitis, optimizing the time spent in the therapeutic execution.

Resumo Na busca do tratamento ideal da doença periodontal varias são técnicas não-cirúrgicas que podem ser consideradas. O objetivo deste estudo foi avaliar a eficácia da técnica de desinfecção total de boca (FMD, na sigla em Inglês) por parâmetros clínicos e microbiológicos. Foram avaliados 670 indivíduos com 230 indivíduos atendendo aos critérios de seleção e divididos em dois grupos; 115 indivíduos tratados com FMD e 115 tratados com sessões semanais de raspagem e alisamento corono radicular (SRP, na sigla em Inglês). A população avaliada tinha idade média de 51,67 anos, com periodontite crônica moderada. Os sujeitos foram avaliados antes do tratamento (T1) e 90 dias após a execução da terapia (T2), quanto à profundidade de sondagem (PS), nível de inserção clínica (NIC), índice de placa (IP), índice gengival (IG) e detecção microbiana da presença de Porphyromonas gingivalis (P.g.) e Prevotella intermedia (P.i.) por método de cultura e confirmada por testes bioquímicos. Os indivíduos tratados no grupo FMD também realizaram bochechos com clorexidina 0,12% durante sete dias após o tratamento. Os resultados foram analisados ​​utilizando o teste estatístico t de Student e o teste de qui-quadrado. Não foram observadas diferenças estatisticamente significativas para PS e NIC entre T1 e T2 em ambos os grupos. Para IG e IP observou-se diferença significativa entre os grupos. Para os parâmetros microbianos avaliados foi observada redução de P.g. e P.i., mas apenas para P.g. com uma redução significativa em ambos os grupos. A técnica FMD com a metodologia utilizada neste estudo proporcionou condições clínicas melhoradas e redução da P.g. Em indivíduos com periodontite moderada, otimizando o tempo gasto na execução terapêutica.

Relationships between Pleasant Events, Depression, Functionality and Socio-demographic Variables in the Elderly / Relações entre Atividades Prazerosas, Depressão, Funcionalidade e Variáveis Sociodemográficas em Idosos / Relaciones entre las Actividades Placenteras, Depresión, Funcionalidad y Variables Sociodemográficas en Ancianos

Abstract Involving the elderly in pleasant activities plays an important role in the prevention and treatment of depression. In addition to the influence of mental health benefits, the frequency of involvement in pleasant activities is also affected by the level of functional dependence and socioeconomic conditions of the elderly. The objective of this study was to investigate relationships between scores of the Brazilian version of an instrument to evaluate the involvement of the elderly in pleasant events (OPPES-BR) and depressive symptoms, functional dependence and socio-demographic variables, to verify the external validity of the OPPES-BR. The sample consisted of 337 non-institutionalized elderly individuals without cognitive impairments, who completed the Beck Depression Inventory, Pfeffer's Functional Activities Questionnaire, Brazil's Economic Classification Criterion and the OPPES-BR. The frequency of involvement in potentially pleasant activities was negatively correlated with depressive symptoms, functional dependence and less favorable socio-demographic conditions, suggesting evidence for the external validity of the OPPES-BR.

Resumo O envolvimento de idosos em atividades agradáveis desempenha importante papel na prevenção e tratamento da depressão. Além da influência da saúde mental, a frequência de envolvimento em atividades agradáveis é afetada pelo nível de dependência funcional e pelas condições socioeconômicas dos idosos. O objetivo deste estudo foi investigar relações entre os escores da versão brasileira de um instrumento para avaliar o envolvimento de idosos em atividades prazerosas (OPPES-BR) e sintomas depressivos, dependência funcional e variáveis sociodemográficas, com o propósito de verificar evidências de validade externa do OPPES-BR. A amostra foi composta por 337 idosos não-institucionalizados e sem comprometimento cognitivo. Foram aplicados o Inventário de Depressão de Beck, a Escala de Atividades Instrumentais da Vida Diária de Pfeffer, o Critério de Classificação Econômica Brasil e o OPPES-BR. A frequência de envolvimento em atividades potencialmente agradáveis apresentou correlações negativas com sintomas depressivos, dependência funcional e condições sociodemográficas menos favoráveis, sugerindo evidências de validade externa do OPPES-BR.

