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.

Discomfort associated with fixed orthodontic appliances: determinant factors and influence on quality of life

OBJECTIVE: To investigate the determinant factors of discomfort attributed to the use of fixed orthodontic appliance and the effect on the quality of life of adolescents. MATERIAL AND METHODS : Two hundred and seventy-two individuals aged between 9 and 18 years old, enrolled in public and private schools and undergoing orthodontic treatment with fixed appliance participated in this cross-sectional study. The participants were randomly selected from a sample comprising 62,496 individuals of the same age group. Data was collected by means of questionnaires and an interview. Discomfort intensity and bio-psychosocial variables were assessed using the Oral Impact on Daily Performance questionnaire. Self-esteem was determined using the Global Negative Self-Evaluation questionnaire. Statistical analysis involved the chi-square test and both simple and multiple Poisson regression analyses. RESULTS: Although most individuals did not present discomfort, there was a prevalence of 15.9% of impact on individuals' daily life exclusively due to the use of fixed orthodontic appliance . Age [PR: 3.2 (95% CI: 1.2-8.5)], speech impairment [PR: 2.2 (95% CI: 1.1-4.6)], poor oral hygiene [PR: 2.4 (95% CI: 1.2-4.8)] and tooth mobility [PR: 3.9 (95% CI: 1.8-8.1)] remained independently associated with a greater prevalence of discomfort (P ≤ 0.05). CONCLUSIONS: Discomfort associated with the use of fixed orthodontic appliances exerted a negative influence on the quality of life of the adolescents comprising the present study. The determinants of this association were age, poor oral hygiene, speech impairment and tooth mobility. .

OBJETIVO: investigar os fatores determinantes do desconforto atribuído ao uso do aparelho ortodôntico fixo e sua influência na qualidade de vida de adolescentes. MÉTODOS: participaram desse estudo transversal 272 indivíduos, com idades entre 9 e 18 anos, estudantes de escolas públicas e privadas, que usavam aparelhos ortodônticos fixos (braquetes). Os participantes foram selecionados aleatoriamente, entre 62.496 indivíduos da mesma faixa etária. A coleta de dados foi feita em forma de entrevista e questionário. A intensidade do desconforto e variáveis biopsicossociais foram avaliadas por meio do Oral Impact on Daily Performance (OIDP). A autoestima foi determinada pela Global Negative Self-Evaluation (GSE). A análise estatística envolveu o teste qui-quadrado e a análise de regressão de Poisson, simples e múltipla. RESULTADOS: embora a maioria dos indivíduos não apresentasse desconforto, observou-se uma prevalência de impacto na vida diária devido, exclusivamente, ao uso do aparelho ortodôntico fixo, de 15,9%. Variáveis idade de 15 a 18 anos [RP = 3,2 (IC 95% = 1,2-8,5)], dificuldade de falar [RP = 2,2 (IC 95% = 1,1-4,6)], dificuldade de limpar a boca [RP = 2,4 (IC95% = 1,2-4,8)] e mobilidade dos dentes [RP = 3,9 (IC 95% = 1,8-8,1)] permaneceram associadas, de forma independente, à maior prevalência de desconforto (p ≤ 05). CONCLUSÕES: desconforto associado ao uso de aparelhos ortodônticos fixos influenciou negativamente a qualidade de vida de adolescentes. Os fatores determinantes foram idade, dificuldade de limpar a boca, de falar e mobilidade dentária. .

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. .

OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo. .

