Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial

Abstract Objective: This study aims to evaluate the clinical and biochemical (oxidative stress and pro-inflammatory mediators) effects of the gaseous ozone use accompanied by scaling and root planning (SRP) in periodontal treatment. Material and Methods: The study population consisted of 40 patients with chronic periodontitis (CP) randomly sorted into two groups of 20. The experimental group received SRP plus 3 watts gaseous ozone in two separate applications five days apart, whereas the control group received SRP plus placebo. Clinical periodontal parameters were assayed and saliva samples were taken before the initial and one month after the second treatment. Periodontal examination assessed plaque index (PI), gingival index (GI), probing depth, and clinical attachment level (CAL). Total antioxidant status (TAS), total oxidant status (TOS), nitric oxide (NO), 8-hydroxy-2'-deoxyguanosine (8-OHdG), myeloperoxidase (MPO), glutathione (GSH), malondialdehyde (MDA), and transforming growth factor-beta (TGF-β) levels were evaluated from saliva samples. Results: Changes following treatment in PI, GI, probing depth, and CAL scores were similar for both groups (p>0.05). Of note, TGF-β levels were observed to be higher in the treatment group than in controls (p<0.05). Changes in 8-OHdG, TAS, TOS, NO, MPO, GSH and MDA levels, however, were not significantly different between groups (p>0.05). Conclusion: The findings of this study indicate that SRP plus gaseous ozone versus SRP alone does not correlate to a significant improvement in periodontal recovery.

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.

Measurement of oral health quality of life among patients who underwent haematopoietic stem-cell transplantation

Abstract Oral mucositis is a painful condition that occurs in patients who have undergone haematopoietic stem-cell transplantation (HSCT) and has a huge impact on their quality of life. The objective of this study was to examine the extent to which interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) are associated with oral health quality of life among patients who underwent HSCT. A. C. Camargo Cancer Center patients were evaluated over 20 months at 4 different time-points: a) at patient admission (M1); b) on the day of infusion of HSC (M2); c) 12 and 20 days after the first day of the conditioning regimen for autologous and allogeneic transplantation, respectively (M3); and d) 30 days after the first day of the conditioning regimen (M4). Mucositis clinical evaluations were performed using World Health Organization (WHO) criteria. Oral health quality of life was measured using the Oral Health Impact Profile short form (OHIP-14), Oral Mucositis Quality of Life (OMQoL) and Patient-Reported Oral Mucositis Symptom (PROMS) scales. Correlations between clinical data and quality of life scores were examined. STATA 11.0 was used to perform the statistical analyses (5% level of significance). Eighty-two patients participated in the study; 62.2% were male, 28.05% had multiple myeloma, and the mean age was 48.49 years (SD 13.76). Higher scores (worse quality of life) were observed as mucositis scores increased, but the results were not significant. The OMQoL had a high correlation with OHIP-14 (0.8377), but the correlation between the PROMS scale and the OHIP-14 was lower (0.6643). Higher concentrations of IL-6 and TNF-α were associated with worse quality of life, according to all indices (p < 0.05). Oral mucositis was associated with quality of life scores (p < 0.01).

Comparative study of oral and salivary parameters in patients with and without loss of bone mass

Abstract Osteoporosis is an insidious and increasingly prevalent disease that can cause fractures and affect patients' quality of life. The current study comparatively evaluates patients with and without loss of bone mass in terms of salivary calcium, viscosity, and pH. A controlled cross-sectional study was conducted in two groups of 32 postmenopausal women subjected to a bone densitometry scan and later referred for dental management at the Federal University of Minas Gerais, Brazil. The patients were assigned to two groups: Group 1 - patients with low bone mineral density (BMD) and Group 2 - patients without bone mineral changes. The following salivary parameters were evaluated: calcium concentration, flow rate, viscosity, pH, and average total protein. An oral examination was performed for assessment of DMFT variables and tongue coating. Data were analyzed using descriptive and inferential statistics, adopting a p-value < 0.05. The patients' mean age was 60 years (± 7.35). Salivary flow, pH, and viscosity were similar among the groups. Average total protein was 14.8 mg/mL and 19.0 mg/mL in Groups 1 and 2, respectively. Tongue coating and salivary calcium levels were significantly higher in Group 1 (p < 0.001). Salivary calcium is an important screening tool and may eventually be used for the diagnosis of bone mineral changes.