Resumen La participación de los ancianos en actividades agradables desempeña un importante papel en la prevención y el tratamiento de la depresión. La frecuencia de participación en actividades agradables también se ve afectada por el nivel de dependencia funcional y las condiciones socioeconómicas de los ancianos. El objetivo de este estudio fue investigar relaciones entre los escores de la versión brasileña de un instrumento para evaluar la participación de ancianos en actividades placenteras (OPPES-BR) y síntomas depresivos, dependencia funcional y variables sociodemográficas, además de verificar evidencias de validez externa del OPPES BR. La muestra fue compuesta por 337 ancianos no institucionalizados y sin compromiso cognitivo. Fueron aplicados el Inventario de Depresión de Beck, la Escala de Actividades Instrumentales de la Vida Diaria de Pfeffer, el Criterio de Clasificación Económica Brasil y el OPPES-BR. La frecuencia de participación en actividades potencialmente agradables presentó correlaciones negativas con síntomas depresivos, dependencia funcional y condiciones sociodemográficas menos favorables, sugiriendo evidencias de validez externa del OPPES-BR.

Eficacia de la azitromicina asociada al raspado y alisado radicular en periodontitis crónica / Efficacy of azithromycin associated with scaling and root planing in chronic periodontitis

RESUMEN: Objetivo: evaluar la eficacia de la azitromicina asociada al RAR asociada al (raspado y alisado radicular) en pacientes con periodontitis crónica. Material y método: El presente ensayo clínico paralelo aleatorizado, controlado y triple ciego, se desarrolló en la Clínica Estomatológica de la Universidad Católica Los Ángeles de Chimbote (Trujillo, Perú), entre marzo y diciembre de 2015. Participaron 30 pacientes adultos, distribuidos aleatoriamente en 2 grupos, designados con las letras A y B, de 15 integrantes cada uno. Cada paciente fue evaluado periodontalmente antes de realizarle el raspado y alisado radicular y optimización de las técnicas de higiene. A los pacientes del grupo A se les indicó tratamiento antibiótico con Azitromicina 500 mg por vía oral cada 24 horas durante 3 días y al grupo B se les indicó un placebo con las mismas características físicas del antibiótico escogido. Los pacientes fueron evaluados a los 3, 4 y 5 meses. La eficacia fue evaluada mediante el test T de Student para comparación de medias, considerando un nivel de significancia para los valores de p<0,05. Resultados: Se encontró que ambos grupos lograron mejorar la profundidad de sondaje y el nivel de inserción clínica sin embargo no presentaron diferencias estadísticamente significativas entre ellos. Conclusión: La azitromicina asociada al RAR no es eficaz como terapia coadyuvante en pacientes con periodontitis crónica.

ABSTRACT: Objective: To evaluate the efficacy of azithromycin associated with the RAR (scaling and root planing) in patients with chronic periodontitis. Material and Methods: This clinical trial parallel randomized, controlled, triple blind, was developed in the Stomatology Clinic of the Catholic University Los Angeles of Chimbote (Trujillo, Peru), between March and December 2015. The participants were 30 adult patients randomized 2 groups, designated by the letters A and B of 15 members each. Each patient was evaluated periodontally before Give you the scaling and root planing and optimization hygiene techniques. Patients in group A, were prescribed antibiotic treatment with azithromycin 500 mg orally every 24 hours for 3 days. While, group B were prescribed a placebo with the same physical characteristics of the antibiotic chosen. Patients were evaluated at 3, 4 and 5 months. The efficacy was evaluated using the Student t test to compare means, considering a level of significance for the values of p <0.05. Results: It was found that both groups were able to improve probing depth and clinical attachment level however no statistically significant differences between them. Conclusion: Azithromycin associated with the RAR is not effective as adjunctive therapy in patients with chronic periodontitis.

Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis

Abstract The aim of this study was to perform a systematic review and meta-analysis to examine the effect of systemic antibiotics in the periodontal treatment of smokers. The selection criteria were as follows: controlled randomized clinical trials; studies published in English; studies with smoker patients diagnosed with chronic periodontitis; patients without systemic diseases; studies that used systemic antibiotic therapy associated with periodontal treatment; studies that presented results for the test and control groups and assessments of clinical periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). The differences in average weights were calculated with a confidence interval (CI) of 95% for PD reduction, CAL gain and BOP. The means of the periodontal clinical parameters were compared between the baseline and post-treatment periods between the test groups and the control groups. The heterogeneity was assessed using the Cochran Q test (Q (df = 3), α = 5%). A total of 67 articles were found, and after the selection process, three randomized controlled trials were included in the meta-analysis. The results indicate that SRP associated with systemic antibiotics promoted additional benefits when compared to SRP alone, with a greater reduction of PD (p = 0.0359, CI = -0.42, -0.01) and a gain of CAL (p = 0.0161, CI = -0.39, -0.04). There was a modest PD reduction (PD, DM -0.21) and a modest CAL gain (CAL, DM -0.22). The results of our meta-analysis reveal the clinical benefits of systemic antibiotics as an adjunct to the non-surgical periodontal treatment of smokers. These clinical improvements, although statistically significant, appeared to be of little clinical relevance.

Efecto clínico del uso de probiótico en el tratamiento de la periodontitis crónica: ensayo clínico / Clinical effect of probiotic in treatment of chronic periodontitis: clinical trial

Objetivo El objetivo de este ensayo clínico aleatorizado, doble ciego, de brazos paralelos y controlado por placebo fue evaluar el efecto clínico del consumo de Lactobacillus rhamnosus SP1 en un polvo de disolución oral, adicional a la terapia periodontal no quirúrgica. Material y método Cuarenta y nueve sujetos fueron examinados para participar en este estudio. Veintiocho participantes sistémicamente sanos, con diagnóstico de periodontitis crónica, fueron reclutados y monitorizados clínicamente en el tiempo basal, 3 y 6 meses después de la terapia periodontal. Los parámetros clínicos registrados fueron presencia de placa, sangrado al sondaje, profundidad al sondaje y pérdida de inserción clínica. Todos recibieron terapia periodontal no quirúrgica, incluyendo pulido y alisado radicular (PAR), y fueron asignados aleatoriamente al grupo experimental (PAR + probiótico, n = 14) o control (PAR + placebo, n = 14). Luego de la última sesión de PAR debieron ingerir un sobre con polvo de disolución oral de Lactobacillus rhamnosus SP1 o placebo, una vez al día durante 3 meses. Resultados Ambos grupos mejoraron sus parámetros clínicos en todos los tiempos evaluados. Además, el grupo experimental redujo significativamente el porcentaje de sitios, dientes y número de participantes con profundidad al sondaje ≥ 5 mm entre el tiempo basal y los 6 meses postratamiento. Conclusiones La administración oral de L. rhamnosus SP1 asociado a la terapia periodontal genera similares mejorías en los parámetros clínicos comparado con solo usar terapia periodontal en el tratamiento de la periodontitis crónica en adultos.

Objective The aim of this double- blind, placebo- controlled parallel- arm, randomised clinical trial was to evaluate the clinical effects of a sachet of Lactobacillus rhamnosus SP1-containing probiotic as an adjunct to non-surgical therapy. Material and method Fourty- nine subjects were screened for their elegibility to participate in this study. Twenty-eight systemically healthy volunteers with chronic periodontitis were enrolled and monitored clinically at baseline, and at 3 and 6 months after therapy. Clinical parameters measured included plaque index, bleeding on probing, pocket probing depths (PPD), and clinical attachment loss. Patients received non-surgical therapy including scaling and root planing (SRP), and were randomly assigned to a test (SRP + probiotic, n = 14) or control (SRP + placebo, n = 14) group. The administration of a sachet of Lactobacillus rhamnosus SP1 probiotic once a day for 3 months commenced after the last session of SRP. Results Both test and control groups showed improvements in clinical parameters at all time points evaluated. Furthermore, at initial visits and after 6 months follow-up, the test group showed a statistically significant reduction in percentage of sites, teeth, and number of participants with PPD ≥ 5 mm. Conclusions The results of this trial indicate that oral administration of L. rhamnosus SP1 sachets during initial therapy resulted in similar clinical improvements compared to SRP alone.

