Self-reported questionnaire on periodontal condition validated for use in Brazil

Abstract: There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

New tendencies in non-surgical periodontal therapy

Abstract The aim of this review was to update the evidence of new approaches to non-surgical therapy (NSPT) in the treatment of periodontitis. Preclinical and clinical studies addressing the benefits of adjunctive antimicrobial photodynamic therapy, probiotics, prebiotics/synbiotics, statins, pro-resolving mediators, omega-6 and -3, ozone, and epigenetic therapy were scrutinized and discussed. Currently, the outcomes of these nine new approaches, when compared with subgingival debridement alone, did not demonstrate a significant added clinical benefit. However, some of these new alternative interventions may have the potential to improve the outcomes of NSPT alone. Future evidence based on randomized controlled clinical trials would help clinicians and patients in the selection of different adjunctive therapies.

Gingival crevicular fluid response to protocols of non-surgical periodontal therapy: A longitudinal evaluation

Context and Aim: Gingival crevicular fluid (GCF) volume reflects the level of periodontal inflammation. This secondary analysis aimed to evaluate the GCF volume in patients submitted to non-surgical periodontal therapies under a split-mouth design. Materials and Methods: GCF volume of 25 participants (47.24 ± 6.47 years) with moderate-to-severe chronic periodontitis was collected at Days 0, 30, 60, 90, 120, 270, and 450. The participants were submitted to three different non-surgical therapies randomly assigned per quadrant [GI: supragingival control (Supra) as only intervention (one quadrant); GII: Supra plus scaling and root planing (SRP) on Day 0 (two quadrants); GIII: Supra on Day 0 and SRP 30 days later (one quadrant)]. During treatment (0–60 days) and maintenance (90–450 days) participants were submitted to supragingival plaque control reinforcements. GCF volumes were analyzed after logarithmic transformation (log10) and linear models were used for intra- and inter-group comparisons, considering the data dependence. Results: Baseline GCF volumes were similar between groups (GI: 0.39 ± 0.22 μl; GII: 0.42 ± 0.26 μl; GIII: 0.41 ± 0.14 μl;P > 0.05). At Day 60, GCF volumes were significantly reduced (GI: 0.20 ± 0.13 μl; GII: 0.18 ± 0.11 μl; GIII: 0.22 ± 0.13 μl; P < 0.001), without inter-groups differences. These results were maintained along maintenance period (P > 0.05). Even in sites bleeding on probing (BOP) + the means of GCF volume did not differ between groups (P > 0.05). Conclusions: All therapies determined reductions on the GCF volume along time. Supragingival plaque control modulated the subgingival area during the study, reinforcing the importance of this control over the subgingival inflammatory response.

Impact of smoking on gingival inflammation in representative samples of three South American cities

Abstract The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

A multicenter study of oral health behavior among adult subjects from three South American cities

Abstract The aims of this study were to describe the self-reported oral hygiene habits, dental visit frequency, and gingival bleeding perception in adult populations from three South American cities, and also to assess the association of these variables with sociodemographic data and with the clinical presence of plaque and gingival inflammation. Five-hundred and fifty adult subjects from each city (Porto Alegre, Brazil; Tucumán, Argentina; Santiago, Chile) received full mouth examinations to determine visible plaque and gingival index. A structured questionnaire on demographics, habits, attitudes and knowledge of oral health was also administered. The data were analyzed according to dental visit frequency, toothbrushing frequency, interproximal tooth cleaning frequency, subjects' perception of gum bleeding, and proportion of subject sites with VP and bleeding sites. Analysis of the association among the variables was performed using either a chi-square test or Fischer's exact test. Toothbrushing twice a day or more was reported by 84.2% of the subjects, but only 17.7% reported daily interdental cleaning, and 60.2% reported visiting a dental clinic only in an emergency. Only 2.97% had no bleeding sites, whereas 33.7% had 50% or more bleeding sites. Regular interdental self-cleaning and a dental visit every 3-6 months was associated with less plaque and less gingival bleeding. More than 12 years of education was associated with healthier habits, less bleeding and plaque scores. In conclusion, the oral health behavior of South American adult subjects from these cities is below the international recommendations, especially in relation to interdental cleaning and regular dental visits.