Impact of inhalation therapy on the incidence of carious lesions in patients with asthma and COPD

Abstract Objective: The aim of this study was to investigate the incidence of carious lesions, the amount of salivary flow rate and pH value in patients with asthma and chronic obstructive pulmonary diseases (COPD), using inhalation therapy. The obtained results were compared with the results of adult healthy subjects, forming a control group. Material and Methods: The study included 80 participants aging between 18 and 65 years. The experimental group (EG) was comprised of 40 participants, previously diagnosed with asthma or COPD undergoing inhalation therapy for more than five years. The control group (CG), comprised of 40 participants, mirrored the same age and gender status of the EG. Dental status was determined by decayed, missing, and filled teeth (DMFT index). Quantity and pH value of saliva were determined in the laboratory. Results: In the EG, the mean value of the salivary flow rate and pH value were statistically significantly lower than in the CG (p<0.001). Patients in the EG had a higher value of DMFT index when compared with the CG, although the difference was not statistically significant (p=0.199). Mean number of decayed teeth, as well as missing teeth, in the EG was statistically significantly higher than in the CG (p<0.001). Mean number of filled teeth in the EG was statistically significantly lower than in the CG (p<0.001). Conclusion: It was found that patients undergoing inhalation therapy face increasing risk of dental caries due to the lower salivary flow rate and pH value along with the inhalation therapy. They should receive intensive preventive care, including oral hygiene instruction and dietary advice.

Effects of periodontal treatment on primary sjogren's syndrome symptoms

Abstract The aim of this longitudinal prospective study was to evaluate the effects of periodontal treatment on the clinical, microbiological and immunological periodontal parameters, and on the systemic activity (ESSDAI) and subjective (ESSPRI) indexes in patients with primary Sjögren’s Syndrome (pSS). Twenty-eight female patients were divided into four groups: pSS patients with or without chronic periodontitis (SCP, SC, respectively), and systemically healthy patients with or without chronic periodontitis (CP, C, respectively). Periodontal clinical examination and immunological and microbiological sample collection were performed at baseline, 30 and 90 days after nonsurgical periodontal treatment (NSPT). Levels of interleukin IL-1β, IL-8 and IL-10 in saliva and gingival crevicular fluid (GCF) were evaluated by ELISA, as well as the expression of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans, (Aa) Tannerella forsythia (Tf), and Treponema denticola (Td), by qPCR. Systemic activity and pSS symptoms were evaluated by ESSDAI and ESSPRI. NSPT resulted in improved periodontal clinical parameters in both SCP and CP groups (p>0.05). Pg, Aa, and Tf levels decreased after NSPT only in CP patients (p<0.05). Significantly greater levels of IL-10 in GCF were verified in both SCP and CP groups (p<0.05). SCP patients showed increased salivary flow rates and decreased ESSPRI scores after NSPT. In conclusion, NSPT in pSS patients resulted in improved clinical and immunological parameters, with no significant effects on microbiological status. pSS patients also showed increased salivary flow and lower ESSPRI scores after therapy. Therefore, it can be suggested that NSPT may improve the quality of life of pSS patients.

Caries experience and salivary aspects in individuals with fragile X syndrome

Abstract Fragile X syndrome (FXS) is the most common cause of hereditary mental retardation, but studies on the oral health condition of these patients are rare. The aim of this study was to determine the experience of dental caries in individuals with FXS, by examining the saliva profile, oral hygiene, socioeconomic characteristics and use of controlled drugs in these patients. Dental health was estimated using the decayed, missing and filled teeth index (DMF-T) and sialometry, and the pH value and buffering capacity of the saliva, colony forming units of S. mutans (CFU/mL), visible biofilm index, and socioeconomic status were all examined. The sample, comprising 23 individuals, had an average age of 17.3 ± 5.6 years, a DMF-T index of 5.5, a diminished salivary flow (78.3%), and a low (73.9%) saliva buffering capacity. Most (52.2%) individuals presented with a high abundance (CFU/mL) of S. mutans. The experience of caries was correlated with salivary parameters, poor oral hygiene, lower socioeconomic status and an increased count of S. mutans in saliva.

Marcadores salivares para a periodontite crônica no diabético tipo 2 / Salivar markers for chronic periodontitis in diabetic type 2

Introdução: a periodontite crônica é a sexta doença infecciosa mais prevalente no mundo, seus fatores de risco são o aumento da idade, tabaco, fatores genéticos, obesidade e distúrbios sistêmicos como o diabetes. O diabetes é uma pandemia tanto em países desenvolvidos como em desenvolvimento, é uma doença complexa com graus variados de complicações sistêmicas e orais. Assim, é urgente a necessidade de um método fácil para detectá-la permitindo a intervenção antes da progressão da doença periodontal. Á análise de metabólitos da saliva tem sido proposta como uma ferramenta efetiva para o diagnóstico e tratamento periodontal. Objetivo: discorrer sobre alternativas de diagnóstico de periodontite crônica em pacientes diabéticos tipo 2 utilizando marcadores salivares. Metodologia: Foi realizada uma busca eletrônica no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), para a realização do referido levantamento, utilizou-se os descritores "Type 2 diabetes mellitus, chronic periodontitis, Biomarkers, Saliva". Resultados: a detecção precoce da periodontite crônica não é apenas vital para reduzir a sua gravidade e prevenir complicações, mas também crítico para aumentar a taxa de sucesso da terapia. Conclusão: a utilização de biomarcadores na medicina é uma realidade difundida e tem relação direta com a modernização dos meios de saúde, na odontologia vem se pleiteando seu uso, mas ainda necessita de maiores estudos e aperfeiçoamentos das técnicas já empregadas com o intuito de diminuir seus custos, aumentar especificidade e acesso dos profissionais de saúde.(AU)