Phenytoin-Induced Gingival Overgrowth Management with Periodontal Treatment

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

O crescimento gengival induzido pela fenitoína é uma complicação comum do uso contínuo da medicacão. Este artigo apresenta um caso de crescimento gengival excessivo que dificultava a função oral e comprometia a higiene oral e a estética, o qual foi tratado com uma combinação de terapias periodontais não-cirúrgicas e cirúrgicas. Paciente masculino de 39 anos de idade foi encaminhado para tratamento odontológico com várias queixas, especialmente do crescimento gengival superior e inferior que prejudicava a fala e deglutição. Profundidades de sondagens severas generalizadas e perda óssea foram detectadas. Diagnóstico de crescimento gengival induzido pela fenitoína e periodontite crônica foi estabelecido. O plano de tratamento consistiu de terapia conservadora com educação, motivação e meticulosa instrução de higiene oral em associação com raspagem e alisamento corono-radicular. Durante o período de reavaliação, uma acentuada redução nos parâmentros clínicos foi observada, principalmente uma redução das profundidades de sondagem. Terapia cirúrgica para remoção do excesso de tecido gengival também foi realizada para conseguir redução das bolsas. Terapia periodontal de suporte foi proposta e o paciente está atualmente sob acompanhamento por um período de 4 anos. O manejo do crescimento gengival induzido pela fenitoína pode ser obtido pelo uso de procedimentos periodontais combinados com uma boa higiene oral e cuidados periodontais de suporte.

Avaliação clínica e microbiológica das técnicas de full mouth disinfection e raspagem e alisamento radicular associadas à azitromicina ou clorexidina no tratamento da periodontite crônica: ensaio clínico controlado randomizado / Clinical and microbiological analysis of full mouth disinfection and scaling and root planing per quadrant techniques associated with chlorhexidine or azithromycin in the treatment of chronic periodontitis: randomized controlled trial

O tratamento não cirúrgico da doença periodontal inclui a realização de procedimentos de instrução de higiene oral e a raspagem e alisamento radicular por quadrantes (RAR). Com a finalidade de prevenir a rápida recolonização das bolsas periodontais por bactérias presentes em outros sítios intraorais, foi proposta a técnica de one stage full-mouth disinfection (FMD). De acordo com essa técnica as raspagens de todos os hemi-arcos são realizadas em 24 horas associadas à realização da descontaminação de tonsilas, mucosas, bolsas e língua com diferentes concentrações e formas de apresentação da clorexidina. Estudos revelaram dados controversos sobre a efetividade da técnica FMD, questionaram a necessidade de uso da clorexidina e, em adição propuseram o uso adjuvante de antibióticos. Neste sentido, a justificativa deste é a necessidade de estudos controlados que comparem a técnica FMD com a RAR, com as diferentes variações que podem ser aplicadas a ambos, analisando o seu impacto nos parâmetros periodontais clínicos e microbiológicos. Assim, o objetivo deste estudo foi avaliar, por meio de ensaio clínico controlado randomizado, a efetividade da técnica FMD e sua associação com clorexidina ou azitromicina em relação à RAR associada à clorexidina e azitromicina sob uma perspectiva clínica (avaliação da profundidade de sondagem, nível clínico de inserção, índice gengival e índice de placa) e microbiana (quantificação da carga bacteriana total e das seguintes bactérias: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola e Streptococcus oralis, por meio de PCR em tempo real, nos períodos de 90 e 180 dias após o tratamento). No presente ensaio clínico controlado randomizado foram avaliados 77 indivíduos divididos em 6 grupos: FMD-CX (raspagem e alisamento radicular de todos os dentes em 24 h associada à clorexidina para desinfecção de bolsas, tonsilas e mucosa ­ n= 15), FMD (raspagem e alisamento radicular de todos os dentes em 24 h ­ n=10), FMD-AZ (raspagem e alisamento radicular de todos os dentes em 24 h + azitromicina ­ n=15), RAR-AZ (raspagem e alisamento radicular por quadrante em intervalos semanais + azitromicina ­ n=11), RAR-CX (raspagem e alisamento radicular por quadrante, em intervalos semanais + clorexidina ­ n=13), RAR (raspagem e alisamento radicular, por quadrantes, em intervalos semanais ­ n=13). Os parâmetros clínicos foram analisados estatisticamente pelo teste de análise de variância (ANOVA) baseado em um planejamento para medidas repetidas e teste de comparações múltiplas de médias. A carga bacteriana total e das bactérias foi avaliada intragrupo (Teste de Friedman) e intergrupos (Teste de Kruskal Wallis). O grupo FMD-CX mostrou maior redução da profundidade de sondagem e ganho do nível clínico de inserção que os demais. Além disso, esse grupo mostrou redução de carga para quatro das cinco bactérias avaliadas: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus oralis, Treponema denticola, Tannerella forsythia. Os grupos que utilizaram azitromicina não mostraram melhores resultados clínicos e microbiológicos. Pode-se concluir que a utilização da clorexidina nos grupos FMD-CX e RAR-CX mostrou melhores resultados clínicos e microbiológicos. Por outro lado, a utilização da azitromicina não apresentou melhorias nesses parâmetros