Tooth Loss in Patients under Periodontal Maintenance in a Private Practice: A Retrospective Study

Abstract The aim of the present study was to evaluate the incidence and causes of tooth loss in periodontal subjects from a private practice in Brazil. Two trained examiners extracted data from the records of subjects who sought periodontal treatment from 1980 to 2013. Only records of patients who completed the non-surgical periodontal treatment and had at least one visit for maintenance were included. Data were analyzed by chi-square test, Student's t-test, Kaplan-Meier survival curve and Cox regression. A total of 3,319 records were reviewed and 737 records included (58.6% women, mean age of 46.6±13.0 years at the beginning of the treatment). Maintenance period ranged from 1 to 33 years (7.4±6 years). During this period, 202 individuals (27.4%) lost 360 teeth, 47.5% of losses within the first five years (n=171). Non-compliers lost more teeth than compliers (p<0.001), respectively 211 and 149 teeth. Regarding reasons of tooth loss, 84 individuals lost 38% of the teeth from periodontal disease progression (n=137). Survival analysis showed that most patients lost only one tooth from periodontal disease, and differences in the survival rates between compliers and non-compliers were observed following the second tooth loss. Approximately one-third of tooth losses was related to periodontal disease progression, and there was stability in time of the proportion of losses from disease progression and other reasons. Therefore, it is possible to conclude that compliant patients in a private practice lose fewer teeth than do non-compliers. Among compliers, periodontal disease progression was not the main cause of tooth loss.

Resumo O objetivo do presente estudo foi avaliar a incidência e causas de perda dentária em pacientes em manutenção periódica preventiva (MPP) de uma clínica privada. Dois examinadores extraíram os dados de registros de pacientes que procuraram tratamento periodontal entre 1980 a 2013. Os registros de pacientes que completaram o tratamento periodontal não cirúrgico e tiveram ao menos uma visita de MPP foram incluídos. Os dados foram avaliados utilizando os testes chi-quadrado, T de Student, curva de sobrevida de Kaplan-Meier e regressão de Cox. Dos 3.319 prontuários, 737 foram incluídos (58,6% mulheres, 46,6±13,0 anos). O período de MPP variou de 1 a 33 anos (7,4±6 anos). Durante este período, 202 indivíduos (27,4%) perderam 360 dentes, 47,5% das perdas durante os primeiros 5 anos de manutenção (n=171). Indivíduos irregulares nas consultas de MPP perderam mais dentes (p<0.001) do que indivíduos com regularidade, 211 e 149 dentes respectivamente. Oitenta e quatro indivíduos perderam 38% de dentes por progressão de doença periodontal (n=137). A maioria dos indivíduos perdeu 1 dente por doença periodontal, e foram observadas diferenças na sobrevida a partir da segunda perda dentária quando comparados indivíduos regulares e irregulares na MPP. Aproximadamente um terço dos dentes perdidos estava relacionado à progressão de doença periodontal. Foi observada uma estabilidade na proporção de perdas por progressão de doença e outras razões ao longo do tempo. Desta forma, conclui-se que indivíduos com uma frequência regular de MPP perdem menos dentes e a progressão de doença nesses indivíduos não é a principal razão para perda dentária.

Microbiological outcomes from different periodontal maintenance interventions: a systematic review

Abstract This study aimed to investigate the differences in the subgingival microbiological outcomes between periodontal patients submitted to a supragingival control (SPG) regimen as compared to subgingival scaling and root planing performed combined with supragingival debridement (SPG + SBG) intervention during the periodontal maintenance period (PMP). A systematic literature search using electronic databases (MEDLINE and EMBASE) was conducted looking for articles published up to August 2016 and independent of language. Two independent reviewers performed the study selection, quality assessment and data collection. Only human randomized or non-randomized clinical trials with at least 6-months-follow-up after periodontal treatment and presenting subgingival microbiological outcomes related to SPG and/or SPG+SBG therapies were included. Search strategy found 2,250 titles. Among these, 148 (after title analysis) and 39 (after abstract analysis) papers were considered to be relevant. Finally, 19 studies were selected after full-text analysis. No article had a direct comparison between the therapies. Five SPG and 14 SPG+SBG studies presented experimental groups with these respective regimens and were descriptively analyzed while most of the results were only presented graphically. The results showed that both SPG and SPG+SBG protocols of PMP determined stability in the microbiological results along time. Nevertheless, new studies comparing these interventions in PMP are needed, especially if the limitations herein discussed could be better controlled.

Do controle de placa ao controle do biofilme supragengival: o que aprendemos ao longo dos anos? / From plaque control to the supragingival biofilm control: what have we learnt over time?