History of Chronic Periodontitis Is a High Risk Indicator for Peri-Implant Disease

The success rates in implant dentistry vary significantly among patients presenting previous history of periodontitis. The aim of this study was to evaluate if patients with history of chronic periodontitis (CP) are more susceptible to peri-implant disease (PID) than those without history of CP. Two hundred and fifteen individuals, under periodontal maintenance, presenting 754 osseointegrated implants, were selected for this study. The patients were divided into two groups according to the peri-implant status: Control group (patients without PID; n=129) and PID group (patients with PID; n=86). All peri-implant regions were clinically evaluated, including analyses of mucosa inflammation, edema and implant mobility. Periapical radiography assessed the presence of peri-implant bone loss. According to the clinical/radiographic characteristics, patients in Control and PID groups were diagnosed as having CP or not. Nominal variables were evaluated by the chi-square test. The distribution of numeric variables was analyzed by Shapiro-Wilk test. Student's t-test and Mann-Whitney test were used to analyze significant differences for parametric and non-parametric data. A p-value <0.05 was considered significant. There was a highly significant correlation between CP history and PID (p<0.0001). Patients with CP had 4 times more chance of developing PID than patients with healthy periodontal tissues. Also, CP patients showed higher bleeding on probing (p=0.002) and bone loss around implant (p=0.004) when compared with patients without CP. In conclusion, history of CP is a high risk factor for the development of PID, irrespective of gender or region of implant placement.

Resumo O índice de sucesso em implantodontia varia significantemente entre indivíduos apresentando história prévia de periodontite. O objetivo deste estudo foi avaliar se pacientes com história de periodontite crônica (CP) são mais susceptíveis ao desenvolvimento de doença peri-implantar (PID) do que pacientes sem história de CP. Duzentos e quinze indivíduos, sob manutenção periodontal, apresentando 754 implantes osseointegrados, foram selecionados para este estudo. Os pacientes foram divididos em 2 grupos de acordo com o estado peri-implantar: Grupo Controle (pacientes sem PID, n=129) e Grupo PID (pacientes com PID, n=86). Todas as regiões peri-implantares foram clinicamente avaliadas, incluindo análise da inflamação na mucosa, edema e mobilidade do implante. Radiografias periapicais avaliaram a presença de perda óssea peri-implantar. De acordo com as características clínico/radiográficas, pacientes nos Grupos Controle e PID foram diagnosticados como tendo CP ou não. As variáveis nominais foram avaliadas pelo teste do qui-quadrado. A distribuição das variáveis numéricas foi avaliada pelo teste de Shapiro-Wilk. O Teste t e o teste de Mann-Whitney foram utilizados para analisar a significância dos dados, em caso de distribuição normal e não-normal, respectivamente. Valor de p<0,05 foi considerado significante. Os resultados mostraram que há correlação altamente significativa entre história de CP e presença PID (p<0,0001), com risco 4 vezes maior de desenvolver PID para pacientes com CP. Pacientes com CP também mostraram maior sangramento à sondagem (p=0,002) e perda óssea peri-implantar (p=0,004) quando comparados a pacientes sem CP. Concluímos que história de periodontite crônica é um fator de alto risco ao desenvolvimento ...

Efecto del tratamiento periodontal sobre la microbiota subgingival en pacientes con preeclampsia / Effect of periodontal therapy on the subgingival microbiota in preeclamptic patients