Introduction: Chronic periodontitis is the sixth most prevalent infectious disease in the world. Its risk factors are increased age, tobacco, genetic factors, obesity, and systemic disorders such as diabetes. Diabetes is a pandemic in both developed and developing countries, it is a complex disease with varying degrees of systemic and oral complications. Thus, there is an urgent need for an easy method to detect it allowing intervention before the progression of periodontal disease. The analysis of saliva metabolites has been proposed as an effective tool for periodontal diagnosis and treatment. Objective: To discuss alternatives for diagnosis of chronic periodontitis in type 2 diabetic patients using salivary markers. Methodology: An electronic search was performed in the Portal of Periodicals of the Coordination of Improvement of Higher Level Personnel (CAPES). The descriptors "Type 2 diabetes mellitus, chronic periodontitis, Biomarkers, Saliva" were used to perform this survey. Results: early detection of chronic periodontitis is not only vital to reduce its severity and prevent complications, but also critical to increase the success rate of therapy. Conclusion: the use of biomarkers in medicine is a widespread reality and has a direct relationship with the modernization of health facilities. In dentistry, its use has been sought, but it still needs further studies and improvements of techniques already employed with the intention of reducing its Increase the specificity and access of health professionals.(AU)

Chemical salivary composition and its relationship with periodontal disease and dental calculus

Aim: To determine the relationship between the chemical composition of saliva, periodontal disease and dental calculus. Methods: An observational analytical cross-sectional study was conducted with patients over 55 years of age. Ethical principles of autonomy and risk protection were applied according to the international standards. Sociodemographic and diagnosis variables (presence of dental calculus and periodontal status) were considered to measure salivary concentrations of glucose (by the glucose oxidase/peroxidase method, amylase (by the colorimetric test), urea (by the amount of indophenol), total protein (by the Bradford method) and albumin (by the nephelometric method). Patients chewed a sterile rubber band and 3 mL of stimulated saliva were collected. The samples were stored at -5 °C, centrifuged at 2,800 rpm for 10 min, and the supernatant was removed and stored at -20 °C. Data were presented as frequencies and proportions for qualitative variables and measures of central tendency and dispersion for quantitative variables. Data were analyzed by either analysis of variance or Kruskal Wallis test . A p value <0.05 was considered statistically significant. Results: Significant relationships were observed between the concentration of salivary urea and periodontal status (p = 0.03) and the presence of dental calculus and urea (p = 0.04) was demonstrated. Conclusions: A relationship between the salivary urea concentration and the presence of periodontal disease and dental calculus is suggested.

Psoriasis severity and hypothalamic-pituitary-adrenal axis function: results from the CALIPSO study

Psoriasis is a chronic inflammatory disease that significantly impacts life quality, being associated with stress and mental disorders. We investigated whether the activity of the hypothalamic-pituitary-adrenal (HPA) axis was associated with psoriasis severity, daily life stress and anxiety, and depressive symptoms. In this ancillary study, which was part of the CALIPSO (coronary artery calcium in psoriasis) study, saliva was collected from 102 patients with psoriasis immediately upon awakening, 30, and 60 min after awakening, at 2:00 pm and at bedtime (five time points) to determine salivary cortisol levels. We used Pearson's correlation coefficient to evaluate the association of clinical and psychopathological variables with HPA activity. We found a direct correlation between bedtime cortisol and psoriasis severity evaluated by the psoriasis area severity index (PASI; r=0.39, P<0.001). No correlations between other clinical and psychopathological variables or with other cortisol assessments were observed. The findings indicated that HPA dysfunction may be present in psoriasis, as bedtime cortisol was correlated with psoriasis severity. Our study is limited by the lack of a control group; therefore, we were not able to explore whether these cortisol values were different compared with a concurrent, healthy sample.