As doenças periodontais de maior prevalência são aquelas relacionadas à presença da placa bacteriana, hoje entendida como um biofilme dental. A compreensão da dinâmica deste reacendeu antigas discussões que, desde então, buscavam determinar quais as formas elegíveis e preferíveis para o tratamento daquelas doenças. Sob o conceito de "placa dentária", o tratamento da gengivite, mas principalmente o da periodontite, ora levaram ao extremo da tentativa de eliminação de toda e qualquer "placa", ora conduziram ao uso, até hoje indiscriminado, de antibióticos. Atualmente, o conceito de biofilme dental, entendido como comunidades microbianas com mecanismos interdependentes de autorregularão, nutrição e comunicação, a ponto de manterem um sinergismo que vai ao encontro da sua subsistência, alterou a forma não só de entender a etiologia das doenças periodontais, mas de como tratá-las. Neste conceito, o papel dos microrganismos não necessariamente aponta para tipos bacterianos específicos como causadores da doença, mas para as doenças periodontais como uma infecção oportunista. Paralelamente, o biofilme supragengival passou a significar mais do que o fator etiológico das gengivites, passando a ser compreendido, também, como fundamental modulador do ambiente subgengival. Neste cenário, a terapia periodontal passa por desafios inerentes a uma mudança conceitual, tais como compreender o significado do controle supragengival para a prevenção, tratamento e manutenção dos resultados terapêuticos. Portanto, esta revisão teve por objetivo apresentar a plausibilidade biológica do controle do biofilme supragengival como fundamental para a terapia periodontal e, além disto, discutir resultados de estudos sob o conceito de doença periodontal como uma infecção oportunista.

The most prevalent periodontal diseases are those associated with the presence of dental plaque, nowadays understood as a dental biofilm. The comprehension of the biofilm dynamics rekindled old discussions that, since then, sought to determine the eligible and preferred therapies for periodontal diseases. Under the concept of "dental plaque", the gingivitis treatment, and also the periodontitis one were based on the elimination of every and any plaque or of some bacteria species. The later determining the indiscriminate use of antibiotics. Currently, the biofilm concept, understood as microbial communities with interdependent mechanisms of self-regulation, nutrition and communication and involved in a synergism to render its subsistence, changed the way not only to understand the periodontal diseases etiology but, in special, the way to treat them. Under this concept, the role of microorganisms not necessarily points to specific bacteria infecting the sites and causing diseases, but to periodontal diseases as an opportunist infection linked to a retro feeding process between the dental biofilm and the host. Alongside, the supragingival biofilm has meant more than the etiologic factor of gingivitis, but also as an important modulator of subgingival environment. In this sense, the periodontal therapy is challenged by conceptual trends, such as the comprehension of the meaning of supragingival control for the prevention, treatment and maintenance of therapeutic results. Therefore, the present review aimed to revise the role of the supragingival biofilm control to periodontal condition, and, also, to discuss results of studies under the concept of periodontal diseases as opportunists infections.

Influence of supragingival biofilm control and smoking habit on Interleukin-1β concentration

This investigation compared gingival crevicular fluid (GCF) interleukin-1β (IL-1β) concentrations in periodontitis patients subjected to a strict supragingival biofilm control (Supra) for 6 months. Never-smokers (23) and smokers (n = 20; 19.6 ± 11.8 cigarettes/day) moderate-to-severe chronic periodontitis patients underwent a 6 months period of supragingival control with weekly recall visits. Periodontal probing depth (PPD), bleeding on probing (BOP) and GCF samples (from different PPD category sites: 3-5 mm and 6–10 mm) were obtained at the baseline, 30, and 180 days. IL-1β was assessed by enzyme-linked immunosorbent assay. Generalized estimating equations were used to fit prediction models of IL-1β changes, considering the dependence between the examinations, and using only data from experimental sites. Overall IL-1β concentrations decreased from 3.2 pg/µL to 1.9 pg/µL. Higher baseline IL-1β concentrations were associated with higher baseline PPD values in both groups. There were no differences in IL-1β concentrations between never-smokers and smokers over time for any PPD category. Higher baseline PPD values and the presence of BOP on day 180 were significantly associated with higher IL-1β concentrations. A strict Supra regimen reduced IL-1β concentrations over time in periodontitis patients. The benefits observed for smokers underline the importance of oral hygiene measures, even considering the presence of this important risk factor.

Efficacy of a triclosan formula in controlling early subgingival biofilm formation: a randomized trial

The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the testversus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.

