Randomized clinical trials in periodontology: focus on outcomes selection

Abstract Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Abstract Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT)

Abstract The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Clinical trials sponsored by industry and other private organizations

Abstract The present manuscript discussed some relevant aspects related to private sponsored clinical trials in dentistry. For decades, the academy has been the major responsible for research in Brazil. Distant from the trade sector, academic research has not always provided clear benefits to society. A key aspect of making benefits clearer is the process of scientific knowledge transference to decision-makers, which is, in fact, the ground of evidence-based dentistry. Although private sponsoring of clinical research seems to be part of the research progress of the business rates, investment in Brazil is lower than those observed in other countries. It is particularly important to understand that instead of creating its own rules, dentistry imported the high-quality standards originally designed for pharmaceutical studies. Therefore, it is critical to understand the original rules and how dental items are classified by regulatory agencies. In fact, knowledge about international and local regulation is a basic assumption in industry-sponsored research. Despite globalization, the identification of industry-sponsored studies through open access databases is still very hard and time-demanding. A common concern when conducting industry-sponsored trials is study biases. Fortunately, many relevant organizations, academic and industry groups, have been working seriously against that. Finally, for less experienced researchers, many aspects related to industry-sponsored studies - such as confidentiality, authorship, budget - are deeply discussed until a final version of the trial agreement can be written and signed, protecting all sides. In short, the scenario should be improved, but it already represents a nice opportunity for dental research.

Periodontitis and periodontopathogens in individuals hospitalized in the intensive care unit: a case-control study

Abstract The aim of the present study was to compare periodontal conditions between intensive care unit (ICU) in-patients and non-ICU patients through clinical and microbiological periodontal parameters. This case-control study included 88 individuals hospitalized in ICU and 176 non-hospitalized controls. All individuals underwent a complete periodontal examination and microbiological sampling. The total bacterial load and counts of Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetemcomitans were evaluated using qPCR. Data were analyzed through the Chi-square, Fisher exact, and t-Student tests, and the Spearman correlation, as appropriate. The prevalence of periodontitis was 39.7% among controls and 59.0% among ICU in-patients (OR=2.18; p=0.002). ICU in-patients had a significantly higher occurrence of cardiovascular disease (p=0.002; OR=2.20) and history of periodontal disease (p=0.031; OR=1.92) than controls. Bacterial counts of A. actinomycetemcomitans, T. denticola and P. gingivalis were significantly higher in ICU in-patients with periodontitis than in controls. The correlation between periodontal parameters and microbiological findings among cases and controls showed a significant and positive correlation between: total bacteria load and % of sites with probing depth (PD) ≥ 4 mm (cases: r=0.22 and controls: r=0.13) and P. gingivalis and % sites with bleeding on probing (BOP) (cases: r=0.22 and controls: r=0.23). Thus, ICU in-patients presented a higher prevalence of periodontitis and worse periodontal condition (higher mean plaque index, BOP, clinical attachment level ≥3 mm, and sites with PD 4 to 6 mm).

Resumo O objetivo deste estudo foi comparar as condição periodontais entre pacientes internados em Unidade de terapia intensiva (UTI) e indivíduos não hospitalizados através de parâmetros periodontais clínicos e microbiológicos. Este estudo caso-controle incluiu 88 indivíduos hospitalizados em UTI e 176 controles não hospitalizados. Todos os indivíduos foram submetidos a um exame periodontal completo e amostragem microbiológica. A carga bacteriana total e as contagens de Porphyromonas gingivalis, Treponema denticola e Aggregatibacter actinomycetemcomitans foram avaliadas utilizando qPCR. Os dados foram analisados, conforme apropriado, por meio dos testes de Qui-quadrado, Fisher exato, t-Student, Mann-Whitney e correlação de Spearman. A prevalência de periodontite foi de 39,7% entre os controles e de 59,0% entre pacientes internados em UTI (OR=2,18, IC 95%: 1,29-3,68; p=0,002). Pacientes admitidos na UTI apresentram significativamente uma maior ocorrência de doença cardiovascular (p=0,002, OR=2,20) e história de doença periodontal (p=0,031; OR=1,92) do que os controles. As contagens bacterianas de A. actinomycetemcomitans, T. denticola e P. gingivalis foram significativamente maiores nos pacientes em UTI com periodontite do que nos controles. A correlação entre os parâmetros clínicos periodontais e os achados microbiológicos entre casos e controles mostrou correlação significativa e positiva entre: carga bacteriana total e % de sítios com profundidade de sondagem (PS) ≥4 mm (casos: r=0,22 e controles: r=0,13) e P. gingivalis e % de sítios com sangramento à sondagem (SS) (casos: r=0,22 e controles: r=0,23). Pacientes internados na UTI apresentaram maior prevalência de periodontite e pior condição periodontal (maior média de índice de placa, SS, de sítios com nível de inserção clínica ≥ 3mm e PS de 4 a 6 mm) do que os controles.