Alkali production in the mouth and its relationship with certain patient's characteristics

Objectives To assess the relationships among alkali production, diet, oral health behaviors, and oral hygiene. Methods Data from 52 subjects including demographics, diet, and oral hygiene scores were analyzed against the level of arginine and urea enzymes in plaque and saliva samples. An oral habit survey was completed that included: use of tobacco (TB), alcohol (AH), sugary drinks (SD), and diet. Alkali production through arginine deiminase (ADS) and urease activities were measured in smooth-surface supragingival dental plaque and un stimulated saliva samples from all subjects. ADS and urease activities were measured by quantification of the ammonia generated from the incubation of plaque or saliva samples. Spearman correlations were used to compute all associations. Results Participants in the lowest SES (Socio-economic status) group had the habit of consuming sugary drinks the most and had the highest rate of tobacco use. Males consumed significantly more alcohol than females. No significant relationship was found between age or gender and alkali production. Higher rates of sugary drink consumption and tobacco use were significantly related to lower alkali production. Conclusion The study showed a relationship between alkali production and oral hygiene, diet, and certain oral health behaviors. Poor oral hygiene was significantly associated with age, lower SES, tobacco use, and alcohol, and sugary drinks consumption. Clinical relevance Certain oral health behaviors have an impact on oral hygiene and on alkali production; it is important to address these factors with patients as a strategy for caries control. .

Have drivers at alcohol outlets changed their behavior after the new traffic law?

Objective: In an attempt to reduce high levels of traffic crashes, a new legislation was approved in Brazil in 2008. This study aimed to assess behavioral change among drivers who had drunk at alcohol outlets (AO) after implementation of the law. Method: A three-stage probability sampling survey was conducted in Porto Alegre, state of Rio Grande do Sul, Brazil. Individuals seen leaving AOs after drinking were approached (n=3,018). Selected drivers (n=683) answered a structured interview, were breathalyzed, and had saliva specimens collected for drug screening. Results: Overall, 60.3% (SE 4.5) of drivers reported they did not change their behavior. Among those who reported behavioral changes, most reported drinking less as their main strategy toward safer driving behavior. Variables independently associated with behavior change included having drunk at a high outlet density area (odds ratio [OR] 1.7 [1.1-2.8]) and having a favorable opinion about the law (OR 4.3 [2.1-8.9]). Conclusions: Our findings suggest that awareness of the law has not been enough to promote behavioral change. As most drivers had a favorable opinion of the law and this variable was found to be the strongest predictor of behavior change, efforts to better integrate education and enforcement seem to be pivotal and might be well received by the population. .

Exame da cavidade bucal de pacientes com câncer: avaliação clínica e dosagem indireta de óxido nítrico / Examination of the oral cavities of patients with cancer: clinical evaluation and indirect measurement of the nitric oxide level / Examen de la cavidad oral de los pacientes con cáncer: evaluación clínica y medición indirecta de óxido nítrico

Neste estudo buscou-se verificar associação entre avaliação clínica da cavidade oral (pelos Índices de dentes Cariados,Perdidos e Obturados e Índice de Higiene Oral - Simplificado) e a determinação indireta de óxido nítrico em pacientes com patologias onco-hematológicas. Trata-se de estudo observacional, no qual foram incluídos vinte sujeitos internados, diagnosticados com Leucemia (35%), Linfoma (50%), Mieloma (15%), em avaliação para início de quimioterapia, sendo que 50% apresentaram normalidade da condição bucal (sem lesões ou traumas); a maioria apresentou higiene satisfatória (35%) ou regular (35%), porém, 30% tiveram higiene deficiente ou péssima. A expressão indireta do óxido nítrico variou de 13,34 a 257. O óxido nítrico não apresentou associação com os outros parâmetros; houve grande variabilidade de seus valores. Novos estudos são necessários, em especial pela potencialidade deste indicador na detecção precoce de alterações bucais.

This observational study aimed to verify the association between the clinical state of the oral cavity (based on the Index of Decayed, Missing, and Filled Teeth and the Simplified Oral Hygiene Index) and the indirectly determined nitric oxide level in patients with oncologic and hematologic diseases. This study included 20 hospitalized patients who were in the evaluation phase prior to starting chemotherapy and who had been diagnosed with leukemia (35%), lymphoma (50%) or myeloma (15%). Fifty percent of these patients had normal oral health (no injury or trauma), and most had satisfactory (35%) or typical (35%) hygiene, but 30% had poor or very poor hygiene. The indirectly measured levels of nitric oxide ranged from 13.34 to 257. The nitric oxide level was not associated with other parameters, and there was great variability in its level. Further studies are necessary given the potential of using this indicator in the early detection of oral diseases.