Introducción. Pocos estudios han descrito la microbiota subgingival en mujeres embarazadas con preeclampsia leve. Objetivo. Identificar cambios periodontales y de la microbiota subgingival en mujeres embarazadas con preeclampsia, después del tratamiento periodontal. Materiales y métodos. En un análisis secundario de un ensayo clínico de asignación aleatoria, se estudiaron 57 pacientes con preeclampsia en el Hospital Universitario del Valle de Cali. Se asignaron al azar 31 al grupo de intervención periodontal (detartraje y alisado subgingival ultrasónico y manual) durante su embarazo y otras 26 al grupo control (profilaxis supragingival). Se determinaron los parámetros clínicos periodontales y la microbiota subgingival a la inclusión al estudio y en el posparto. Se evaluaron 8 bacterias periodontopáticas y 2 virus herpes por reacción en cadena de la polimerasa. Se usaron las pruebas de ji al cuadrado, test de McNemar o t de Student, con un nivel de significancia de p≤ Resultados. Los grupos fueron comparables en las variables clínicas y microbiológicas al inicio del estudio. El tratamiento periodontal redujo el promedio de la profundidad de bolsa en el grupo de intervención de 2,44±0,31 a 2,31±0,24 mm (p=0,000) y en el grupo control de 2,58±0,37 a 2,44±0,39 mm (p=0,000),y el índice de sangrado, de 16,4±1,5 a 7,9±0,7 % en el primero (p=0,000), y de 17,1±1,8 a 10±0,9 %, en el segundo (p=0,002). La frecuencia de detección de microorganismos no varió de manera significativa entre los grupos. Conclusión. El raspaje y alisado radicular, así como la profilaxis supragingival, redujeron de manera significativa la profundidad a la sonda y el índice de sangrado gingival. El tratamiento periodontal no fue más efectivo que la profilaxis para reducir los organismos periodontopáticos o los virus herpes.

Introduction. Few studies have described subgingival microbiota in pregnant women with mild preeclampsia. Objective. Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment. Materials and methods. In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again at postpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Student´s t tests were used, with a significance level of p≤0.05. Results. Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p<0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p<0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p<0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups. Conclusion. Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.

Acute myeloid leukemia: a case report with palatal and lingual gingival alterations

Acute myeloblastic leukemia (AML) is a malignant bone marrow disease. Due to its high morbidity rate, early diagnosis and appropriate medical therapy are essential. Dentists and physicians should be aware of the importance of recognizing oral manifestations of this systemic disease.Here we report a case of gingival alterations AML. The interesting clinical findings about this case are the severe alterations of palatal and lingual gingiva with almost normal labial gingiva. The need for early diagnosis and referral of this fatal disease are also underlined.

Influence of khat chewing on periodontal tissues and oral hygiene status among Yemenis

Khat chewing is popular among Yemenis. This study was performed to investigate the effects of khat chewing on periodontal tissue and oral hygiene status. A total of 730 subjects [336 chewers and 394 non-chewers with a mean age of 31.5 +/- 0.8 and 29.4 +/- 0.9 years, respectively] were involved. Clinical data on periodontal tissues, oral hygiene status, gingival bleeding, burning sensation in the soft tissues, halitosis, ulcers in the oral cavity, difficulty in opening the mouth and swallowing solid food were collected to evaluate periodontal condition. Logistic regression analysis, student t test and chi-squared test were employed according to which hypotheses were being tested. The oral hygiene status of non-chewers was significantly better than that of chewers. The mean oral hygiene index of chewers was 2.12 +/- 0.86 while that of non-chewers was 1.54 +/- 1.12, the difference being statistically significant [P < 0.001]. The incidence of gingival bleeding was significantly higher in khat-chewers. About 23% of chewers complained of difficulty in mouth-opening, as compared with only about 1% of non-chewers. Furthermore, 10% of chewers had difficulty in swallowing solid food. A burning sensation in the soft tissues was also found in a higher proportion of khat-chewers. Similarly, ulcers on the oral mucosa were present in about 7% of chewers, as compared to 0.5% of non-chewers. Gingival recession was present in about 51% and 26% of chewers and non-chewers, respectively. There does appear to be a relationship between the effect of chewing khat on periodontal tissue and oral hygiene status

Condição periodontal de crianças e adolescentes com diabetes melito tipo 1 / Periodontal status in children and adolescents with type 1 diabetes mellitus