Perspectivas atuais sobre halitose bucal: revisão de literatura / Current Perspectives on Oral Halitosis: a literature review

Datam da década de 70 os primeiros estudos para elucidar uma questão bucal relevante e até hoje ainda não totalmente explorada, a halitose. Apesar de avanços no conhecimento etiológico, a busca pelos meios e métodos mais adequados para o diagnóstico da halitose, bem como a identificação das terapias eletivas para as diversas origens do mau hálito, permanecem necessárias. Sabe-se que a halitose de origem bucal, a forma mais prevalente, pode ser diagnosticada por vários métodos, seja pela utilização de aparelhos e instrumentos onerosos e complexos, seja por meio da percepção do cirurgião-dentista ou do próprio paciente. Supostamente nenhum instrumento é desprovido de deficiências, cabendo, portanto, ao profissional a escolha do melhor método de diagnóstico em cada caso. Confirmando se o diagnóstico da halitose bucal, sua terapia deverá ser direcionada primariamente à eliminação de sua etiologia, comumente a presença de doenças periodontais. Pelo exposto, o objetivo da presente revisão de literatura é levantar e fornecer informações que possam auxiliar o dia-a-dia do cirurgião-dentista na busca por métodos que facilitem o diagnóstico da halitose e que, concomitantemente, conduzam a um adequado manejo terapêutico.

The first studies that aimed to elucidate a relevant, and still little explored, oral condition such as the halitosis date from the Seventies. Despite of advances in the knowledge of halitosis etiology, the search for the best method of diagnosis, as well as the possible therapies for bad breath, are still necessary. Halitosis of oral origin, the most prevalent, and can be diagnosed by different methods, since from the use of complex and expensive equipment and instruments to patients’ perceptions. As there is no method devoid of problems, it is up to the dentist to select the best method to each case. When confirmed the halitosis diagnosis, the therapy must be directed to eliminate its etiology, usually periodontal diseases. Therefore, the aim of this review of the literature is to provide information that may assist dentists in the selection of the best diagnostic method for halitosis and that, consequently, lead to an appropriate therapeutic approach.

Espaço biológico do periodonto: um conceito a ser revisto / Periodontal biological width: a concept to be revisited

O espaço biológico do periodonto (EBP) é parte da união dentogengival e compreende o epitélio juncional e a inserção conjuntiva supracrestal. Tradicionalmente, a odontologia postulou que, sob hipótese alguma, esse espaço poderia ser invadido por qualquer procedimento restaurador, porque, frente à invasão, sugerir-se-ia que uma perda óssea alveolar contínua inexoravelmente aconteceria, colocando inclusive o dente sob risco de perda. Entretanto, estudos em animais e em humanos, dedicados a essa temática, têm questionado alguns dos tradicionais conceitos vinculados ao EBP. É comum que, frente à invasão desse espaço, haja inflamação crônica, que somente acarretará perda tecidual continuada, caso haja um paciente suscetível às doenças periodontais, associado a um controle do biofilme deficiente. O presente texto faz uma reflexão sobre o significado do EBP para a odontologia, considerando-se as evidências contemporâneas sobre as consequências de sua invasão.

Periodontal biological width is part of the dentogingival area and comprises the junctional epithelium and the connective tissue attachment. Traditionally, dentistry has postulated that, under no conditions, periodontal biological width could be invaded by any type of restorative procedure. This is related to the fact that, if it is trespassed, it is suggested that alveolar bone loss would certainly occur, thus increasing the risk of tooth loss. However, animal and human studies have dedicated to this subject and have observed that the inviolability of this width might be questioned. It is common that, in face of the trespass of this width, chronic inflammation would occur, however this would lead to continuous tissue loss if the patient is susceptible to periodontal diseases, associated with an improper biofilm control. The present text discusses the meaning of the biological width for dentistry, considering the contemporary evidence about the consequences of its trespass.