Este estudio observacional buscó verificar la asociación entre evaluación clínica de la cavidad oral (por medio de el índice de dientes cariados, perdidos y obturados y el índice de higiene oral simplificado) y la determinación indirecta de óxido nítrico en pacientes con enfermedades oncohematológicas. Estudio observacional, que incluyó a 20 pacientes hospitalizados, con diagnóstico de leucemia (35%), linfoma (50%), mieloma (15%), bajo evaluación para el inicio de la quimioterapia, de los cuales el 50% tenía salud bucal normal (sin lesión o trauma). La mayoría mostró higiene satisfactoria (35%) o regular (35%), pero el 30% tenía mala o muy mala higiene. La expresión indirecta del óxido nítrico varió de 13,34 hasta 257. El óxido nítrico no presentó asociación con otros parámetros, hubo gran variabilidad de los valores. Se necesitan más estudios, en particular, el potencial de este indicador para la detección precoz de las enfermedades bucodentales.

Avaliação dos impactos do trabalho em turnos noturnos na produção de citocinas inflamatórias salivares e na secreção dos hormônios rítmicos melatonina e cortisol / Effects of night work in salivary cytokine production and salivary melatonin and cortisol secretion

Introdução. Embora necessário ao desenvolvimento econômico e bastante disseminado na sociedade atual, o trabalho em turnos noturnos fixos contribui para consequências sociais negativas e prejuízos à saúde dos trabalhadores deste turno de trabalho. Objetivo. Investigar possíveis efeitos do trabalho em turnos fixos noturnos sobre o sono e biomarcadores hormonais e inflamatórios selecionados. Métodos. Estudo transversal em indústria de metais sanitários da cidade de São Paulo, de que participaram 17 trabalhadores do sexo masculino do turno noturno (das 21h às 6h) e 21 trabalhadores de um dos turnos diurnos (das 7h às 17 h). Dados sociodemográficos, de saúde e de condições de trabalho e sobre fadiga, sonolência, estresse e matutinidade-vespertinidade foram obtidos por questionário. O ciclo atividade/repouso foi avaliado por actimetria e por protocolo diário de atividades durante 10 dias consecutivos, abrangendo ao menos um ciclo de turnos completo. Amostras de saliva coletadas em momentos diferentes durante três dias de trabalho foram analisadas por ELISA para determinação das concentrações dos cinco biomarcadores. Todos os dados obtidos foram então submetidos às análises matemáticas e estatísticas mais adequadas a cada caso. Resultados. O trabalho noturno foi associado a uma diminuição na secreção da melatonina e a alterações em seu ritmo de secreção. Foram observadas também alterações no ritmo de secreção do cortisol e no padrão de variação diário das citocinas salivares TNF, IL-1 e IL-6. Nos trabalhadores diurnos, a privação parcial do sono foi associada a aumento significativo da concentração da IL-6 na saliva. Um maior grau de dessincronização crônica entre os trabalhadores noturnos estaria associado a um maior encurtamento do sono diurno em dias de trabalho, a uma grande variabilidade no ritmo circadiano de secreção do cortisol e a uma maior variabilidade no padrão de variação diário da produção da IL-1 salivar. Conclusões. Os resultados indicam que o trabalho noturno em turnos fixos pode vir a ocasionar prejuízos à saúde dos trabalhadores deste esquema de turnos, tornando-o desaconselhável desse ponto de vista. Diferentes graus de sincronização do sistema de temporização endógeno estariam associados a maior ou menor adaptação ao trabalho em turnos noturnos fixos, com possíveis reflexos, em médio e longo prazos, sobre a tolerância ao trabalho em turnos e os efeitos à saúde nesses trabalhadores

Manifestações extraesofágicas da DRGE / Extraesophageal manifestations of GERD

A doença do refluxo gastroesofágico é decorrente do fluxo retrógrado de secreção cloridropéptica para o esôfago e órgãos adjacentes, causando um espectro variável de lesões e sintomas. Sua incidência vem aumentando nos últimos anos e sua prevalência estimada na população brasileira é de cerca de 12%. A DRGE tem como manifestações típicas a pirose e a regurgitação, podendo se apresentar com queixas extraesofágicas tais como asma, tosse crônica, dor torácica não cardíaca e sintomas otorrinolaringológicos.

Gastro-oesophageal reflux disease is caused by the retrograde flow of gastric acid-peptic secretion into the esophagus and adjacent organs, causing a variable spectrum of lesions and symptoms. Its incidence has been increasing in recent years and its estimated prevalence in the Brazilian population is about 12%. Typical manifestations of GERD are heartburn and regurgitation, but the disease may present with extraesophageal complaints such as asthma, chronic cough, non-cardiac chest pain and ENT symptoms.

