Unvaccinated periodontal patients with a history of COVID-19: clinical findings in a Dental School setting

Abstract This study analyzed the periodontal clinical data of individuals with a history of COVID-19 treated in a dental school during the pandemic in 2021 before vaccination. Methods: This analysis included individuals older than 18 years with no history of systemic disorders other than systemic arterial hypertension. Individuals who had COVID-19 were classified according to the World Health Organization as asymptomatic, with mild, moderate, severe, or critical symptoms. Results: A total of 95 individuals were evaluated, which included 24 with a history of COVID-19. Seventeen percent had been asymptomatic, 21% had mild, 25% moderate, 21% severe, and 17% critical symptoms, including intubation. Individuals with no history of COVID-19 presented significantly lower measurements of probing depth (p=0.003; Mann-Whitney test) and clinical attachment level (p=0.002) compared to individuals with a history of COVID-19. A significant negative association was found between bleeding on probing and the severity of characteristics of COVID-19 (rho= -0.233; p=0.023). Conversely, positive associations between the values of probing depth (rho= 0.292; p=0.004) and mean clinical attachment level (rho= 0.300; p=0.003) and the characteristics of COVID-19 were found. Conclusions: The periodontal data shows that patients who had COVID-19 before vaccination may present a worse periodontal status when compared to patients in the same clinical setting with no history of COVID-19. However, a more extensive study should confirm it with more participants.

Resumo Este estudo analisou os dados clínicos periodontais de indivíduos com histórico de COVID-19 tratados em uma escola de odontologia durante a pandemia em 2021, antes da vacinação. Métodos: Essa análise incluiu indivíduos maiores de 18 anos sem histórico de distúrbios sistêmicos, exceto hipertensão arterial sistêmica. Os indivíduos que tiveram COVID-19 foram classificados de acordo com a Organização Mundial da Saúde como assintomáticos, com sintomas leves, moderados, graves ou críticos. Resultados: 95 indivíduos foram avaliados, incluindo 24 com histórico de COVID-19. 17% eram assintomáticos, 21% tinham sintomas leves, 25% moderados, 21% graves e 17% críticos, incluindo intubação. Os indivíduos sem histórico de COVID-19 apresentaram medidas significativamente mais baixas de profundidade de sondagem (p=0,003; teste de Mann-Whitney) e nível de fixação clínica (p=0,002) em comparação com indivíduos com histórico de COVID-19. Foi encontrada uma associação negativa significativa entre o sangramento à sondagem e a gravidade das características da COVID-19 (rho= -0,233; p=0,023). Por outro lado, foram encontradas associações positivas entre os valores de profundidade de sondagem (rho = 0,292; p = 0,004) e o nível médio de apego clínico (rho = 0,300; p = 0,003) e as características da COVID-19. Conclusão: Os dados periodontais mostraram que os pacientes que tiveram COVID-19 antes da vacinação podem apresentar um pior estado periodontal quando comparados a pacientes no mesmo ambiente clínico sem histórico de COVID-19. No entanto, um estudo mais extenso deve ser realizado para confirmar tal achado com maior número de participantes.

Colonization dynamics of subgingival microbiota in recently installed dental implants compared to healthy teeth in the same individual: a 6-month prospective observational study

