Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

ABSTRACT Introduction: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. Objective: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. Methods: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. Results: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. Conclusion: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

RESUMO Introdução: a expansão rápida da maxila assistida cirurgicamente (ERMAC) é um procedimento que reduz a resistência das suturas, corrigindo a mordida cruzada posterior em adultos. Objetivo: o objetivo deste estudo foi avaliar o status periodontal de 17 adultos submetidos a esse procedimento. Métodos: o nível clínico de inserção (NCI), a recessão gengival, gengiva inserida e sangramento foram avaliados nos primeiros pré-molares, molares, incisivos centrais e laterais superiores dos lados direito e esquerdo antes da cirurgia, e depois de 5 dias e 6 meses. Médias, desvios-padrão, medianas, valores mínimos e máximos foram comparados entre as avaliações, usando os testes de Friedman e McNemar. Resultados: houve aumento estatisticamente significativo no NCI no incisivo central direito, pré-molares direito e esquerdo e molares direito e esquerdo. Houve aumento estatisticamente significativo na recessão gengival nos pré-molares e nos molares direito e esquerdo. A quantidade de gengiva inserida diminuiu significativamente nos pré-molares direitos e molares direitos e esquerdos. Houve aumento no sangramento na maioria dos dentes. Conclusão: os resultados indicaram que a ERMAC pode causar alterações no tecido periodontal.

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. .

Avaliação da perda de inserção dentária em pacientes com doença renal crônica em hemodiálise / Evaluation of dental insertion loss in patients with chronic kidney disease

A doença renal crônica (DRC) é uma síndrome clínica decorrente da perda lenta, progressiva e irreversível da taxa de filtração glomerular. A DRC pode apresentar várias manifestações bucais, como xerostomia, estomatite urêmica e periodontite, diagnosticada por meio da perda de inserção clínica (PIC). Foram avaliados 92 indivíduos em tratamento de hemodiálise na Clínica de Hemodiálise Prontorim, na cidade de Fortaleza, Ceará. O exame periodontal foi realizado por meio da mensuração da PIC e apenas 34 pacientes (37 por cento) estavam aptos a realizar exame periodontal. A perda de inserção por indivíduo registrada no grupo de dentados ficou entre 1,31 e 5,27 mm, com média de 2,30 ± 0,96 mm. Dezoito pacientes (52,9 por cento) apresentaram PIC menor que 2 mm, enquanto 16 (47,1 por cento) mostraram-se portadores de periodontite. A perda dentária e a presença de considerável perda de inserção foram observadas neste estudo. Contudo, fatores como status social devem ser considerados em futuras investigações.

Chronic kidney failure (CKF) is a clinical syndrome due to the slow, progressive and irreversible loss of the glomerular filtration rate. CKF may be associated with several oral manifestations, such as xerostomia, uremic stomatitis and periodontitis, diagnosed as clinical attachment loss (CAL). 92 patients, from the Prontorim Hemodialysis Clinic of Fortaleza, Ceará, Brazil, were investigated. Only 34 patients (37 percent) were eligible for periodontal investigation, which consisted of CAL measurement (values grater than 2 mm diagnosing periodontitis). CAL measurements ranged from 1.31 to 5.27 mm (2.30 ± 0.96 mm). 18 (52.9 percent) patients had smaller than 2 mm CAL, while 16 (47.1 percent) had periodontitis. Tooth loss and considerable CAL were observed in this study. Nevertheless, factors such as social status should be considered in further investigations.

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

Relación entre el consumo de fármacos y la pérdida de inserción periodontal / Relationship between drug consumption and periodontal attachment loss

La relación entre la administración de fármacos y la pérdida de inserción clínica no está claramente determinada. Se realizó un estudio epidemiológico de corte transversal en el cual se incluyeron 1.793 pacientes que concurrieron a la Cátedra de Periodoncia de la Facultad de odontología de Rosario. El estado periodontal se analizó teniendo en cuenta la extensión y la severidad de la pérdida de inserción. Los datos fueron analizados por modelos univariados y multivariados mediante un análisis de regresión logística. Las variables utilizadas fueron: edad, sexo, índice de placa, profundidad de sondaje, nivel de inserción, índice de sangrado, presencia de piezas dentarias, hábito de fumar y exposición a medicamentos, y fueron calculados los correspondientes odds-ratios (OR). La edad (OR =1,6), género masculino (OR = 1,4), hábito de fumar (OR = 1,5) y la exposición a medicamentos (OR =1,3), especialmente el grupo de los ansiolíticos y los antidepresivos, mostraron una significativa asociación con la severidad de la pérdida de inserción periodontal. Nuestros resultados indican que el consumo de psicofármacos podría considerarse junto a la edad, el hábito de fumar y el género masculino como indicador de riesgo de mayor severidad en la pérdida de inserción clínica periodontal.