OBJETIVO: Avaliar a condição periodontal de crianças e adolescentes diabéticos e fatores relacionados. MÉTODOS: O índice de placa (IPL), sítios com sangramento à sondagem (SS), profundidade de sondagem (PS) e nível de inserção clínica (NIC) foram avaliados em todos os dentes permanentes em oclusão de 168 diabéticos tipo 1, não fumantes, com 13 ± 3,5 anos de idade. IPL e SS foram avaliados também em dentes decíduos. RESULTADOS: Observou-se prevalência de 20,8 por cento de gengivite e 5,9 por cento de periodontite. Indivíduos com mau controle metabólico tiveram maiores percentuais de sítios com alteração da PS (p = 0,004) e NIC (p = 0,014). Indivíduos com > 5 anos de doença apresentaram maiores percentuais de sítios afetados à avaliação da PS (p = 0,002), NIC (p = 0,007) e SS (p < 0,001). CONCLUSÕES: Maior duração do diabetes melito tipo 1 e mau controle metabólico foram significativamente associados a alterações periodontais indicando maior suscetibilidade para doença periodontal nessa população.

OBJECTIVE: To evaluate periodontal condition of diabetic children and its related factors. METHODS: The plaque index (PI), sites with bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) were evaluated in all occlusion permanent teeth of 168 non smoking type 1 diabetic children, 13 ± 3.5 years old. The PI and BOP evaluations were also performed in deciduous teeth. RESULTS: It was observed a prevalence of 20.8 percent of gingivitis and 5.9 percent of periodontitis. Those individuals with poor metabolic control had higher percentage of affected sites on PD (p = 0.004) and on CAL (p = 0.014). Patients having more than five years with diabetes mellitus type 1 showed higher percentual of affected sites on PD (p = 0.002), on BOP (p < 0.001) and on CAL (p = 0.007). CONCLUSIONS: DM1 duration and poor glycemic control were significantly associated with periodontal disturbances suggesting higher susceptibility of this population in developing DP.

The effect of ibuprofen on bleeding during periodontal surgery.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications for both medical and dental ailments. These drugs have been shown to increase bleeding during surgeries, which may prompt practitioners to discontinue their use before surgical procedures. The aim of the present study is to assess the effect of a common NSAID, ibuprofen, on bleeding during periodontal surgery. MATERIALS AND METHODS: The study group consisted of 10 patients who were scheduled to undergo periodontal surgery of similar type, complexity, and duration. Each subject acted as control as well as case group. The case group consisted of 10 surgeries in which patients were administered ibuprofen prior to surgery, whereas ibuprofen was not administered in control group. Bleeding time was measured at first visit and prior to first and second surgeries. The volume of blood loss during each surgery was measured by subtracting the amount of water used for irrigation from the total volume of fluid collected in the portable aspirator at the end of the surgery. RESULTS: The result showed a statistically significant (P < 0.05) increase in intraoperative bleeding during periodontal surgery when ibuprofen was preadministered. In addition, there was statistically significant (P < 0.05) increase in bleeding time. CONCLUSION: Ibuprofen taken prior to periodontal surgery increases intraoperative bleeding and should be administered cautiously before periodontal surgeries.

Bleeding gums: duloxetine may be the cause.

Duloxetine is a newly introduced drug. It is being prescribed for the management of diabetic neuropathic pain and major depressive disorder. The most frequently observed adverse events with duloxetine are nausea, dry mouth and somnolence, constipation, diarrhea, decreased appetite, weight loss, feeling of fatigue, dizziness, somnolence, hypohidrosis, decreased libido and erectile dysfunction. One of the patients being prescribed the drug developed bleeding gums on being started with the drug which resolved on stopping it. We hereby report this case.

Eosinophilic granuloma with oral manifestations: a case report.

Eosinophilic granuloma is the most benign disorder of the triad commonly known as histocytosis X. In this article a case of a 6 year old female child with multiple eosinophilic granuloma with additional liver dysfunction and its oral manifestation is presented. This case demonstrated that oral findings, may be an early manifestation of the disease, definitive diagnosis needs to be determined by correlation of the clinical findings with histologic features. For the duration of 8 years the case has been followed up, there has been a progressive healing of the lesion, the clinical manifestations of the disease resolved with only chemotherapy and provided a very good prognosis.