Mast cell degranulation in periodontal disease from HIV-infected individuals

Aim: The objective was to compare the density and degranulation of mast cells on specimens obtained from individuals diagnosed with gingivitis or chronic periodontitis who were either non-HIV-infected or HIV-infected patients treated with highly active antiretroviral therapy (HAART). Methods: Gingival samples were taken from 16 non-HIV-infected individuals and 17 HIV-infected individuals diagnosed with gingivitis and chronic periodontitis. The samples were processed and tained with 0.3 percent o-toluidine blue. Densities (cells/mm²) and percentages of intact and degranulated mast cells were obtained. Results: No statistically significant differences were observed in the mast cell density and the percentage of degranulated mast cells between non-HIV-infected and HIV-infected individuals diagnosed with gingivitis and chronic periodontitis. Mononuclear inflammatory infiltrate was weakly correlated with the percentage of mast cells degranulated for both groups. Conclusions: There are no differences of the density and degranulation of mast cells in gingival tissue between non-HIV-infected and HIV-infected patients undergoing HAART, both groups with diagnosis of gingivitis or chronic periodontitis. This may be a result of the recovery of the immunologic system by HAART treatment.

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TGF-ß and TNF-α: follow-up over 5 years

Abstract Objective The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. Material and Methods Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. Results A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. Conclusions The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

Salivary arginase activity after mechanical-chemical therapy / Atividade de arginase salivar após tratamento mecânico-químico

Introduction: Salivary components can be used as biomarkers for diagnosing and monitoring oral diseases. There is evidence that one potential biomarker, arginase, is associated with the inflammatory processes of periodontal disease, and its enzymatic activity is reduced according to the improvement in the clinical parameters after treatment. Objective: The present study aimed to evaluate the salivary arginase activity in gingivitis and periodontitis patients treated with full-mouth mechanical procedures combined with the adjunctive use of essential oils or chlorhexidine mouthwash, respectively. Material and method: Twenty-six gingivitis and 16 periodontitis patients received complete periodontal examinations at the baseline and 3 months after therapy, in which the periodontal probing depth, clinical attachment loss, plaque index, and gingival index measurements were taken. At these same appointments, the salivary total protein level and salivary arginase activity were also established via spectrophotometry. Result: There were improvements in all of the clinical parameters (p < 0.05) evaluated from the baseline to 3 months in both groups. In addition, the salivary arginase activity and total protein levels were reduced after the gingivitis treatment. Conclusion: Similar to the clinical results, both therapeutic protocols positively affected the salivary arginase activity; however, further studies are necessary to clarify its potential as a salivary biomarker for periodontal monitoring.