Response of molars and non-molars to a strict supragingival control in periodontal patients

The posterior position in the arches is one of the factors that underlies the poor prognosis of molar teeth (M). It is speculated that M do not benefit from the oral hygiene routine as well as non-molars (NM) do. This study evaluated the response of M and NM to supragingival control during a 6-month period in 25 smokers (S) and 25 never-smokers (NS) with moderate-to-severe periodontitis. One calibrated examiner assessed visible plaque (VPI) and gingival bleeding (GBI) indexes, periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) at days 0 (baseline), 30 and 180. At baseline, M showed significantly higher mean values of VPI (p = 0.017) and PPD (p < 0.001) compared with NM; CAL was also greater in M (p < 0.001) and was affected by smoking (p = 0.007). The reductions obtained for periodontal indicators at day 180 showed similar responses between M and NM. For CAL, M (NS 0.57 ± 0.50; S 0.67 ± 0.64) and NM (NS 0.38 ± 0.23; S 0.50 ± 0.33) reached an almost significant difference (p = 0.05). Smoking did not influence the response to treatment. Multilevel analysis revealed that, only for PDD reductions, the interaction between sites, teeth and patient was significant (p < 0.001). It was concluded that M benefit from an adequate regimen of supragingival biofilm control; therefore, supragingival condition should be considered in the prognosis of molar teeth.

Qualidade de vida relacionada à saúde bucal: perspectivas para a periodontia / Oral health-related quality of life: periodontal perspectives

O conceito de qualidade de vida, principalmente na área médica, tem sido abordado nas últimas décadas. Na Odontologia, abre-se, também, uma perspectiva interessante à medida que se percebe que as condições bucais determinam, sim, impactos relacionados à percepção de qualidade de vida. Recentemente, vem se demonstrando, por exemplo, que a doença periodontal interfere, negativamente, com esta percepção. Por outro lado, apesar de identificado por poucos estudos, o tratamento periodontal tem demonstrado ser capaz de proporcionar uma melhora na percepção dos pacientes. Na odontologia, existem diversos instrumentos capazes de avaliar o impacto de problemas bucais na qualidade de vida das pessoas. No entanto, neste universo, ainda desconhecido, muitas são as dúvidas a respeito destas pesquisas. Condições a serem avaliadas, instrumentos a serem utilizados e populações a serem investigadas ainda são questões abertas. Portanto, o objetivo do presente estudo é, a partir de uma revisão da literatura referente aos impactos causados pela doença periodontal e o efeito de seu tratamento na qualidade de vida relacionada à saúde bucal dos pacientes, trazer informações que possam auxiliar o dia a dia do periodontista na busca por métodos que possam conferir uma abordagem completa das propostas terapêuticas empregadas

The concept of quality of life has been widely discussed in the last few decades. It is well known that conditions, such as, denture usage, caries and number of teeth can produce impacts on oral health related quality of life. Recently, studies described that periodontal disease has an important effect on patients’ perceptions concerning their quality of life. On the other hand, although described by few studies, periodontal treatment can be beneficial regarding these impacts. In dentistry, there are several instruments capable to evaluate the effect of oral problems on people’s quality of life. However, there are still doubts upon this subject. Conditions evaluated, questionnaires used and populations investigated are still questions to be answered. Therefore, the aim of this study is, from a review of the literature referring to impacts caused by periodontal diseases and its treatment on oral health related quality of life, to provide information to assist periodontists on the search of methods that can provide complete therapeutic approaches

Efeito do controle do biofilme supragengival na condição periodontal de pacientes tabagistas: uma revisão sistemática / Effect of supragingival plaque control on periodontal disease in smokers: a systematic review

Objetivo: avaliar, por meio de uma revisão sistemática da literatura, se o controle do biofilme supragengival, em pacientes fumantes, é capaz de alterar os critérios clínicos e microbiológicos associados à periodontites. Metodologia: a estratégia de busca envolveu o uso de bases de dados eletrônicos: MEDLINE e Cochrane Oral Health Group, entre 1965 e Janeiro de 2009. As palavras-chave utilizadas no MEDLINE foram: supragingival plaque control AND (subgingival OR debridement OR scaling and root planing OR non surgical OR oral hygiene OR periodontitis OR gingivitis OR plaque subgingival OR lost attachment OR probing pocket depth OR bleeding).Nessa busca foram localizadas 307 referências bibliográficas, contemplando os mais variados tipos de estudos. No Cochrane as palavras-chave aplicadas foram: supragingival plaque control AND oral hygiene, sendo obtidas 137 referências. A aplicação de critérios de inclusão permitiu que 4 estudos fossem avaliados na íntegra: 3 ensaios clínicos com seleção randômica de sítios experimentais e 1 ensaio clínico sem randomização. Resultados: dos estudos avaliados, 2 avaliaram somente a intervenção supragengival e 2avaliaram, também, a intervenção subgengival. Pôde-se observar que o controle supragengival, como intervenção única, foi capaz de determinar redução dos indicadores clínicos e microbiológicos periodontais, sendo os melhores resultados condicionados a um adequado programa de controle do biofilme supragengival. Conclusão: o estudo mostrou que o efeito do controle de biofilme supragengival em pacientes tabagistas é capaz de melhorar significativamente os indicadores clínicos e microbiológicos associados à gengivite e periodontite.