Abstract Objectives To evaluate the colonization dynamics of subgingival microbiota established over six months around newly installed dental implants in periodontally healthy individuals, compared with their corresponding teeth. Methodology Seventeen healthy individuals assigned to receive single dental implants participated in the study. Subgingival biofilm was sampled from all implant sites and contralateral/ antagonist teeth on days 7, 30, 90, and 180 after implant installation. Microbiological analysis was performed using the Checkerboard DNA-DNA hybridization technique for detection of classical oral taxa and non-oral microorganisms. Significant differences were estimated by Mann-Whitney and Friedman tests, while associations between implants/teeth and target species levels were assessed by linear regression analysis (LRA). Significance level was set at 5%. Results Levels of some species were significantly higher in teeth compared to implants, respectively, at day 7 ( V.parvula , 6 × 10 5 vs 3 × 105 ; Milleri streptococci , 2 × 10 6 vs 6 × 10 5 ; Capnocytophaga spp., 2 × 10 6 vs 9 × 10 5 ; E.corrodens , 2 × 10 6 vs 5 × 10 5 ; N. mucosa , 2 × 10 6 vs 5 × 10 5 ; S.noxia , 2 × 10 6 vs 3 × 10 5 ; T.socranskii , 2 × 10 6 vs 5 × 10 5 ; H.alvei , 4 × 10 5 vs 2 × 10 5 ; and Neisseria spp., 6 × 10 5 vs 4 × 10 4 ), day 30 ( V.parvula , 5 × 10 5 vs 10 5 ; Capnocytophaga spp., 1.3 × 10 6 vs 6.8 × 10 4 ; F.periodonticum , 2 × 10 6 vs 10 6 ; S.noxia , 6 × 10 5 vs 2 × 10 5 ; H.alvei , 8 × 10 5 vs 9 × 10 4 ; and Neisseria spp., 2 × 10 5 vs 10 6 ), day 120 ( V.parvula , 8 × 10 5 vs 3 × 10 5 ; S.noxia , 2 × 10 6 vs 0; and T.socranskii , 3 × 10 5 vs 8 × 10 4 ), and day 180 ( S.enterica subsp. enterica serovar Typhi, 8 × 10 6 vs 2 × 10 6 ) (p<0.05). Implants showed significant increases over time in the levels of F.nucleatum , Gemella spp., H.pylori , P.micra , S.aureus , S.liquefaciens , and T.forsythia (p<0.05). LRA found that dental implants were negatively correlated with high levels of S. noxia and V. parvula (β=-0.5 to -0.3; p<0.05). Conclusions Early submucosal microbiota is diverse and only a few species differ between teeth and implants in the same individual. Only 7 days after implant installation, a rich microbiota can be found in the peri-implant site. After six months of evaluation, teeth and implants show similar prevalence and levels of the target species, including known and new periodontopathic species.

Hipertensão arterial sistêmica autorrelatada em pacientes atendidos no curso de Odontologia da Unigranrio e sua relação com parâmetros periodontais e CPOD / Self-reported systemic arterial hypertension in patients treated at Unigranrio's Dentistry course and its relationship with periodontal parameters and DMFT

Objetivo: Avaliar a frequência de hipertensão arterial sistêmica e sua associação com parâmetros periodontais e do índice de dentes cariados, perdidos, obturados (CPOD) em indivíduos atendidos na clínica do Curso de Odontologia da Unigranrio. Materiais e métodos: Noventa e cinco indivíduos de ambos os sexos foram incluídos no estudo entre março e maio de 2021. Os participantes responderam a questionários anamnésicos, tiveram sua pressão arterial sistêmica aferida e foram examinados para obtenção do índice CPOD e de parâmetros periodontais. Resultados: A frequência de hipertensão arterial sistêmica na população estudada foi 23,15%. Em pacientes com periodontite, essa prevalência foi 27%, e, em pacientes com gengivite, 19%. Pacientes com periodontite tiveram médias superiores de pressão arterial sistólica (PAS) e diastólica (PAD) comparado ao grupo com gengivite (p<0,0001). Foram identificadas correlações significativas positivas entre PAS e bolsas periodontais moderadas (rho=0,356) e profundas (rho=0,342), perda de inserção avançada (rho=0,538), CPOD (rho=0,365) e quantidade de dentes ausentes (rho=0,477), p < 0,001. A PAD apresentou correlações significativas (p < 0,001) positivas com bolsas periodontais moderadas (rho=0,331) e profundas (rho=0,283), perda de inserção avançada (rho=0,465), CPOD (rho=0,361) e dentes ausentes (rho=0,348). Conclusões: A frequência de hipertensão arterial sistêmica autorrelatada é relativamente alta na população estudada e, em especialmente, dentre as pessoas com periodontite. Pressão arterial sistólica e diastólica são correlacionadas positivamente com parâmetros periodontais indicadores de severidade de doença, assim como piores escores do CPOD.