Introdução: Componentes salivares podem ser usados como biomarcadores para diagnóstico e monitoramento de doenças orais. Há evidências de que um potencial biomarcador, arginase, está associado com os processos inflamatórios da doença periodontal, e após o tratamento sua atividade enzimática é reduzida em concordância com a melhora nos parâmetros clínicos. Objetivo: O presente estudo objetivou avaliar a atividade da arginase salivar em pacientes com gengivite e periodontite tratados com procedimentos mecânicos em estágio único combinados ao uso coadjuvante de enxaguatórios com óleos essenciais ou clorexidina, respectivamente. Material e método: Vinte e seis pacientes com gengivite e 16 pacientes com periodontite receberam exame periodontal completo antes e 3 meses após a terapia, em que mensurações de profundidade de sondagem, perda de inserção clínica, índice de placa e índice gengival foram realizadas. Nestas mesmas consultas os níveis de proteína total e a atividade de arginase salivar foram estabelecidos via espectrofotometria. Resultado: Todos os parâmetros clínicos melhoraram, em ambos os grupos, do exame inicial para o de 3 meses (p < 0,05). Adicionalmente, após tratamento para gengivite houve redução da atividade de arginase salivar e do nível de proteína total. Conclusão: Semelhante aos resultados clínicos, ambos os protocolos terapêuticos afetaram positivamente a atividade da arginase salivar; entretanto, estudos futuros são necessários para clarificar seu potencial como biomarcador salivar para o monitoramento periodontal.

Individuals' quality of life in periodontal maintenance therapy - critical literature review

Abstract: oral health is an integral part of an individual's general health, interfering with all dimensions of life: functional, aesthetic, psychological, social, physical, nutritional, and even psychosocial. hence oral health is directly related to quality of life. periodontitis is one of the most prevalent oral diseases and one of the major causes of tooth loss, impacting negatively on self-reported individuals' quality of life. periodontal maintenance therapy aims to effectively minimize the recurrence of periodontal disease, as well as the incidence of tooth loss. in periodontal literature, studies associated with quality of life indicators, presented in the form of questionnaires aimed at measuring the impact of periodontitis and tooth loss on self-reported individual's quality of life, highlight the "oral impacts on daily performance" (OIDP) and "oral health impact profile" (OHIP). as such, this study presents a critical review of the literature and describes the impact of periodontal disease and tooth loss on the quality of life of patients undergoing periodontal maintenance therapy.

Periodontal condition and immunological aspects of individuals hospitalized in the intensive care unit

Abstract There are few studies on the clinical and immunological periodontal status of intensive care unit (ICU) in-patients. The aim of the present study was to evaluate the periodontal condition among ICU in-patients through clinical and immunological periodontal parameters. From the sample of 373 hospitalized ICU patients, 182 were submitted' to a thorough clinical periodontal and immunological evaluation. Data on bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were collected and gingival sulcular fluid samples were quantified through ELISA on IL-1, IL-6, and MMP-2 for immunological evaluation. Data was statistically analyzed by Chi-square, Fisher's exact, Mann-Whitney tests, and Sperman's correlation and multivariate logistic regression analysis. A high dental plaque index and a high prevalence of periodontitis (48.3%), mostly in moderate and localized chronic form, were observed. Individuals with periodontitis presented higher levels of IL-1 and MMP-2, while individuals with cardiovascular disease (CVD) and individuals with two or more systemic diseases (MSD) presented higher levels of IL-1; diabetes mellitus (DM) and MSD individuals presented higher levels of IL-6. A positive association was found between the severity of periodontitis and CVD (OR 2.2; CI = 1.11-4.42). This study reported a 48.3% of the prevalence of periodontitis in ICU patients and a positive association between the severity of periodontitis and CVD. Additionally, higher levels of IL-1 and MMP-2 were found in individuals with periodontitis, higher levels of IL-6 were found in individuals with DM, and higher levels of IL-1 were found in individuals with CVD.