Hemorragia gengivo-jugal pós-contato com Lonomia Oblíqua / Gengivo-jugal bleeding due to contact with Lonomia Obliqua

Síndrome hemorrágica induzida pelo contato com lagartas Lonomia obliqua representa, nos dias de hoje, um acidente frequente em nosso meio, variando de 1,1 até 24,6 casos por 100.000 habitantes em determinados municípios, gerando pânico entre a populaçäo rural. Relata-se caso de um paciente que, após o contato com um grupo de taturanas, apresentou sangramento em feridas recentes, equimoses e hemoragia gengivo-jugal. Faz-se um retrospecto desses acidentes na literatura mundial

Lesiones de la mucosa bucal secundarias al uso de metotrexato en pacientes con artritis reumatoidea (AR) que recibieron ácido fólico / Oral mucosal lesions secondary to the use of methotrexate in rheumatoid arthritis (RA) patients receiving folic acid therapy

El MTX es uno de los medicamentos más empleados en el tratamiento de la AR, al que por ser un antimetabolito de ácido fólico se asocia a reacciones secundarias que implican principalmente a los tejidos donde las células se producen rápidamente. Así, la mucosa bucal y el aparato gastrointestinal son susceptibles a estos efectos indeseables. Hay evidencias que sugieren que el ácido fólico disminuye el potencial efecto de este medicamento. Se revisaron 40 pacientes con diagnóstico de AR, de 46 años de edad en promedio y evolución de artritis reumatoide de 9 años, que recibieron dosis promedio de 12.5 de MTX y dosis total de 2.373 gr.; el fólico se administró a dosis de 5-10 mg./semana vía oral. El 42.5 por ciento de los pacientes presentaron úlceras múltiples en encía móvil y el 10.5 por ciento hemorragia gingival; esas manifestaciones se dieron en la mayoría de los pacientes aun ante la persistencia del medicamento. Así, las manifestaciones fueron transitorias y en general de poca magnitud. Se concluyó que los efectos indeseables del MTX en cavidad bucal son relativamente frecuentes, reversibles y leves, lo que seguramente en esta población se debe en parte a la administración conjunta con ácido fólico

Conductas y factores determinantes en salud oral de los adolescentes / Decisive factors and behavior in adolescent oral health

Con el propósito de contribuir al conocimiento sobre las conductas en salud oral de los adolescentes y los factores que las determinan, se aplicó una encuesta semiestructurada de 53 contenidos a 381 escolares de ambos sexos de 7º básico a 4º medio y 12 a 20 años de edad, de los cuales 189 eran de nivel socioeconómicoalto y 192 medio bajo, eligiendo por azar 8 mujeres y 8 hombres de cada uno de los cursos por cada año, nivel escolar, escuela de ambos niveles socioeconómicos. Los adolescentes mostraron escasos conocimientos sobre las enfermedades bucales más comunes y su prevención. Los dentistas del sector público parecen realizar proporcionalmente menos educación que los del sector privado y el resto de los profesionales de la salud parece no entregar información sobre salud oral. El estado de salud oral declarada es peor en el NSEMB, que asiste menos a consulta dental. Influyen en la baja demanda el horario de los servicios públicos y el miedo al dentista, que es mayor en este nivel. La mayoría de los jóvenes práctica cepillado dental, que es inadecuado en lato porcentaje de los casos, muy pocos utilizan flúor en enjuagatorios, 40 por ciento declaran sangramiento gingival, al que otorgan escasa importancia. La estética es la razón principal para el cuidado de la dentadura. Al consumo frecuente de azúcares se asocia a las caries, pero no al aumento de peso, efectos que debieran relacionarse en las intervenciones educativas. Parece conveniente disponer de un programa de atención dental específico para este grupo de edades e incorporar la salud oral en las acciones de educación para la salud que se ofrecen a los adolescentes y otras de detección precoz de las afecciones dentales de mayor prevalencia