Aim: The study evaluated the prevalence of systemic arterial hypertension and its association with periodontal parameters and decayed-missing-filled teeth (DMFT) index in individuals treated in a Dental School clinic. Material and methods: Ninety-five individuals of both genders were included in the study in the period between March and May 2021. All participants answered anamnestic questionaries, had their systemic blood pressure measured, and were examined to obtain the DMFT and periodontal parameters. Results: The prevalence of systemic arterial hypertension in the study population was 23.15%. In periodontitis individuals, that prevalence was 27%, and, in gingivitis patients, 19%. Patients with periodontitis have higher mean systolic (SBP) and diastolic (DBP) blood pressure compared with gingivitis individuals (p<0.0001). Significant positive correlations were found between SBP and moderate (rho=0.356) and deep (rho=0.342) periodontal pockets, severe attachment loss (rho=0.538), DMFT (rho=0.365), and amount of missing teeth (rho=0.477), p ? 0.001. The DBP showed significant (p?0.001) positive correlations with moderate (rho=0.331) and (rho=0.283) deep periodontal pockets, severe attachment loss (rho=0.465), DMFT (rho=0.361), and missing teeth (rho=0.348). Conclusions: The prevalence of systemic arterial hypertension is relatively high in the study population and, in particular, among individuals with periodontitis. Systolic and diastolic blood pressure are positively correlated with periodontal parameters that indicate the severity of disease, as well as with worse DMFT scores.

AVALIAÇÃO DO CONHECIMENTO DE MÉDICOS SOBRE A RELAÇÃO ENTRE DOENÇAS PERIODONTAIS E DOENÇAS SISTÊMICAS / EVALUATION OF PHYSICIANS' KNOWLEDGE ON THE RELATIONSHIP BETWEEN PERIODONTAL AND SYSTEMIC DISEASES

Existe uma conexão entre a saúde bucal e a saúde sistêmica, principalmente no caso de paciente portadores de doenças periodontais. Objetivo: O objetivo deste estudo é avaliar o conhecimento de médicos, que trabalham no Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias, sobre a relação entre doenças periodontais e doenças sistêmicas. Metodologia: Questionários com 13 perguntas, que incluem questões sobre a relação entre as doenças orais e as metabólicas foram aplicados a 50 médicos que trabalham no Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias. Os participantes foram grupados em até 8 anos de formado (n = 26) e mais de 8 anos de formado (n = 24). Os dados foram testados pelos testes Mann-Whitney e do Qui-quadrado, ao nível de significância a 5%. Resultados: A grande maioria dos participantes, independentemente do grupo, já referiu paciente ao cirurgião-dentista, e o principal motivo foi a presença de lesão intra-oral. Maior parte dos respondentes apontou o sangramento gengival como sintoma primário da doença periodontal. Além disso, quase 100% dos participantes apontou existir relação entre doença periodontal e doenças sistêmicas, sendo doença cardiovascular a mais frequentemente citada. O principal meio de obtenção de informação sobre o assunto citado foram livros e periódicos. Conclusão: A grande maioria dos médicos, participantes do presente estudo, está ciente da relação existente entre doenças periodontais e doenças sistêmicas, principalmente, as doenças cardiovasculares. Isto foi evidenciado pela alta taxa de encaminhamento dos pacientes a dentistas e o conhecimento sobre os sinais clínicos da doença periodontal.