Aim: to conduct a systematic review of the literature to assess whether supragingivalplaque control is able to change clinical and microbiological markers associated with periodontal disease in smokers. Methodology: articles published between 1965 and January 2009 and indexed in the MEDLINE and Cochrane Oral Health Group databases were browsed. The following keywords were used on MEDLINE: supragingival plaque control AND (subgingival OR debridement OR scaling and root planing OR non surgical OR oral hygiene OR periodontitis OR gingivitis OR plaque subgingival OR lost attachment OR probing pocket depth OR bleeding);the search on MEDLINE yielded 307 references, including different types of studies. On Cochrane, the keywords employed were supragingival plaque control AND oral hygiene; this search yielded 137 studies. After application of inclusion criteria, four studies were selected for full-text review: three clinical trials with randomly selected experimental sites and one nonrandomized clinical trial. Results: of the four studies reviewed, two assessed the effects of supragingival plaque control alone, whereas the other two assessed both supragingival and subgingival interventions.It was possible to observe that supragingival plaque control alone was able to reduce clinical and microbiological indicators associated with periodontal disease, and that the best results were obtained after an adequate supragingival plaque control regimen. Conclusion: our study showed that supragingival plaque control is able to significantly improve clinical and microbiological markers associated with gingivitis and periodontitis in smokers.

Controle do biofilme supramucoso: revisão sistemática da literatura / Supragingival plaque control: systematic review of literature

O controle do biofilme supragengival determina mudanças significativas nos indicadores clínicos associados à gengivite e à periodontite. No entanto, não está claro se existe melhora no padrão inflamatório ao redor de implantes a partir do controle do biofilme supramucoso. Objetivo: identificar a resposta físico-biológica do controle do biofilme supramucoso periimplantar. Metodologia: um revisor (PCC) avaliou a base de dados em literatura médica e odontológica internacional (MEDLINE e Cochrane Oral Health Group) até dezembro de 2008, com restrição de idiomas (inglês e espanhol). A lista de referências bibliográficas dos artigos selecionados também foi consultada. Os critérios de inclusão estabelecidos foram: ensaios clínicos controlados e não controlados e estudos em animais que realizaram avaliação do controle do biofilme supramucoso sob uma condição de edentulismo parcial. Resultados: a aplicação das estratégias de busca resultou num total de 556 estudos. Inicialmente, baseando-se no título, 125 artigos repetidos foram eliminados. Os títulos dos artigos remanescentes (n= 431) foram lidos por examinadores distintos (PCC e LHMP). Um terceiro examinador (SCG) participou quando da presença de discordância. A partir da utilização dos critérios de inclusão, 22 artigos foram selecionados para a leitura de seus resumos. Após a leitura destes, dois artigos foram selecionados para serem analisados na íntegra e foram mantidos para a presente revisão. Considerações finais: existem poucos estudos elucidando o impacto do controle mecânico supramucoso, mas sugere-se que ele seja importante na redução de indicadores inflamatórios submucosos e prescinda de complementação química.

Supragingival plaque control results in significant changes in clinical signs of gingivitis and periodontitis, but it is unclear whether inflammation around implants improves after supragingival plaque removal. OBJECTIVE: To describe the physical and biological response to supragingival plaque control around implants. Methods: A reviewer (PCC) evaluated international medical and dental literature databases (MEDLINE and Cochrane Oral Health Group) to select studies in Spanishand English published up to December 2008. The reference lists of selected studies were also reviewed. Inclusion criteria were: controlled and uncontrolled clinical trials and studies in animals that evaluated supragingival plaque control in partially edentulous patients. Results: A total of 556 studies were retrieved. Based on their titles, 125 repeated articles were excluded. The titles of the remaining studies (n=431) were read by two reviewers (PCC and LHMP), and a third reviewer (SCG) participated in the decision in case of disagreement. Based on inclusioncriteria, 22 studies were selected and their abstracts were read. After that, 2 studies were selected to be analyzed infull and to be included in this review.Final Considerations: Few studies explain the impact of mechanical supragingival plaque control, but findingssuggest that it is important to reduce subgingival inflammation regardless of chemical treatments.