Alteraciones bucodentales en niños con insuficiencia renal crónica y transplante renales / Oral disorders in children with chronic renal failure and renal transplant

El propósito de este trabajo es determinar las manifestaciones bucodentales en niños con insuficiencia renal crónica y/o transplantados en el Servicio de Nefrología Infantil del Hospital de Niños J. M. de los Ríos en Caracas - Venezuela. Se realizó un estudio descriptivo, de campo e intencional donde se seleccionaron 30 pacientes niños con edades entre los 7 y 17 años con insuficiencia renal crónica y/o transplantados de riñón y 30 niños no comprometidos sistémicamente. Todos los pacientes tenían un consentimiento informado de los padres y/o representantes como también los del grupo control. Se utilizó una Historia Clínica con datos socioepidemiológicos; se utilizó instrumental básico para el examen clínico intrabucal, revelador de placa dentoalveolar, vasillas indicadoras universal de Ph para la recolección de saliva y titulación de las mismas. El 77% de la población con insuficiencia renal crónica presentó hipoplasia del esmalte, el 93% presentó caries y la población control presentó el 50%, el 50% presentó gingivitis generalizada y el grupo control el 20%, el pH salival es más ácido en los niños con insuficiencia renal crónica y el grupo control mostró un pH neutro y alcalino y el 93% presentó xerostomía y el grupo control no presentó dicha afección; el 86% de los niños con insuficiencia renal crónica presentaron retardo de crecimiento, un 75% de retraso dentario y el 97% presentaron aumento del vello corporal. Los pacientes con insuficiencia renal crónica presentan alteraciones del aparato masticatorio que son propias de la enfermedad y también como consecuencia del tratamiento aplicado, por tal motivo el odontopediatra juega un papel importante en la instrucción a padres y/o representantes, médicos y paramédicos para el control y tratamiento de lesiones en boca de estos niños

The chronic renal shortage, is one of the nefropatias more known, which is a transtorn of etiology characterized by the decrease of Renal Function progress. The purpose of this work is to determine the oral dental patologic, in children with chronic renal shortage or transplanted at Servicio Infantil del Hospital de Niños J.M. de Los Rios in Caracas, Venezuela. A a descriptive study was made, in which were chosen 30 children patients from 7 to 17 years old with chronic renal shortage and/ or kidney transplanted, and 30 children not involved with this illness. All patients were authorized by their parents as well as the control Group. A clinical history was used with socioepidemiologic data, also the basic instruments to clinic intra- oral exam. The 77 % of population with chronic reanl shortage showed, the 93% showed dental cavity and the control population showed the 50%, the 50% showed and the control Group the 20%, the is more acid in childrens with chronic renal shortage and the control Group a neutral PH, and the 93% showed , and the control Group do not showed xerestomia; the 86 % of childrens with chronic renal shortage showed delay in raising, one 75 % of dental delay and the 97% showed an increase of corporal The patients with chronic renal shortage showed alterations in chewing apparatus, which are commons of this illness and also the consequence of treatment used, for this reason the dentist has an important rol in teaching to parents, medic and paramedic the control and treatment of this lesions in children.

Evaluation of organic and inorganic compounds in the saliva of patients with chronic periodontal disease / Avaliação de compostos orgânicos e inorgânicos na saliva de pacientes com doença periodontal crônica

The aim of this study was to evaluate the influence of periodontal disease on the biochemical parameters of the saliva, including salivary flow rate, pH, total protein, alkaline phosphatase activity and urea concentration, in individuals with chronic periodontitis. Methods: Forty subjects were allocated into two groups: twenty subjects without periodontal disease (control group) and twenty subjects with chronic periodontitis (test group). Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were obtained by a previously trained and calibrated clinical examiner. Saliva from both groups was collected for analysis of its biochemical parameters. The Student's t-test and correlation coefficient (Pearson) were used at a 5% level of significance. Results: The results showed alterations in the alkaline phosphatase activity, urea concentration and total protein in the subjects of the test group compared to the control group (P<0.05). However, there was no correlation between the clinical periodontal parameters and the salivary parameters (P>0.05). Conclusion: The results suggest that chronic periodontitis can affect the composition of the saliva and that analysis of the salivary parameters can be useful as an additional exam for the diagnosis of periodontal disease.

Objetivo: O objetivo deste estudo foi avaliar a influência da doença periodontal sobre os parâmetros bioquímicos da saliva, incluindo taxa de fluxo salivar, pH, proteína total, atividade de fosfatase alcalina e a concentração de uréia, em indivíduos com periodontite crônica. Metodologia: Quarenta indivíduos foram alocados em dois grupos: vinte indivíduos sem doença periodontal (grupo controle) e vinte indivíduos com periodontite crônica (grupo teste). Índice de placa (IP), índice gengival (IG), profundidade de sondagem (PD) e nível de inserção clínica (CAL) foram obtidos anteriormente por um examinador treinado e calibrado clinicamente. Saliva de ambos os grupos foram coletadas para análise de seus parâmetros bioquímicos. O teste T de Student e coeficiente de correlação (Pearson) foram utilizados em um nível 5% de significância. Resultados: Os resultados mostraram alterações na atividade da fosfatase alcalina, uréia e proteína total nos indivíduos do grupo teste em comparação ao grupo controle (P<0,05). No entanto, não houve correlação entre os parâmetros clínicos periodontais e os parâmetros salivares (P>0,05).Conclusão: Os resultados sugerem que a periodontite crônica pode afetar a composição da saliva e que a análise dos parâmetros salivares pode ser útil como um exame complementar para o diagnóstico da doença periodontal.