The non-surgical treatment of periodontal disease involves performing procedures of oral hygiene instruction and scaling and root planing per quadrant (SRP). This therapeutic approach aims to prevent rapid recolonization of bacteria in periodontal pockets in other intraoral sites, the technique of one stage full -mouth disinfection (FMD) is proposed. According to this technique the scalings of all hemi - arches are made within 24 hours associated with performing the decontamination of tonsils, mucosa, periodontal pockets and tongue with different concentrations and forms of presentation of chlorhexidine. Studies over the years have revealed controversial data on the effectiveness of the technique FMD, questioned the need to use chlorhexidine, and proposed adding the adjuvant use of antibiotics. In this sense, the justification of this research is the need for further controlled studies comparing the FMD technique with conventional quadrant scaling with differnt variations that can be applied to both, analyzing their impact on clinical and microbiological periodontal parameters. The objective of this study was to evaluate through a randomized controlled trial the effectiveness of the technique one stage full -mouth disinfection and its association with chlorhexidine or azithromycin compared to scaling and root planing per quadrant associated with chlorhexidine and azithromycin under a clinical perspective (evaluation of probing depth, clinical attachment level , gingival index and plaque index ) and microbial (assessment of the total bacterial load and the following bacteria : Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola and Streptococcus oralis) through of real-time PCR , in periods of 90 and 180 days after treatment. In the present randomized controlled trial evaluated 77 individuals were divided into 6 groups : FMD-CX (scaling and root planing of all teeth in 24 associated with chlorhexidine for disinfection pockets, tonsils and mucosa - n = 15 ) , FMD ( scaling and root planing of all teeth in 24 hours- n = 10 ) , FMD- AZ (scaling and root planing of all teeth in 24 hours + azithromycin - n = 15 ) , RAR - AZ ( scaling and root planing per quadrant at weekly intervals + azithromycinn = 11 ) , RAR - CX ( scaling and root planing per quadrant at weekly intervals + chlorhexidine - n = 13 ) , RAR ( scaling and root planing per quadrants at weekly intervals - n = 13 ) . The clinical parameters were statistically analyzed by analysis of variance (ANOVA) based on a planning for repeated measures and multiple comparisons of means test. The total bacterial load and bacteria was evaluated intragroup (Friedman test) and between groups (Kruskal Wallis). The FMD- CX group showed greater reduction in probing depth and gain in clinical attachment level than the others. Moreover, this group showed reduced load for four of five surveyed bacterias: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus oralis, Treponema denticola, Tannerella forsythia. Groups using azithromycin did not show improved clinical and microbiological outcomes. It can be concluded that the use of chlorhexidine groups FMD-CX and RAR-CX showed the best clinical and microbiological results. On the other hand, the use of azithromycin did not show improvements in these parameters

Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease

This study investigated the effect of non-surgical periodontal therapy on the composition of subgingival microbiota of patients with chronic kidney disease (CKD). Sixteen CKD pre-dialysis individuals (CKD) and 14 individuals without clinical evidence of kidney disease (C) presenting chronic periodontitis were treated by scaling and root planing. Subgingival samples were collected from each patient and analyzed for their composition by checkerboard at baseline and 3 months post-therapy. Significant differences between groups at baseline were sought by the Mann-Whitney and χ² tests. Changes over time were examined by the Wilcoxon test. At baseline, the CKD group had significantly lower counts of E. faecalis compared to the C group (p < 0.05). After treatment, the levels of a greater number of species were reduced in the C group. Higher levels of A. israelii, C. rectus, F. periodonticum, P. micra, P. nigrescens, T. forsythia, N. mucosa, and S. anginosus (p < 0.05) were found in the CKD group compared to the C group. Also, non-responsive sites in CKD individuals harbored significantly higher levels of pathogenic species (T. forsythia, P. gingivalis, T. denticola, Fusobacterium spp., D. pneumosintes, E. faecalis and S. aureus; p < 0.05) than sites that responded to therapy, as well as non-responsive sites in the C group. The periodontitis-associated subgingival microbiota of CKD and systemically healthy individuals was similar in composition. However, high levels of pathogenic species persisted in the subgingival microbiota of patients with CKD after treatment.

Periodontite ulcerativa necrosante: relato de caso, diagnóstico, tratamento e um ano de acompanhamento / Necrotizing ulcerative periodontitis: case report-diagnoses, treatment and one year follow-up

As doenças periodontais necrosantes (DPNs) são as formas mais graves de doença periodontal causada pela placa bacteriana. Nas DPNs, as bactérias são mais agressivas do que as observadas em uma periodontite crônica e, quando associadas a uma saúde debilitada do indivíduo, causam um dano ainda maior ao periodonto. Por outro lado, as DPNs têm uma prevalência extremamente baixa na população, o que faz com que casos diagnosticados dessa doença devam ser documentados e divulgados, para contribuir para o conhecimento da mesma pelos profissionais de saúde. Dessa forma, o objetivo do presente trabalho é ilustrar, através de um caso clínico, as características clínicas de uma das DPNs e as etapas clínicas do tratamento correspondente. Um indivíduo com 22 anos de idade compareceu à clínica odontológica para atendimento de urgência, apresentando como sinais e sintomas: febre, sangramento espontâneo, supuração, dor e halitose extrema. Clinicamente, apresentava na gengiva interproximal de diversos dentes ulcerações e necrose com ampla extensão, necrose e exposição de osso alveolar interproximal, e pobre higiene bucal. Radiograficamente, constataram-se perdas ósseas horizontais. O tratamento foi baseado no diagnóstico de periodontite ulcerativa necrosante. Noventa dias após o início do tratamento, foi realizada reavaliação periodontal, observando-se ausência de bolsas periodontais e permanência dos defeitos anatômicos produzidos pela inflamação. Após um ano do início do tratamento, observaram-se focos de placa bacteriana e cálculo supragengival, porém não foram observadas bolsas periodontais e sangramento à sondagem.

Necrotizing Periodontal Diseases (NPDs) are the most severe inflammatory periodontal disorders caused by plaque bacteria. In the NPDs the bacteria are more aggressive than those observed in chronic periodontitis and when combined with a poor health of the patient causing a further damage to the periodontium. On the other hand, the prevalence of NPD is extremely low in the population, however, diagnosed cases of this disease should be documented and disseminated to contribute to the knowledge by health professionals. The objective of this paper is to illustrate through a clinical case the clinical characteristics of one of the NPDs and the stages of its treatment. A 22-year-old patient attended in the dental clinic for urgent care presenting the following signs and symptoms: fever, spontaneous bleeding, suppuration, pain and extreme halitosis. Clinically, there were ulcerations and extensive necrosis in the interproximal gingiva of several teeth, exposure of interproximal alveolar bone and poor oral hygiene. In the radiograph it was found horizontal bone loss. The treatment realized was based on the diagnostic of Necrotizing Ulcerative Periodontitis. Ninety days after the treatment beginning it was performed a periodontal reevaluation, and there was absence of periodontal pockets, and anatomic defects produced by the inflammation were observed. After one year of the treatment beginning it was observed plaque and supragengival calculus, but pockets and bleeding on probing were not observed.