Validation of an alternative absorbent paper for collecting gingival crevicular fluid / Validação de um papel absorvente para coleta de fluido crevicular gengival

O Fluido Crevicular Gengival (FCG) expressa a condição inflamatória periodontal, sendo seu volume e composição importantes para o estudo da patogênese da mesma. Este estudo investigou um papel absorvente alternativo (T) para coleta de FCG confeccionado nas mesmas medidasdo grupo referência (R, Periopaper®). Foram, então, constituídas curvas-padrão para R e T, em três tempos experimentais entre a embebição e a leitura no Periotron®[imediatamente (T1), 15 (T2) e 30 (T3) segundos após]. As médias das Unidades de Periotron® (UP) foram comparadas(teste t, amostras independentes) e não foram observadas diferenças entre R e T, em T1 (R = 73,8; T = 64,6), T2(R = 69,9; T = 61,4) e T3 (R = 66,6; T = 58,1). Na avaliação intragrupo (ANOVA) não foram observadas diferenças para R e T nos tempos experimentais. O Coeficiente de Correlação Intraclasse entre os grupos foi excelente (T1 = 0,95, T2= 0,92 e T3 = 0,96). Conclui-se que o dispositivo alternativo pode ser utilizado para coleta de FC e que intervalos de até 30 segundos, entre a embebição e a leitura no Periotron®, não influenciaram as medidas.

Gingival crevicular fluid (GCF) is a marker of periodontal inflammatory status and thus its volume and composition are important to assess the pathogenesis of this inflammatory condition. This study investigated an alternative absorbent paper (test group, T) for collecting GCF comparing to thereference paper (R, Periopaper®) Standard curves for R and T were plotted after the tests at three time intervals between GCF collection and readings on the Periotron® [immediatelyafter collection (T1) and after 15 (T2) and 30 (T3) seconds]. Mean results as read in Periotron® units (PU) were compared (t test for independent samples), and no differences were found between R and T at T1 (R = 73.8, T = 64.6), T2 (R =69.9, T = 61.4) or T3 (R = 66.6, T = 58.1). Intragroup assessment (ANOVA) also revealed no difference for R and T at T1, T2 or T3. The intraclass correlation coefficientbetween groups was excellent (T1 = 0.95, T2 = 0.92 and T3= 0.96). These results suggest that the alternative GCFcollection method using paper strips is accurate and that intervals of up to 30 seconds between GCF collection andreading on the Periotron® do not influence the measurements.

Condição clínica e microbiológica periodontal e periimplantar em edentados parciais: revisão de literatura / Periodontal and peri-implant conditions and microbiological composition in partially edentulous patients: review of literature

As doenças periodontal e periimplantar apresentam o mesmo fator etiológico (biofilme bacteriano subgengival/submucoso), muito embora análises detalhadas da microbiota associadas a estas duas patologias sejam ainda escassas. Objetivo: identificar a condição física e a composição microbiológica periodontal e periimplantar em pacientes edentados parciais. Metodologia: A busca eletrônica foi realizada por um revisor na base de dados em literatura médica e odontológica internacional MEDLINE e Cochrane Oral Health Group até abril de 2008. Foram incluídos na presente revisão estudos observacionais transversais e de caso-controle que realizaram avaliação microbiológica periodontal e periimplantar nos mesmos pacientes. Resultados: A aplicação das estratégicas de busca resultou em um total de 259 resumos. Destes, dez artigos foram selecionados, compondo a amostra da presente revisão. Considerações finais: Uma das maiores causas de perdas dentárias entre a população adulta são formas avançadas de periodontite e um grande número de pessoas que recebe implantes apresenta história passada de perda dentária por doença periodontal. Portanto, as observações desta revisão sugerem um prognóstico cauteloso para os implantes, indicado, assim, um monitoramento do status periodontal/periimplantar acurado.

Validation of an alternative absorbent paper for collecting gingival crevicular fluid/Validação de um papel absorvente para coleta de Fluido Crevicular Gengival