Resumo Existem poucos estudos sobre o estado clínico periodontal e imunológico de pacientes em unidade de terapia intensiva (UTI). O objetivo do presente estudo foi avaliar a condição periodontal entre os pacientes internados na UTI através de parâmetros clínicos periodontais e imunológicos. De uma amostra inicial de 373 pacientes internados em UTI, 183 foram submetidos a exame periodontal completo e análise imunológica. Os dados sobre o sangramento na sondagem (BOP), profundidade de sondagem (PD) e nível clínico de inserção (CAL) foram coletados e as amostras de fluido sulcular gengival foram quantificadas para avaliação imunológica através de ELISA para IL-1, IL-6 e MMP-2. Os dados foram analisados estatisticamente pelos testes de Qui-quadrado, exato de Fischer, Mann-Whitney, correlação de Sperman e análise de regressão logística multivariada. Foi observado um alto índice de placa dental e uma alta prevalência de periodontite (48,3%), principalmente na forma crônica moderada e localizada. Os indivíduos com periodontite apresentaram níveis mais altos de IL-1 e MMP-2, enquanto indivíduos com doença cardiovascular (CVD) e com mais de duas doenças sistêmicas (MSD) apresentaram níveis mais altos de IL-1 e os com diabetes mellitus (DM) e MSD apresentaram níveis mais elevados de IL-6. Foi encontrada associação positiva entre a gravidade da periodontite e CVD (OR 2.2; IC = 1,11-4,42). Este estudo reportou uma prevalência de periodontite em 48.3% dos pacientes em UTI e uma associação positiva entre ocorrência de periodontite e CVD. Além disso, níveis mais elevados de IL-1 e MMP-2 foram encontrados em indivíduos com periodontite, de IL-6 em indivíduos com DM e de IL-1 em indivíduos com CVD.

Erupção passiva alterada: tratamento e diagnóstico com tomografia computadorizada feixe cônico / Altered passive eruption: treatment and diagnosis with cone-beam computed tomography

O plano de tratamento para a exposição gengival excessiva depende da determinação precisa de importantes estruturas anatômicas através do exame clínico periodontal. A tomografia computadorizada é um exame que produz uma série de radiografias transversais que, posteriormente, são processadas por um computador, melhorando a precisão diagnóstica. Este artigo apresenta um relato de caso clínico sobre o planejamento terapêutico de exposição gengival excessiva, decorrente da erupção passiva alterada, utilizando o exame tomográfico. O exame tomográfico foi realizado com a paciente utilizando um retrator labial de plástico. A análise desse exame complementar demonstrou que a coroa clínica real era maior que a coroa aparente. Adicionalmente, revelou que a distância entre a junção cemento esmalte e a crista óssea alveolar era de 1 mm em média, indicando a ressecção óssea. O exame tomográfico com o uso de retrator labial permitiu maior qualidade e precisão na análise das estruturas anatômicas, auxiliando no diagnóstico, na determinação do prognóstico e no planejamento do tratamento da exposição gengival excessiva.

The treatment plan for excessive gingival display depends on the precise determination of important anatomical structures through periodontal clinical examination. The computed tomography is an examination that produces a series of transverse radiographies that are later processed by a computer, improving diagnostic accuracy. This article presents a clinical case report on the therapeutic planning of excessive exposure, due to altered passive eruption, using tomographic examination. The tomography exam was performed with the patient using a plastic labial retractor. The analysis of this complementary exam showed that the actual clinical crown was larger than the apparent crown. Additionally, it was found that the distance between cemento-enamel junction and the alveolar bone crest was 1mm on average, indicating bone resection. The tomographic exam with the use of a labial retractor allowed greater quality and precision in the analysis of the anatomical structures, aiding diagnosis, in the determination of the prognosis and in the planning of the treatment of excessive gingival display.

Associação entre beta-defensinas e periodontite / Association between beta-defensins and periodontitis: literature review

Objetivo: as beta-defensinas humanas (hBDs) podem ter um papel-chave na susceptibilidade às doenças na cavidade bucal. Além do efeito antimicrobiano direto, as hBDs aumentam a imunidade adaptativa. O objetivo deste estudo foi realizar uma revisão de literatura científica sobre a relação entre beta-defensinas (hBD) e periodontite. Material e métodos: foi realizada uma pesquisa bibliográfica na base de dados PubMed sobre a expressão de hBDs em indivíduos com periodontite. Os termos beta defensins e periodontitis foram utilizados nessa busca. Resultados: foram selecionados, por um revisor, sete artigos para serem incluídos nessa revisão de literatura: dois estudos de intervenção e cinco estudos transversais. Conclusão: o número de estudos sobre a expressão de beta-defensinas em indivíduos com periodontite é reduzido. O conhecimento sobre o papel das beta-defensinas na periodontite pode trazer um maior entendimento de sua etiopatogenia, além de possibilitar novos indicadores de risco e terapias. Estudos adicionais são necessários para a elucidação da relação entre esses peptídeos antimicrobianos e a periodontite.