Tabaquismo durante el embarazo en Argentina y Uruguay / Smoking during pregnancy in Argentina and Uruguay

Argentina y Uruguay están entre los países con mayor proporción de mujeres jóvenes fumadoras. Se desconoce cuál es la proporción exacta de ellas que fuman durante el embarazo así como las características de las que dejan de fumar y las que continúan fumando durante el embarazo. Realizamos una encuesta administrada por un/a entrevistador/a a 1512 mujeres embarazadas de 18 años o mayores (796 en Argentina; 716 en Uruguay), que concurrían a control prenatal en hospitales públicos de grandes conglomerados urbanos. 44% de las mujeres en Argentina y 53% en Uruguay habían sido o eran fumadoras. Durante el embarazo, 11% de las mujeres en Argentina y 18% en Uruguay continuaron fumando. En ambos países, la proporción de mujeres que vive con fumadores, permite fumar en el hogar y regularmente o siempre se encuentra en lugares cerrados con personas que estén fumando fue 49%, 46% y 20% entre las mujeres que nunca fumaron, 67%, 60% y 32% entre las que dejaron, y 78%, 75% y 52% entre las que continuaron fumando respectivamente. El estudio confirma un importante problema de salud pública y documenta que la exposición ambiental persiste en subgrupos de mujeres, aun en aquéllas que dejaron de fumar. Es importante que el sector de salud pública provea acceso a programas efectivos para dejar de fumar durante el embarazo. Cualquier nueva intervención a desarrollar que intente tener un éxito al menos moderado y sostenible, debiera incluir componentes que actúen sobre el entorno fumador de la mujer embarazada que fuma.

Argentina and Uruguay are among the countries in which a large proportion of young women smoke. The rate of smokers during pregnancy in both countries is not well known, and data on the characteristics of women who quit smoking during pregnancy compared to those who continue smoking are not available. We conducted a survey including 1512 pregnant women >18 years old (796 in Argentina; 716 in Uruguay), during antenatal visits in public hospitals of large urban regions; 44% of the women in Argentina and 53% in Uruguay had been or were regular smokers. 11% of the surveyed women in Argentina and 18% in Uruguay continued smoking during pregnancy. In both countries, the proportion of women who lived with smokers, allowed smoking at home, and were regularly or always exposed to tobacco smoke indoors, were 49%, 46% and 20% in the subgroup of women who never smoked, 67%, 60% and 32% in those who quit, and 78%, 75% and 52% in those who continued smoking, respectively. The study confirms a serious public health problem in both countries, and documents that environmental exposure persists in subgroups of women, even in those who quit smoking. It is important that the public health sector should provide access to effective programs for smoking cessation, to women who smoke during pregnancy. For the development of a new program, any intervention intending to have at least a moderate and sustainable success, it should seriously consider including components targeting the smoking environment of the pregnant women who smoke.

Estudo comparativo da concentração salivar do fator de crescimento epidérmico em indivíduos com laringite crônica por doença do refluxo gastroesofágica antes e após o tratamento: resultados preliminares / Salivary egf concentration in adults with reflux chronic laryngitis before and after treatment: preliminary results

Os mecanismos fisiopatológicos do refluxo laringofaríngeo (RLF) são pouco conhecidos. O Fator de Crescimento Epidérmico (EGF) é a proteína de produção salivar com maior ação na regeneração do epitélio da orofaringe e tubo digestivo alto, tendo sido demonstradas deficiências em sua concentração salivar em indivíduos com RLF. OBJETIVO: Comparar a concentração salivar de EGF em um mesmo indivíduo com RLF antes e após o tratamento. MATERIAL E MÉTODO: Neste estudo prospectivo doze indivíduos com DRGE e RLF de moderada intensidade tiveram sua saliva espontânea coletada antes e após o tratamento e controle da doença. A concentração salivar de EGF foi estabelecida através de exame de ELISA (Quantikine ®). RESULTADOS: Onze pacientes eram do sexo feminino e um do sexo masculino, com idade média de 49 anos. A concentração salivar de EGF pré-tratamento foi de 2.867,6pg/mL e a pós-tratamento foi 1.588,5pg/mL, sendo esta diferença estatisticamente significante (p=0,015). DISCUSSÃO E CONCLUSÕES: Apesar de a concentração salivar de EGF ser maior nos indivíduos antes do tratamento, esta não consegue alcançar àquela de uma população normal (estabelecida previamente), o que sugere uma deficiência primária deste importante fator de defesa em indivíduos com RLF.