There is a connection between oral and systemic health, especially concerning patients with periodontal diseases. Aim: The objective of this study was to evaluate the knowledge of physicians working at the Adão Pereira Nunes Hospital, Saracuruna, Duque de Caxias, on the relationship between periodontal and systemic diseases. Methodology: Questionnaires with 13 questions, which include questions about the relationship between oral and metabolic diseases, were applied to 50 physicians working at Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias. Participants were distributed to 2 groups, according with years of graduation (up to 8 years, n = 26; and over 8 years, n = 24). Data were tested for significant differences by Mann-Whitney and Chi-square tests, at a significance level of 5%. Results: The majority of the participants, regardless of the group, referred patients to the dentist, and the main reason was the presence of intra-oral lesions. Most respondents pointed to gingival bleeding as a primary symptom of periodontal disease. Almost 100% of the participants indicated a relationship between periodontal disease and systemic diseases; moreover, cardiovascular disease was the most frequently cited. Books and scientific periodicals were the main source of obtaining information on the matter. Conclusion: The great majority of participants physicians are aware of the relationship between periodontal diseases and systemic diseases, mainly cardiovascular diseases. This was evidenced by the high referral rate of patients to dentists and the knowledge about the clinical signs of periodontal disease.

NOVA CLASSIFICAÇÃO DAS PERIODONTITES ADAPTADO DO RELATÓRIO DE CONSENSO DO 2017 WORLD WORKSHOP ON THE CLASSIFICATION OF PERIODONTAL AND PERI-IMPLANT DISEASES AND CONDITIONS / NEW CLASSIFICATION OF PERIODONTITIS ADAPTED FROM THE 2017 WORLD WORKSHOP ON THE CLASSIFICATION OF PERIODONTAL AND PERI-IMPLANT DISEASES AND CONDITIONS CONSENSUS REPORT

Em novembro de 2017, ocorreu nos Estados Unidos um evento conjunto da Academia Americana de Periodontia e da Federação Europeia de Periodontia. Este evento teve como objetivo discutir pontos não resolvidos da classificação periodontal de 1999, o que culminou com uma nova classificação das doenças periodontais. Modificações importantes foram estabelecidas, principalmente no que tange às periodontites. Assim, este texto em língua portuguesa visa atualizar os dentistas e estudantes de Odontologia sobre a nova classificação das periodontites, com base na publicação no relatório de consenso do 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions em junho de 2018. A nova classificação abrange todas as doenças e condições periodontais e peri-implantares, incluindo a definição de saúde periodontal, a reorganização das doenças e condições gengivais não induzidas por placa, a inclusão de doenças e condições sistêmicas que afetam o tecido periodontal de suporte, as bases para o tratamento de retração gengival, a substituição de termos periodontais e a introdução de uma nova classificação para doenças e condições peri-implantares. Como pode ser observado, não seria possível detalhar todos estes aspectos da nova classificação, assim, este artigo apresenta somente a nova classificação referente às periodontites.

In November 2017, a joined meeting between the American Academy of Periodontology and the European Federation of Periodontology was held in United States. This meeting had the aim to discuss non-solved issues regarding 1999 periodontal classification, which culminated with a new periodontal classification. Important changes were established, mainly in reference to different forms of periodontitis. Thus, the current paper aims to update dentists and dental students on the new classification of periodontitis, based on the consensus report of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions published in June 2018. The new classification covers all periodontal and peri-implant diseases and conditions, including the periodontal health definition, the re-organization of gingival diseases and conditions non-induced by plaque, the inclusion of systemic diseases and conditions that affect the support periodontal tissue, the basis for gingival retraction treatment, the replacement of periodontal terms, and the introduction of a new classification for peri-implant diseases and conditions. As can be observed, it would be impossible to detail all aspects of the new classification, thus, this paper presents only the periodontitis new classification.

