Fixed and on-demand regimens of acetaminophen in periodontal surgery: randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized". Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen "as needed," at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery

Oral health related quality of life among pregnant women: a randomized controlled trial

Abstract: The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

Abstract The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

Abstract In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Abordagem endodôntica e periodontal de uma reabsorção radicular cervical externa: relato de caso / Endodontic and periodontal treatment of external cervical root resorption: a case report

A reabsorção radicular cervical externa (RCE) consiste na perda de tecido duro dentário como resultado da ação odontoclástica. Frequentemente, inicia-se na região cervical da superfície radicular e as lesões são diagnosticadas de maneira equivocada, sendo confundidas com lesões de cárie e reabsorção interna. Como resultado, corriqueiramente é realizado o tratamento inadequado. O diagnóstico precoce e uma abordagem adequada são as chaves para o sucesso do tratamento. A etiologia da RCE é principalmente o trauma, tratamento ortodôntico ou fatores idiopáticos. O objetivo do presente estudo é descrever o tratamento endodôntico, periodontal cirúrgico e restaurador de um caso de reabsorção radicular externa Classe III de Heithersay, o qual apresentava RCE no elemento 43, de natureza idiopática. O tratamento foi combinado, sendo, inicialmente, realizada a exposição cirúrgica do defeito reabsortivo, seguida pela remoção cirúrgica de todo tecido inflamatório de granulação presente e, por fim, o tratamento restaurador utilizando cimento de ionômero de vidro modificado por resina. Além disso, um tratamento endodôntico foi conduzido, devido ao diagnóstico de necrose pulpar. Após 12 meses de acompanhamento clínico e radiográfico, não foi observada recidiva da lesão reabsortiva.

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.

Tratamento odontológico na gravidez: oportunidade, benefícios e cuidados especiais / Dental treatment during pregnancy: opportunity, benefits and special care

As abordagens odontológicas na gravidez são revestidas de grande número de pré-concepções. Esses conceitos vinculam-se ao período especial que a mulher vive, com incremento em seu cuidado, aliado ao aumento das taxas hormonais. No presente artigo, são abordadas algumas das alterações bucais mais prevalentes na gravidez, as possibilidades de as infecções bucais repercutirem negativamente na gestação e os cuidados a ser tomados para tratamento odontológico durante a gravidez. É importante ressaltar que não existem efeitos deletérios maiores na saúde bucal, pelo simples fato de a mulher estar grávida. Existe aumento das taxas hormonais, que pode resultar em aumento dos índices de inflamação gengival. Estudos têm demonstrado que, quando medidas de controle estrito do biofilme são adotadas, a inflamação pode ser prontamente controlada. Essa inflamação poderia gerar eventos adversos na gestação, incluindo-se nascimento prematuro e baixo peso. A literatura é controversa, e, no momento, estudos não sustentam uma relação casual. Já os tratamentos odontológicos são seguros na gravidez, desde que se adotem as medidas de radioproteção no uso de imagens e se prescrevam medicamentos adequados. Uma grávida saudável influenciará potencialmente a criação de um bebê saudável.

Dental treatment during pregnancy is fogged with a number or preconceptions. These concepts are linked to the peculiar period that woman is passing through, with enhancement in self-care, together with important hormonal changes. In the present article, some oral alterations that are more prevalent during pregnancy will be approached, the possibility of oral infections negatively influence pregnancy and the cautions that should be taken for dental treatment during pregnancy. In this sense, it is important to emphasize that there are no major deleterious effects in oral health due to the fact that the woman is pregnant. The hormonal secretion is increased and this may result in increased gingival inflammation. Studies have demonstrated that when strict biofilm control measurements are performed, inflammation can be promptly eliminated. The presence of this inflammatory process could generate adverse pregnancy outcomes, including preterm and/or low birthweight infants. The literature is controversial and, at the moment, studies do not support a causal relationship. In relation to dental treatments, they are safe during pregnancy, as long as radioprotection is taken when imaging is needed, as well as that correct drugs are used. It should be emphasized that a healthy pregnant woman will potentially influence the raise of a healthy baby.

Periodontal disease and systemic complications

Periodontal diseases comprise a number of infectious and inflammatory conditions brought about by the interaction between supragingival and subgingival biofilms and the host inflammatory response. Periodontal diseases should be considered systemic conditions. This means that they are both modulated by the body's systems and play a role as a risk factor for systemic derangements. The current evidence supports some of these interactions, such as smoking as a risk factor for periodontal disease and diabetes mellitus, as both influenced by and influencing inflammatory changes in the periodontal tissue. Other potential associations are still being researched, such as obesity, hormonal changes, cardiovascular disease, and adverse outcomes in pregnancy. These, and others, still require further investigation before the repercussions of periodontal disease can be fully elucidated. Nevertheless, at the present time, the treatment of periodontal diseases-and, most importantly, their prevention-enables adequate intervention as a means of ensuring periodontal health.

