Association among gestational diabetes mellitus, periodontitis and prematurity: a cross-sectional study

ABSTRACT Objective: Gestational diabetes mellitus (GDM) causes maternal and infant morbidity. Periodontitis is associated with adverse pregnancy outcomes. The aim of this study was to evaluate periodontal status, prematurity and associated factors in pregnant women with and without GDM. Subjects and methods: This observational cross-sectional study included 80 pregnant women with GDM (G1 = 40) and without GDM (G2 = 40). Demographic and socioeconomic status, systemic and periodontal health condition, prematurity and newborns' birth weight were analyzed. For bivariate analysis, Mann-Whitney U-test, t test and Chi-squared test were used. Binary logistic regression analyzed independent variables for periodontitis and prematurity (p < 0.05). Results: Patients from G1 presented lower socioeconomic status, higher weight and body mass index (BMI). Prematurity (G1 = 27.5%; G2 = 2.5%; p < 0.05) and severe periodontitis percentages (G1 = 22.5%; G2 = 0; p = 0.001) were higher in G1 than in G2. Logistic regression analysis showed that household monthly income (OR = 0.65; 95% CI 0.48-0.86; p = 0.003) and maternal BMI (adjusted OR = 1.12; 95% CI 1.01-1.25; p = 0.028) were significant predictors of periodontitis during the third trimester of pregnancy. Presence of GDM remained in the final logistic model related to prematurity (adjusted OR = 14.79; 95% CI 1.80-121.13; p = 0.012). Conclusions: Pregnant women with GDM presented higher severity of periodontitis, lower socioeconomic status, higher overweight/obesity and a 10-fold higher risk of prematurity. Socioeconomic-cultural status and BMI were significant predictors for periodontitis, and GDM was a predictor to prematurity.

Cimento cirúrgico periodontal: usar ou não usar? / Periodontal dressing material: to use or not to use?

Existe grande discussão sobre a real necessidade e os benefícios da utilização do cimento cirúrgico nas feridas periodontais. O objetivo dessa revisão de literatura foi realizar um levantamento bibliográfico nas bases de dados PubMed e Science Direct abordando sobre a utilização do cimento cirúrgico em procedimentos periodontais. Os curativos periodontais são indicados em procedimentos específicos, como aqueles que deixam área cruenta e necessitam de estabilidade para o retalho. Algumas características pós-operatórias, como diminuição da sintomatologia dolorosa, controle de infecções e ajuda na cicatrização, são atribuídas a esses materiais, apesar de não existir um consenso na literatura sobre sua efetividade. Entretanto, pode ser considerado irritante aos mesmos, por predispor ao acúmulo de placa bacteriana ou pelo fato de desintegrar-se ou movimentar-se, criando o atrito mecânico e, desta forma, retardar o processo de cura. Como opção ao cimento cirúrgico, tem-se discutido sobre a utilização de bochechos antimicrobianos, que reduzem o biofilme e também o desconforto pós-operatório. Porém, não são capazes de evitar a impacção alimentar ou lesões traumáticas na ferida periodontal, e os pacientes costumam relatar sentir-se mais seguros no pós-operatório quando utilizam o cimento cirúrgico. Pôde-se concluir que o cimento cirúrgico parece exercer um pequeno efeito positivo sobre a ferida cirúrgica periodontal, sendo necessários novos estudos clínicos para que se possa realizar a correta indicação para sua utilização.

There is a great discussion about the real need and the benefits about periodontal dressing use on periodontal wounds. The aim of this revision is to collect articles in data bases (PubMed and Science Direct) about the use of periodontal dressing in periodontal surgery sites. Periodontal dressings are indicated in specific procedures as surgeries that leave an open wound or those which want flap stability. The benefits of periodontal dressing are pain control, infection control, acceleration of wound healing. There is no consensus in literature about their efficacy. Some address the possibility of being a local irritant factor if it disintegrates or dislodges or may predispose bacterial biofilm accumulation, which results in retardation of wound healing. As an option of periodontal dressings there are the antimicrobial mouthwashes because they reduce the bacterial biofilm and reduce the post-operative discomfort. The disadvantage of this substitution is the absence of a mechanical barrier to avoid trauma and accumulation of debris. Besides, the mechanical barrier gives more comfort and safety to the patient. It can be concluded that the periodontal dressing exerts a minimal positive effect on periodontal wound healing and there is a need of acorrect indication for its use.