The Laryngopharyngeal Reflux (LPR) physiopathology is still unknown. The Epidermal Growth Factor (EGF) is a biologically active salivary protein that aids in the rapid regeneration of the oropharyngeal and upper digestive tract mucosas. Salivary deficiency of this protein in patients with LPR has been demonstrated in previous studies. AIM: To compare salivary EGF concentration in patients with LPR before and after treatment. MATERIALS AND METHODS: In this prospective study twelve patients with GERD and moderate LPR were studied. Whole saliva samples were collected before and after treatment and salivary EGF concentration was determined using a commercially available ELISA kit (Quantikine ®). RESULTS: There were eleven females and one male among the patients, the mean age was 49 years. The mean pre-treatment salivary EGF concentration was 2,867.6 pg/mL and the mean post treatment EGF concentration was 1,588.5 pg/mL. This difference was statistically significant (p=0.015). DISCUSSION AND CONCLUSIONS: Although salivary EGF concentrations are higher before LPR treatment, the concentration is still much lower than the mean salivary EGF concentration in normal individuals without LPR, which suggests a primary disorder of this defense factor in individuals with LPR.

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento / Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment

INTRODUÇÃO: A Doença do Refluxo Gastroesofágico (DRGE) é a doença digestiva mais prevalente da atualidade e, recentemente, tem sido implicada em uma gama de alterações do seguimento laringofaríngeo (RLF). No entanto, pouco se sabe dos mecanismos fisiopatológicos destas manifestações supraesofágicas da DRGE. Os achados clínicos contraditórios e recentes pesquisas sugerem haver deficiências na capacidade de defesa deste seguimento. Uma das principais responsáveis pela homeostase da mucosa oral e do trato digestivo é a saliva com seu conteúdo orgânico e inorgânico. Tanto alterações do pH quanto do volume salivar já foram correlacionados com os sintomas e sinais sugestivos da DRGE e RLF. Estudo recente de nossa autoria demonstra diminuição estatisticamente significante do pH salivar de indivíduos com RLF quando comparado a controles sem a doença. Outro estudo constatou correlação entre a redução do volume X pH da saliva em indivíduos com DRGE, estando esta redução diretamente relacionada aos níveis de pH esofágico constatados durante pH-metria esofágica de 24 horas. OBJETIVOS: Avaliar como se comportam o pH e volume da saliva em um mesmo indivíduo com DRGE e RLF antes e após o tratamento clínico. MATERIAL E MÉTODO: Vinte e três pacientes com RLF tiveram o pH e volume da saliva total testados antes e após receberem tratamento com droga bloqueadora de bomba de prótons durante 12 semanas. RESULTADOS: Houve uma diferença estatisticamente significante (p<0,001) entre o pH da saliva antes e após o tratamento, estando este maior após o controle clínico da doença. O volume de saliva no paciente tratado foi significativamente maior do que no paciente pré-tratamento (p=0.009). DISCUSSÃO: Os achados sugerem que o pH salivar é influenciado pela presença de refluxo gastroduodenal à região laringofaríngea. Caso estudos futuros com populações maiores realmente comprovem esta correlação, poderemos cogitar a possibilidade de usar a mensuração do pH salivar, que é feita de forma rápida e não invasiva, como um meio de diagnosticar e avaliar o comportamento e controle do Refluxo Laringofaríngeo.

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) is the most prevalent digestive disease of the modern society and has been associated with abnormalities in the larynx and pharynx (LPR). Nonetheless, little is known about the mechanisms involved in this atypical form of the disease. Contradictory clinical data suggest a defense deficit at this segment. Saliva with its organic and inorganic components is responsible for the homeostasis of the oral mucosa and the digestive tract. Salivary pH and volume abnormalities have been linked to laryngopharyngeal symptoms of GERD and LPR. In a recent study we demonstrated significant salivary pH reduction in patients with LPR. Another study found correlation between reduced salivary pH and volume directly related to esophageal pH-metry results. AIM: To evaluate salivary pH and volume before and after clinical treatment of LPR. MATERIAL AND METHOD: Twenty-three adults with LPR had total fasting saliva tested before and after a 12-week course of oral proton pump inhibitor. RESULTS: A statistically significant difference was found in salivary pH before and after treatment with increase of pH values after control of the disease (p<0.001). Salivary volumes of treated patients were also significantly higher than in pre-treated patients (p=0.009). DISCUSSION: These findings suggest that salivary pH and volume are influenced by the presence of gastroesophageal contents and that salivary pH monitoring can potentially become a cost-effective method for diagnosing and controlling LPR.