Doenças periodontais e desfechos gestacionais adversos / Periodontal diseases and adverse gestational outcomes

A associação das doenças periodontais com várias condições sistêmicas como alteraçõe cardiovasculares, controle metabólico da diabetes, doenças pulmonares, úlcera gástrica e acidentes vasculares passou a ser extensivamente estudada a partir da decada de oitenta. Um tópico em particular que tem merecido atenção de vários autores é o parto pré-termo e o baixo peso ao nascer. O primeiro estudo sobre o assunto realizado em humanos mostrou que gestantes que apresentavam perda de inserção generalizada possuiam sete vezes mais chances de apresentar parto pré-termo e/ou recém-nascidos com baixo peso. Desde então, a doença periodontal passou a ser investigada como possível fator de risco para parto pré-termo e baixo peso ao nascer. A relação entre doenças periodontais e os desfechos gestacionais adversos foi demonstrada em estudos com diferentes desenhos experimentais, e resultados inconsistentes são constantemente apresentados. Esta tese consiste em um ensaio clínico randomizado com 299 gestantes, em que foi avaliado o efeito do tratamento periodontal sobre parto pré-termo e baixo peso ao nascer. As pacientes do grupo teste receberam tratamento periodontal que incluiu raspagem e alisamento supra e subgengivais e instrução para higiene bucal. Consultas de controle para profilaxia profissional e instrução para higiene bucal foram realizadas após o tratamento até o parto. Os desfechos primários avaliados foram parto pré-termo e baixo peso ao nascer. Ambos os grupos não diferiram com relação a taxa de partos pré-termo, sendo que 14 gestantes (9,09%) do grupo controle e 17 gestantes (11,72%) do grupo teste apresentaram término da gestação anterior a 37 semanas (p=0.57). Com relação ao peso ao nascer, também não houve...

The association between periodontal disease and several systemic conditions, such as cardiovascular abnormalities, diabetes metabolic control, pulmonary diseases, gastric ulcer, and stroke, has been widely investigated since the 80s. One particular topic that has been the subject of great attention among several authors is the birth of preterm and low birth weight infants. The first study on the topic involving humans showed that pregnant women with generalized clinical attachment loss were at seven times greater risk of experiencing preterm delivery and/or low birth weight infants. Since then, periodontal disease started to be investigated as a possible risk factor for preterm and low birth weight. The relationship between periodontal disease and adverse pregnancy outcomes has been demonstrated in several studies with different experimental designs, and the results obtained so far are inconsistent. The present thesis consists of a randomized clinical trial involving 299 pregnant women, which assessed the effect of periodontal treatment carried outduring pregnancy on preterm delivery and low birth weight rates. Patients in the study group were submitted to periodontal treatment which included supra and subgingival scaling and root planning and oral hygiene instruction follow-up visits were maintained after treatment up to delivery and consisted of professional prophylaxis and oral hygiene instruction. The primary outcomes assessed were preterm birth and low birth weight. Both groups were similar with regard to the rate of preterm deliveries: 14 pregnant women in the control group (9.09%) and 17 in the test group (1172%) gave birth to their infants before 37 weeks' gestation (p=0.57). Concerning birth weight, no significant differences were observed between the...

Association between periodontal diseases and systemic diseases

Current evidence suggests that periodontal disease may be associated with systemic diseases. This paper reviewed the published data about the relationship between periodontal disease and cardiovascular diseases, adverse pregnancy outcomes, diabetes and respiratory diseases, focusing on studies conducted in the Brazilian population. Only a few studies were found in the literature focusing on Brazilians (3 concerning cardiovascular disease, 7 about pregnancy outcomes, 9 about diabetes and one regarding pneumonia). Although the majority of them observed an association between periodontitis and systemic conditions, a causal relationship still needs to be demonstrated. Further studies, particularly interventional well-designed investigations, with larger sample sizes, need to be conducted in Brazilian populations.

Periodontite crônica em paciente adulto jovem: relato de caso clínico / Chronic periodontitis in young adult patient: a case report

A diferenciação entre as formas de periodontite é importante, pois suas características podem determinar a abordagem em relação ao tratamento e prognóstico destas doenças, como por exemplo, a inclusão de terapia antimicrobiana na forma de coadjuvante da terapia mecânica, a determinação do tempo de avaliação da cicatrização pós-tratamento, da freqüência das consultas de manutenção e na necessidade de exame de familiares. Com este preceito, o objetivo deste estudo é apresentar o processo de diagnóstico de periodontite crônica em um paciente adulto jovem, o qual envolveu exames clínicos radiográficos e de familiares, assim como a seqüência de tratamento periodontal em duas fases: supra e subgengival. O resultado do tratamento em curto prazo (150 dias) mostra os excelentes resultados obtidos com relação aos parâmetros supra e subgengivais.