Effect of non-surgical periodontal treatment on chronic kidney disease patients

Chronic kidney disease (CKD) is a debilitating systemic condition. Our working hypothesis is that CKD predialysis patients with periodontitis would respond poorly to periodontal treatment owing to immunologic compromise. Twenty-one predialysis patients (group 1) and 19 individuals without clinical evidence of kidney disease (group 2) with chronic periodontitis were subjected to non-surgical periodontal treatment with no antibiotics. Clinical periodontal and systemic parameters were evaluated at baseline and 3 months after treatment. Both groups showed significant and similar post-treatment improvements in all periodontal parameters examined. Most interestingly, periodontal treatment had a statistically significant positive effect on the glomerular filtration rate of each individual (group 1, p = 0.04; group 2, p = 0.002). Our results indicate that chronic periodontitis in predialysis kidney disease patients improved similarly in patients with chronic periodontitis and no history of CKD after receiving non-surgical periodontal therapy. This study demonstrates that CKD predialysis patients show a good response to non-surgical periodontal treatment.

Validade e precisão do Questionário de Relacionamento Central 6.0 (CRQ 6.0) para adultos com hepatite C crônica / Validity and reliability of the Central Relationship Questionnaire 6.0 (CRQ 6.0) for adults suffering from Chronic Hepatitis C / Validez y fiabilidad de lo Cuestionario de Relación Central 6.0 (CRQ 6.0) para adultos con Hepatitis C Crónica

Portadores de hepatite C têm grande probabilidade de apresentar sintomas psicopatológicos e conflitos no relacionamento amoroso. Objetivou-se medir a precisão (consistência interna) e a validade (convergente e discriminante) do Questionário de Relacionamento Central 6.0 - CRQ 6.0, para adultos com hepatite C crônica. O CRQ 6.0, de autorrelato, avalia o padrão de relacionamento do indivíduo, segundo três componentes: Desejos (D), Respostas do Outro (RO), Respostas do Eu (RE). Participaram do estudo pacientes ambulatoriais com hepatite C crônica (G1, n = 61) e acompanhantes de pacientes (G2, n= 40). Todos responderam ao CRQ 6.0 e à Escala de Avaliação de Sintomas-40 (EAS-40). Os resultados indicaram consistência interna aceitável para os componentes do CRQ 6.0. Eles se correlacionaram significantemente com sintomas psicopatológicos pela EAS-40. Os escores do CRQ 6.0 foram significantemente mais elevados para participantes de G1, quando comparados aos de G2 (RO e RE), participantes sob medicação (RE) e mulheres (D e RE).

People suffering from chronic hepatitis C have great probability of presenting psychopathologic symptoms and difficulties on relationships with romantic partners. This study aimed to estimate the internal consistency, convergent validity and discriminant validity of the Central Relationship Questionnaire 6.0 (CRQ 6.0) for adults with chronic hepatitis C. The CRQ 6.0 is a self-report, developed to assesses the individuals relationship patterns according to three components: Wishes (W), Responses from Others (RO), Responses of Self (RS). Participants were patients with chronic hepatitis C (G1, n = 61) and persons who accompanied patients (G2, n = 40). They answered to the CRQ 6.0 and to the Symptoms Assessment Scale-40 (EAS-40). Results pointed to the acceptable internal consistency of the CRQ 6.0s components. They significantly correlated to psychopathological symptoms with EAS-40. Scores of the CRQ 6.0 were significantly higher for: participants of G1 (RO, RS), participants under medication (RS) and women (W, RS).

Personas con hepatitis C crónica presentan alta probabilidad de sufrir de síntomas psicopatológicos y conflictos en las relaciones amorosas. El estudio tuvo como objetivo obtener pruebas de fiabilidad (consistencia interna), validad convergente y validad discriminante de lo Cuestionario de Relación Central 6.0 (CRQ 6,0) para adultos con hepatitis C crónica. El CRQ 6.0, de auto-informe, evalúa el patrón de relación del individuo en tres dimensiones: Deseos (D) Respuestas del Otro (RO), Respuestas del Self (RS). Participaran pacientes con hepatitis crónica C (G1, n = 61) y acompañantes de pacientes (G2, n = 40). Todos han respondido al CRQ 6.0 y Escala de Evaluación de Síntomas-40 (EAS-40). El CRQ 6.0 mostró consistencia interna aceptable en sus componentes y correlaciones significantes con síntomas psicopatológicos pela EAS-40. Los escores de CRQ60 fueran significantemente más altos para: participantes de G1 (RO, RS), participantes que tomaban medicación (RS), y para mujeres (D y RS).