O Fluido Crevicular Gengival (FCG) expressa a condição inflamatória periodontal, sendo seu volume e composição importantes para o estudo da patogênese da mesma. Este estudo investigou um papel absorvente alternativo (T) para coleta de FCG confeccionado nas mesmas medidasdo grupo referência (R, Periopaper®). Foram, então, constituídas curvas-padrão para R e T, em três tempos experimentais entre a embebição e a leitura no Periotron®[imediatamente (T1), 15 (T2) e 30 (T3) segundos após]. As médias das Unidades de Periotron® (UP) foram comparadas(teste t, amostras independentes) e não foram observadas diferenças entre R e T, em T1 (R = 73,8; T = 64,6), T2(R = 69,9; T = 61,4) e T3 (R = 66,6; T = 58,1). Na avaliação intragrupo (ANOVA) não foram observadas diferenças para R e T nos tempos experimentais. O Coeficiente de Correlação Intraclasse entre os grupos foi excelente (T1 = 0,95, T2= 0,92 e T3 = 0,96). Conclui-se que o dispositivo alternativo pode ser utilizado para coleta de FC e que intervalos de até 30 segundos, entre a embebição e a leitura no Periotron®, não influenciaram as medidas.

Gingival crevicular fluid (GCF) is a marker of periodontal inflammatory status and thus its volume and composition are important to assess the pathogenesis of this inflammatory condition. This study investigated an alternative absorbent paper (test group, T) for collecting GCF comparing to thereference paper (R, Periopaper®) Standard curves for R and T were plotted after the tests at three time intervals between GCF collection and readings on the Periotron® [immediatelyafter collection (T1) and after 15 (T2) and 30 (T3) seconds]. Mean results as read in Periotron® units (PU) were compared (t test for independent samples), and no differences were found between R and T at T1 (R = 73.8, T = 64.6), T2 (R =69.9, T = 61.4) or T3 (R = 66.6, T = 58.1). Intragroup assessment (ANOVA) also revealed no difference for R and T at T1, T2 or T3. The intraclass correlation coefficientbetween groups was excellent (T1 = 0.95, T2 = 0.92 and T3= 0.96). These results suggest that the alternative GCFcollection method using paper strips is accurate and that intervals of up to 30 seconds between GCF collection andreading on the Periotron® do not influence the measurements

Palito dental: razões para sua utilização e perfil cultural de usuários / Dental toothpick: reasons for its utilization and cultural profile of users

Objetivos: De maneira geral, o palito dental tem seu uso bastante difundido na população, apesar de sua comprovada efetividade anti-placa e anti-gengivite limitadas. Desse modo, esse estudo observacional transversal teve como objetivo avaliar as razões para uso e relacionar o nível cultural dos usuários de palito dental. Materiais e Métodos: A amostra foi constituída de 100 participantes que responderam a dois questionários referentes à higiene oral e ao nível cultural. Resultados: Os resultados demonstram que 62% dos indivíduos utilizavam apenas o palito dental, enquanto 38% utilizavam palito e fio dental. Entretanto, o uso do fio dental foi encontrado ser muito mais eventual do que diário. O nível cultural esteve bastante variado. Entretanto, foi observado que à medida que o nível cultural foi aumentando, o uso do fio dental foi sendo mais frequente. Usuários apenas do palito dental justificaram seu uso principalmente na remoção de restos alimentares e a escolha pelo fio/fita dental foi devido ao fio/fita dental desfiar e a técnica do palito ser fácil e rápida. Nos indivíduos que utilizavam palito e fio dental, a preferência do palito se deu pela dificuldade técnica do fio. Conclusões: A principal razão do uso do palito dental parece estar bastante relacionada à necessidade de remoção de restos alimentares e a facilidade da técnica. Portanto, é importante a conscientização do paciente acerca das limitações da utilização isolada do palito dental como meio de limpeza interdental e maiores informações a respeito da etiopatogenia das doenças cárie e periodontal.

Objectives: Toothpicks, culturally, are widely used in the populations, regarding its limited effectiveness related to plaque and gingivitis. Thus, the aim of this cross-sectional observational study was to analyze reasons for use and relate the cultural level of toothpick users. Materials and methods: The sample comprised 100 participants that ans wered two inquires related to oral hygiene practices and cultural level. Results: The results demonstrated that 62% of the individuals utilized only toothpicks while 38% used toothpick and dental floss. However, dental floss was found to be much more eventual instead daily. Cultural level was found to bevery variable. However, as the cultural level was raising dental floss was being more frequent. Toothpick just users justified its use mainly for food remove and its choice over the use of floss is due to breakness of floss less timing and technique facility required for toothpicks. In the individuals that used toothpick and eventually dental floss the preference of toothpick was due to the technique difficulty of dental floss. Conclusions: Thus, the mainly reason for toothpick seems to be related to the foods removal and technique facility. Thus, it is important to provide understanding of the patients about the limitations of tooth picks as an interdental cleaning agent and the pathogenesis of caries and periodontal diseases.