Objective: human beta-defensins (hBDs) may play a key role in the susceptibility to diseases in the oral cavity. In addition to the direct antimicrobial effect, hBDs enhance adaptive immunity. The objective of this study was to investigate the literature on the relationship between hBD and periodontitis. Material and methods: a literature review was conducted in the PubMed database on the expression of hBDs in subjects with periodontitis. The terms "beta-defensins" and "periodontitis" were used in this search. Results: seven articles were selected being: two intervention studies and fi ve cross-sectional studies. Conclusion: the number of studies on the expression of beta-defensins in individuals with periodontitis is reduced. Knowledge about the role of beta-defensins in periodontitis may lead to a better understanding of their etiopathogenesis, in addition to providing new risk indicators and therapies. Additional studies are needed to elucidate the relationship between these antimicrobial peptides and periodontitis.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis / Os efeitos do tabagismo sobre a perda dentária em indivíduos em terapia periodontal de suporte: uma revisão sistemática e meta-análise / Los efectos del consumo de tabaco en la pérdida de dientes entre personas con una terapia de mantenimiento periodontal: un revisión sistemática y metaanálisis

Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Resumo: A perda dentária tem sido relatada em estudos longitudinais sobre terapia periodontal de suporte (TPS), mas houve menos investigação sobre o efeito independente do tabagismo sobre a perda dentária, ajustado por importantes variáveis de confusão. Esta revisão sistemática teve como objetivo avaliar e analisar o efeito isolado do tabagismo sobre perda dentária em indivíduos em TPS. A estratégia incluiu fontes eletrônicas, busca manual, literatura cinzenta e artigos recentes (publicados a partir de abril de 2018), sem restrição quanto ao idioma; as datas de publicação foram incluídas. Foram selecionados estudos clínico-epidemiológicos com dados sobre perda dentária entre tabagistas em TPS, comparado com grupos-controle de não-tabagistas. A qualidade metodológica foi avaliada com a Escala de Newcastle-Ottawa. Foi realizada uma meta-análise, assim como, I2 testes de heterogeneidade e de sensibilidade. A qualidade das evidências foi avaliada com a escala GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Onze artigos foram incluídos na revisão sistemática, sendo quatro estudos de casos e controles e sete estudos de coorte. Dez dos 11 estudos concluíram que o tabagismo é importante fator de risco para a ocorrência de perda dentária. De acordo com a meta-análise de quatro dos estudos de coorte, os tabagistas em TPS apresentavam risco 3,24 vezes maior de ocorrência de perda dentária quando comparados aos não tabagistas (IC95%: 1,33-7,90). O risco global de viés nos estudos foi baixo. A revisão mostrou qualidade moderada das evidências científicas de que os tabagistas em TPS apresentam risco maior de perda dentária do que os não-tabagistas.