Avaliação do efeito do laser de Er: YAG no tratamento da doença periodontal crônica em humanos: análises clínica, imunológica e microbiológica / Effects of scaling and root planning with Er: YAG laser in chronic periodontitis: a controlled clinical, immune and microbiological human study

Introdução: O objetivo do presente estudo foi de comparar o efeito do laser de Er:YAG (100mJ/pulso, 10Hz, 12,9J/cm2), associado ou não, à raspagem e alisamento radicular (RAR), com a RAR sozinha no tratamento de pacientes com doença periodontal crônica, por meio de parâmetros clínicos, imunológico e microbiológico. Metodologia: Vinte e um pacientes apresentando 4 bolsas entre 5 e 9 mm, em sítios não vizinhos foram selecionados. Em um estudo de boca dividida, cada sítio foi randomizado e divididos nos grupos: 1)RARL - RAR e Laser; 2)L - Laser somente; 3)RAR - RAR somente e 4)C - sem tratamento algum. Os índices de placa (IP) e gengival (IG), sangramento à sondagem (SS), níveis de interleucina 1 Beta (IL-1β – pelo teste ELISA) e a presença de bactérias (Aa, Pg, Pi, Pn e Tf pela técnica PCR) foram avaliados no inicial 12, 30, 90 e 180 dias pós-tratamentos, enquanto profundidade de sondagem (PS), recessão gengival (RG) e nível de inserção (NI) foram avaliados antes, 30, 90 e 180 dias após os tratamentos. Análise estatística dos dados foi realizada (p<0,05) intra e inter grupos. Resultados: Doze dias após os tratamentos, IP reduziu para RARL e RAR (p<0,05); IG aumentou em L, RAR e C (p<0,05) e SS reduziu para RARL, L e RAR (p<0,05). Aos 30 dias, o IP reduziu RARL e RAR (p<0,05), o IG reduziu para RARL (p<0,05) e aumentou para C (p<0,05). Os grupos RARL, L e RAR apresentaram redução no SS e ainda, reduziram significantemente o SS quando comparados ao C (p<0,05). A PS reduziu para os grupos RARL, L e RAR (p<0,05), o NI aumentou para RAR (p<0,05) e RG aumentou para RARL e L (p<0,05). Após 90 dias, o IP reduziu para todos os grupos do estudo (p<0,05); o IG reduziu para o grupo RARL e RAR (p<0,05); o SS reduziu para todos os grupos do estudo (p<0,05). A PS reduziu para os grupos RARL, L e RAR (p<0,05), o NI aumentou para RARL, L e RAR (p<0,05) e RG aumentou para RARL e L (p<0,05).

Background: The Er:YAG laser has recently been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm2) with or without conventional scaling and root planing (SRP), versus SRP only for treatment of periodontal pockets affected with chronic periodontitis. Methods: Twenty-one patients, with pockets from 5 to 9 mm in non-adjacent sites, were studied. In a split-mouth design, each site was randomly allocated to a treatment group: 1) SRPL - SRP and laser; 2) L - laser only; 3) SRP - only SRP; 4) C - no treatment. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin-1 levels in crevicular fluid (IL-1β) were evaluated at baseline, 12, 30, 90 and 180 postoperatively, while probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline, 30, 90 e 180 days after treatment. Statistical analysis was conducted (p<0.05) inter and intra groups. Results: Twelve days postoperatively, PI decreased for SRPL and SRP (p<0,05); GI increased for L, SRP and C (p<0,05) and BOP reduces for SRPL, L and SRP (p<0,05). Thirty days after treatments, PI decreased for SRPL and SRP (p<0,05), GI decreased for SRPL (p<0,05) and increased for C (p<0,05). BOP decreased for SRPL, L and SRP groups and data showed BOP reduction when compared the C (p<0,05). Values of PD decreased in SRPL, L and SRP groups (p<0,05), CAL gain showed an improvement for SRP (p<0,05) and GR increased for SRPL and L (p<0,05). Ninety days postoperatively, PI decreased for all treated groups (p<0,05); GI reduced for SRPL and SRP (p<0,05); BOP decreased for all treated groups (p<0,05). Data of PD showed a reduction for SRPL, L and SRP groups (p<0,05); CAL gain was significant for SRPL, L and SRP groups (p<0,05); GR values increased for SRPL and L groups (p<0,05).