Tratamento da peri-implantite com emprego de L-PRF: relato de caso clínico / Peri-implantitis treatment with adjunctive use of L-PRF: case report

Com o aumento do número de indivíduos reabilitados com implantes dentários, novas complicações clínicas estão surgindo, incluindo as doenças peri-implantares. Várias terapias conservadoras e cirúrgicas têm sido propostas para o tratamento da peri-implantite. Estas abordagens cirúrgicas podem ser complementadas com métodos regenerativos, nos quais poderiam ser englobadas as terapias com fibrina rica em plaquetas e leucócitos (L-PRF). Objetivo: O objetivo deste estudo é relatar um caso clínico de peri-implantite tratado com o emprego de L-PRF após 12 meses a partir da intervenção. Relato de caso: O paciente relatado apresentava três implantes instalados há 9 anos, que apresentavam médias de profundidade de sondagem e de nível clínico de inserção de 3,1 e 2,7 mm, respectivamente. O tratamento da peri-implantite consistiu em desbridamento com instrumentos manuais através de acesso cirúrgico e irrigados com clorexidina a 0,12%. Após estes procedimentos, os implantes receberam membrana de fibrina obtidas com a técnica para L-PRF. Após 12 meses, foi constatado redução das bolsas peri-implantares com redução de profundidade de sondagem para 2,3 mm e de nível clínico de inserção para 2 mm. No exame radiográfico, foi possível observar sinais radiográficos indicativos de preenchimento dos defeitos ósseos. Conclusão: O tratamento utilizado para tratar o caso de peri-implantite relatado, mecânico com acesso cirúrgico e uso de L-PRF, apresentou bons resultados clínicos e radiográficos aos 12 meses (AU)

Along with the increasing number of subjects receiving dental implants, new clinical complications are emerging, including peri-implant diseases. Different conservative techniques are being proposed to treat peri-implantitis. Such approaches include regenerative methods, in which leucocyte - and platelet - rich fibrin (L-PRF) is one of them. Aim: The aim of this study is to present a follow up of a clinical case of peri-implantitis treated with the use of L-PRF. Case report: The individual in this report had three dental implants installed 9 years before, presenting mean probing depth and clinical attachment level of 3.1 and 2.7 mm, respectively. The peri-implantitis treatment was performed by debridement of implants with manual instruments in a surgical approach, and irrigation with 0.12% chlorhexidine. After, implants received fibrin membrane obtained using the L-PRF method. At the 12 months follow up, it was observed a reduction in the probing depth and the clinical attachment level to 2.3 mm and 2 mm, respectively. Radiographic examinations showed indications of bone defect filling. Conclusion: The employed treatment to treat periimplantitis, mechanical with surgical approach and use of L-PRF, showed good clinical and radiographic results at 12 months of observation.(AU)

Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial

Abstract Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

Prevalence of Pseudomonas aeruginosa and Acinetobacter spp. in subgingival biofilm and saliva of subjects with chronic periodontal infection

P. aeruginosa and Acinetobacter spp. are important pathogens associated with late nosocomial pneumonia in hospitalized and institutionalized individuals. The oral cavity may be a major source of these respiratory pathogens, particularly in the presence of poor oral hygiene and periodontal infection. This study investigated the prevalence of P. aeruginosa and Acinetobacter spp. in subgingival biofilm and saliva of subjects with periodontal disease or health. Samples were obtained from 55 periodontally healthy (PH) and 169 chronic periodontitis (CP) patients. DNA was obtained from the samples and detection of P. aeruginosa and Acinetobacter spp. was carried out by multiplex and nested PCR. P. aeruginosa and Acinetobacter spp. were detected in 40% and 45% of all samples, respectively. No significant differences in the distribution of these microorganisms between men and women, subgingival biofilm and saliva samples, patients < 35 and > 35 years of age, and smokers and non-smokers were observed regardless periodontal status (p > 0.05). In contrast, the frequencies of P. aeruginosa and Acinetobacter spp. in saliva and biofilm samples were significantly greater in CP than PH patients (p < 0.01). Smokers presenting P. aeruginosa and high frequencies of supragingival plaque were more likely to present CP than PH. P. aeruginosa and Acinetobacter spp. are frequently detected in the oral microbiota of CP. Poor oral hygiene, smoking and the presence of P. aeruginosa are strongly associated with periodontitis.

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.