Resumen: La mortalidad dental ha sido estudiada en estudios longitudinales acerca de la terapia de mantenimiento periodontal (TMP), pero el efecto independiente de fumar en la pérdida de dientes (PD), ajustado a variables de confusión importantes, se ha evaluado muy poco. Esta revisión sistemática tuvo como objetivo evaluar y analizar el efecto aislado de fumar en la PD con personas bajo TMP. Se investigó en medios electrónicos, manuales, literatura gris, y artículos recientes (desde abril 2018), sin restricciones respecto a la lengua; incluyendo sus respectivas fechas de publicación. Además, se seleccionaron estudios clínicos epidemiológicos que trabajaban sobre datos de PD entre fumadores que estaban bajo TMP, en comparación con grupos de control de no fumadores. La calidad metodológica se evaluó usando la Escala de Newcastle-Ottawa. Se realizó un metaanálisis, así como tests de heterogeneidad I2 y sensibilidad. La evidencia de calidad fue evaluada usando GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Se incluyeron once trabajos en la revisión sistemática (cuatro de caso-control y siete estudios de cohortes). Diez de los once estudios concluyeron que fumar era un factor de riesgo importante para la ocurrencia de PD. Los metaanálisis de cuatro de los estudios de cohorte descubrieron que los fumadores tenían 3,24 veces más la oportunidad de sufrir PD, en comparación con los no fumadores TMP (IC95%: 1,33-7,90). En general, el riesgo de sesgo en los estudios fue bajo. La calidad de la evidencia científica respaldó moderadamente que los fumadores bajo TMP contaban con más oportunidad de PD que los no fumadores.

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

Plaque index and gingival index during rapid maxillary expansion of patients with unilateral cleft lip and palate

ABSTRACT Objective: To assess, during rapid maxillary expansion, the plaque index (PI) and the gingival index (GI) of patients with unilateral cleft lip and palate(UCLP) using Hyrax (HX) or inverted mini-Hyrax (IMHX) rapid maxillary expanders (RME) considering patients' sex and age. Methods: PI (Quigley Index modified by Turesky et al) and GI (Löe and Silness) of 28 UCLP (11 females; 17 males: aged 8 to 15 years) submitted to daily RME activation were assessed before (T0) and 7 (T1), 28 (T2) and 90 (T3) days after activation. Log-linear models and Bonferroni correction were performed to analyze possible differences in PI and GI between RME, sexes or age groups over time. Results: Intra-group comparison revealed significant increases in PI of patients using HX (T0 < T2), IMHX (T0 < T3; T1< T3), males (T0 < T1; T0 < T2; T0 < T3) or aged 12-15 years (T0 < T1; T0 < T2; T0 < T3), and in GI of patients using IMHX (T0 < T3; T1 < T3), females (T1 < T3; T2 < T3) or aged 12-15 years (T0 < T3; T2 < T3). One inter-group difference in GI according to patients' age (8-11 < 12-15; T1) was observed. Conclusions: Since a single difference between groups was encountered, the results of this study indicated that PI and GI during maxillary expansion were similar between HX and IMHX, sexes and the analyzed age groups. Therefore, orthodontists can use these RME in UCLP patients according to the patient's necessity or their preferences.

RESUMO Objetivo: avaliar, durante a expansão rápida da maxila (ERM), o índice de placa dentária (IP) e o índice gengival (IG) de pacientes com fissura labiopalatina unilateral (FLPU), usando o aparelho disjuntor Hyrax (HX) ou o mini-Hyrax invertido (MHXI), considerando-se também o sexo e a idade. Métodos: o IP (Quigley-Hein modificado por Turesky et al.) e o IG (Silness e Löe) de 28 pacientes com FLPU (11 meninas; 8-15 anos de idade) tratados com ativação diária do aparelho de ERM foram avaliados antes (T0) e após 7 (T1), 28 (T2) e 90 (T3) dias da ativação inicial. Modelos de regressão log-linear e correção de Bonferroni foram usados para analisar as possíveis diferenças de IP e IG entre os grupos, de acordo com o tipo de aparelho de ERM, sexo e idade, ao longo do tempo. Resultados: as comparações intragrupos revelaram aumentos significativos do IP em pacientes usando HX (T0< T2) ou MHXI (T0< T3; T1< T3), com idades entre 12 e 15 anos (T0 < T1; T0 < T2; T0 < T3), e do IG de pacientes usando MHXI (T0< T3; T1< T3), que eram meninas (T1 < T3; T2 < T3), com idades entre 12 e 15 anos (T0 < T3; T2 < T3). Uma diferença no IG entre grupos foi observada em relação à idade dos pacientes (8-11 < 12-15; T1). Conclusões: uma única diferença entre grupos foi encontrada, o que sugere que os resultados de IP e IG, durante a expansão maxilar, foram semelhantes entre os grupos HX e MHXI, bem como entre os sexos e idades analisadas. Dessa forma, os ortodontistas podem usar esses aparelhos de ERM no tratamento de pacientes com FLPU de acordo com as necessidades do paciente ou suas preferências.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial

Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.