Fluoride release from restorative materials coated with an adhesive

A retenção aos tecidos dentais, tanto de resinas fluoretadas, quanto de cimentos de iônomero de vidro modificados por resina, pode ser melhorada pela associação de um sistema adesivo, promovendo a formação de camada híbrida. Esta técnica traria vantagens desde que a presença do adesivo, sendo parte da camada híbrida, não funcionasse como uma barreira contra a passagem de íons flúor até a superfície dental próxima às restaurações. O objeitvo do presente estudo foi avaliar a liberação de flúor dos materiais restauradores Vitremer (3M) e Heliomolar (Vivadent), tendo como controle a resina composta Z100 (3M), através de uma aplicação de um adesivo (Scotch Bond Multi Purpose Plus - 3M). Dez discos de cada material foram preparados: 5 foram cobertos com adesivo, enquanto os demais não. Os discos foram imersos em frascos separados contendo saliva artificial, sendo esta trocada diariamente. As medidas de liberação de flúor foram feitas nos dias 1, 5, 10, 15, e 20 por um eletrodo combinado de flúor (9609 BN-Orion) coplado a um analisador de íons (A-720 Procyon). Testes ANOVA de uma via e SNK foram aplicados aos resultados para comparar os perfis de cada material. Os resultados mostraram que, com a metodologia empregada, o uso de um adesivo dental foi capaz de reduzir significantemente a liberação de flúor do material Vitremer e reduzir a níveis não detectßveis o flúor liberado pela resina fluoretada.

Fluoride release and uptake from glass ionomer cements and composite resins / Liberação e absorção de flúor de cimentos de ionômero de vidro e resinas compostas

O objetivo desta investigação foi avaliar a liberação e absorção de flúor de 4 cimentos de ionômero de vidro (CIVs)- Vitremer (VIT), Fuji II LC (FII LC), Fuji IX (FIX), Chelon Fill (CHE)- e duas resinas compostas (RCs)- Heliomolar (H) e Zeta-100 (Z-100). Foram confeccionados 8 discos (8 mm x 2 mm) de cada material e armazenados em recipientes plásticos contendo saliva artificial a 37°C. No grupo 1 (N = 3), os espécimes foram imersos em saliva artificial, a qual foi trocada diariamente durante 25 dias. No grupo 2 (N = 5), além de receber o mesmo tratamento dispensado ao grupo 1, os espécimes foram imersos, após 24 horas, em solução fluoretada (NaF a 1 por cento) durante 1 minuto previamente à troca diária de saliva artificial. A quantidade de flúor liberada nos dias 1, 2, 5, 10, 15, 20 e 25 foi acessada através de um eletrodo específico para flúor (9609 BN-Orion) conectado a um analisador de íons (SA-720 Procyon). Os dados foram analisados através de ANOVA de duas vias e do teste de Friedman. Os CIVs liberaram maior quantidade de flúor nas primeiras 24 horas. Após esse período, a quantidade média de flúor liberada decresceu. A resina composta H liberou flúor apenas durante as primeiras 24 horas, enquanto que a Z-100 não liberou flúor. Com relação ao tratamento com solução fluoretada, as RCs não absorveram flúor, ao contrário dos CIVs (VIT=FII LC=CHE>FIX)

Abertura coronária: guias de orientaçäo / Root canal access: guidelines

O presente estudo propöe-se a fornecer guias que orientem a localizaçäo dos canais a partir de dentes extraídos. Foram radiografados 10 incisivos centrais superiores, 10 molares superiores e 10 molares inferiores, e traçadas linhas nas radiografias tomando como ponto de referência a entrada do canal radicular e um ponto médio situado na incisal ou face oclusal. As linhas foram transferidas para a face vestibular dos dentes extraídos e a abertura coronária foi realizada com brocas da série 700, posicionados paralelamente à linha traçada. Verificou-se em todos os espécimes a coincidência da linha traçada com a entrada dos canais radiculares. Nos molares superiores o ângulo formado pelas duas linhas traçadas mediu em média 16,4º e nos molares inferiores 28,05º. A distância média da entrada do canal MV e parede externa mesial situou-se a 2,78 mm nos molares superiores e 2,63 mm nos molares inferiores. O comprimento da linha traçada nos molares superiores foi, em média, 8,8 mm, nos molares inferiores 9,15 mm e nos incisivos centrais 10,8 mm. Esses achados servem de guias para as etapas de penetraçäo da broca, localizaçäo dos canais e desgaste compensatório durante a abertura coronária