Periodontitis and type 2 diabetes among women with previous gestational diabetes: epidemiological and immunological aspects in a follow-up of three years

Abstract Periodontitis can contribute to the development of insulin resistance. Gestational diabetes is a risk factor for type 2 diabetes. Therefore, periodontitis, when associated with gestational diabetes, could increase the risk for the development of type 2 diabetes after pregnancy. Objective The aim of this study was to verify the incidence on the development of type 2 diabetes in women with previous gestational diabetes with and without periodontitis after a three-year time interval. Material and Methods Initial sample of this follow-up study consisted of 90 women diagnosed with gestational diabetes who underwent periodontal examination. After three years, 49 women were subjected to new periodontal examination and biological, behavioral, and social data of interest were collected. Additionally, the quantification of the C-reactive protein in blood samples was performed. Fasting glucose and glycated hemoglobin levels were requested. Saliva samples were collected for quantification of interleukin 6 and 10, tumor necrosis factor α, matrix metalloproteinase 2 and 9. Results The incidence of type 2 diabetes mellitus was 18.4% and of periodontitis was 10.2%. There was no significant difference in the incidence of type 2 diabetes mellitus among women with and without periodontitis. It was observed impact of C-reactive protein in the development of type 2 diabetes mellitus. However, it was not observed impact of periodontitis on the development of type 2 diabetes mellitus among women with previous gestational diabetes. Conclusions It was not observed impact of periodontitis on the development of type 2 diabetes among women with previous gestational diabetes. The impact of C-reactive protein in the development of type 2 diabetes mellitus highlights the importance of an inflammatory process in the diabetes pathogenesis.

Disfunção endotelial e periodontite ­ predição de risco para eventos cardiovasculares / Periodontitis and endothelial dysfunction ­ risk prediction for cardiovascular events

O objetivo deste estudo foi realizar uma revisão da literatura sobre a associação entre a disfunção endotelial, diagnosticada no exame de dilatação mediada por fluxo (DMF) da artéria braquial, e a periodontite crônica. Algumas evidências demonstraram uma associação entre as infecções periodontais e a disfunção endotelial. Alterações na função endotelial estão intimamente relacionadas com a aterosclerose, bem como seus fatores de risco, e constituem uma etapa intermediária na progressão de eventos adversos ao longo da história natural da doença cardiovascular, sendo esta uma das maiores causas de morte no mundo. A busca por artigos foi realizada no site Pubmed com as palavras-chave: periodontite, periodontite crônica, endotélio vascular, enfartos, derrames e doenças cardiovasculares. Após a busca, nove artigos foram selecionados para entrar nesta revisão. Os resultados dos estudos mostraram que indivíduos com periodontite apresentam a função endotelial prejudicada, quando comparados a indivíduos sem periodontite, e o tratamento da doença periodontal melhora a disfunção endotelial. Concluiu-se que a periodontite (DP) parece influenciar na função endotelial, e o seu tratamento pode melhorar a disfunção endotelial, um preditor de eventos cardiovasculares.

The aim of this study is to conduct a literature review on the association between endothelial dysfunction diagnosed on examination of flow-mediated dilatation (DMF) and chronic periodontitis. Some evidence shows an association between periodontal infections and endothelial dysfunction. Changes in endothelial function are closely related to atherosclerosis and its risk factors and is an intermediary step in the progression of adverse events throughout the natural history of cardiovascular disease, which is one of the largest causes of death worldwide. The electronic search was performed on Pubmed with the following key words: periodontitis, chronic periodontitis, vascular endothelium, heart attacks, strokes, cardiovascular diseases; overall, 9 articles were selected. The results of the studies showed that individuals with periodontitis have impaired endothelial function when compared to patients without periodontitis and the treatment of periodontal disease improves endothelial dysfunction. It was concluded that periodontal disease (PD) appears to influence on endothelial function and the treatment of periodontitis could improve endothelial dysfunction is a predictor of cardiovascular events.

Frequency of periodontal pathogens and Helicobacter pylori in the mouths and stomachs of obese individuals submitted to bariatric surgery: a cross-sectional study

ABSTRACT Objectives This cross-sectional study compared the frequency of oral periodontopathogens and H. pylori in the mouths and stomachs of obese individuals with or without periodontitis submitted to bariatric surgery. Material and Methods One hundred and fifty-four men and women aged 18-65 were conveniently distributed into four groups. Two groups were composed of individuals who underwent bariatric surgery with (BP) (n=40) and without (BNP) (n=39) periodontitis and two obese control groups with (CP) (n=35) and without (CNP) (n=40) periodontitis. The oral pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Parvimonas micra, Treponema denticola, Tannerella forsythia, Campylobacter rectus, and Helicobacter pylori were detected by a polymerase chain reaction technique using saliva, tongue and stomach biopsy samples. Results Statistical analysis demonstrated that periodontopathogens were highly frequent in the mouth (up to 91.4%). In the bariatric surgically treated group, orally, P. gingivalis, T. denticola and T. forsythia were more frequent in periodontitis, while C. rectus was more frequent in non-periodontitis subjects. Stomach biopsies also revealed the high frequency of five oral species in both candidates for bariatric surgery (91.6%) and the bariatric (83.3%) groups. H. pylori was frequently detected in the mouth (50.0%) and stomach (83.3%). In the stomach, oral species and H. pylori appeared in lower frequency in the bariatric group. Conclusions Obese individuals showed high frequencies of periodontopathogens and H. pylori in their mouths and stomachs. Bariatric surgery showed an inverse microbial effect on oral and stomach environments by revealing higher oral and lower stomach bacterial frequencies.

Impact of different settings in periodontitis prevalence / Impacto das diferentes definições na prevalência de periodontite

Methods: The sample consisted of 200 pregnant women from a database. A Medline search was conducted to identify studies that evaluated the association between periodontitis and gestational diabetes. Periodontitis case definitions used in the retrieved studies were applied in the sample. The frequency of periodontitis among the different diagnostic criteria was compared through the Chi-square test. Results: After conducting a search, analysis, and selection from the literature, nine studies were included in the present study. Three studies showed the same criteria. As a result, seven different periodontitis definitions were identified. The frequency of periodontitis in the sample ranged from 24.5% to 72.5%. Conclusion: The prevalence of periodontitis greatly varies when different diagnostic criteria are used. The standardization of periodontitis case definitions in epidemiological studies is crucial for a better comparison among the studies and improvement of the results.(AU)

Objetivo: O objetivo deste estudo foi avaliar o impacto de diferentes critérios de diagnóstico na prevalência de periodontite em mulheres grávidas. Métodos: A amostra foi composta por 200 mulheres grávidas de um banco de dados. Uma pesquisa na base de dados Medline foi realizada para identificar estudos que avaliaram a associação entre periodontite e diabetes gestacional. Os diferentes critérios de diagnóstico para periodontite utilizados nesses estudos foram aplicados em nossa amostra. A comparação da frequência de periodontite entre os diferentes critérios de diagnóstico foi realizada utilizando o teste quiquadrado. Resultados: Após pesquisa bibliográfica, análise e seleção 9 estudos foram incluídos no presente estudo. Três estudos apresentavam o mesmo critério e, portanto, 7 diferentes critérios para diagnóstico da periodontite foram identificados. A prevalência de periodontite na amostra variou de 24,5% a 72,5% dependendo do critério diagnóstico utilizado. Conclusão: Na mesma amostra a prevalência de periodontite pode variar quando diferentes critérios foram utilizados para o diagnóstico. A padronização da definição de periodontite em estudos epidemiológicos é crucial para melhor comparação entre os estudos e melhoria dos resultados.(AU)