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Lõe and O'Leary), clinical attachment level, gingival index (according to Silness and Lõe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats

Alcohol consumption is a risk indicator for periodontal disease. The purpose of this study was to morphometrically evaluate the influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats. Thirty-six female rats (Wistar, 120 days-old) were randomly divided into three groups that received a daily administration of a water diet (control, n = 12), a 10 percent alcohol diet (10 percent ethanol, n = 12) or a 20 percent alcohol diet (20 percent ethanol, n = 12). Four weeks after the onset of the experiment, cotton ligatures were placed around the cervix of the upper right second molar in six rats. The other 6 rats in each group remained unligated. The rats were sacrificed four weeks after ligature placement. The maxillary bones were removed and alveolar bone loss was analyzed by measuring the distance between the cementoenamel junction and the alveolar bone crest at 2 buccal and 2 palatal sites on the upper right second molar. Analyses between the ligated and unligated groups showed that the presence of ligature induced alveolar bone loss (p < 0.05). Unligated groups showed no significant differences between each other (p > 0.05). In the ligated groups, rats receiving 20 percent ethanol showed significantly greater bone loss compared to control rats or rats receiving 10 percent ethanol. These results demonstrate that alcohol consumption may increase alveolar bone loss in female rats in a dose-dependent manner.

Comparación del nivel de inserción periodontal entre individuos fumadores y no fumadores / Comparison of the level of insertion periodontal between smokers individuals and non smokers

El siguiente estudio comparativo de casos y controles tiene como objetivo comparar el nivel de inserción periodontal entre individuos fumadores y no fumadores para determinar la influencia que tiene el hábito tabáquico sobre el periodonto. Se utilizó una muestra de 1738 sitios periodontales específicos obtenidos de 50 sujetos de 19 a 59 años de edad, pertenecientes al Liceo Aníbal Pinto de Temuco, Chile, quienes presentaron un Examen de Salud Preventivo del Adulto Normal. Cada sitio periodontal fue sometido a un sondaje periodontal a través del cual se determinó el nivel de inserción. Además se determino el carácter fumador o no fumador de cada individuo y la frecuencia de este hábito en el primer grupo. Los datos fueron analizados mediante la prueba Chi – cuadrado con p< 0,05. Los resultados obtenidos indican que los individuos fumadores presentan una mayor pérdida de inserción periodontal que los no fumadores y en directa asociación con la frecuencia del hábito de fumar.

The following cases and controls study has as aim compare the level of periodontal insertion between smoking and not smoking individuals to determine the influence of the smoke on the periodontum. There was used a sample of 1738 specifics periodontal sites obtained of 50 subjects between 19 to 59 years old, from the Aníbal Pinto Lyceum of Temuco, Chile, who had received a normal Preventive Examination of Health of the Adult. Every periodontal site was submitted to a periodontal sounding to determinate insertion level. In addition it was determinate the smoking or not smoking character of every individual and the frequency of this habit in the first group. The information were analyzed by Chi - square test with p < 0,05.The results indicate that the smoking individuals present a major loss of periodontal insertion that not smokers and in direct association with the frequency of the smoking habit.

Study of the patterns of periodontal destruction in smokers with chronic periodontitis.

Cigarette smoking is a well-established risk factor for periodontitis and carries an increased risk for loss of periodontal attachment as well as for bone loss. AIMS: The purpose of the study was to investigate the pattern of the intraoral distribution of periodontal destruction among cigarette smokers with periodontitis by assessing the periodontal probing depth (PPD) and clinical attachment level (CAL). MATERIALS AND METHODS: Thirty smokers with chronic periodontitis were enrolled in the study. PPD, CAL, plaque index (PI), and bleeding on probing (BOP) were measured. The data was pooled for the anterior sextant and the posterior sextant as well as for the facial and lingual surfaces. The degree of periodontal destruction was compared in these sextants. STATISTICAL ANALYSIS: Comparisons were made between maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior using the one-way analysis of variance (ANOVA) test. When the overall ANOVA showed statistical significance, post hoc testing (Tukey-Kramer multiple comparisons test) was performed to explore the differences between any two groups. P -values < 0.05 were considered significant. RESULTS: The maxillary anterior sextant showed significantly higher PPD and CAL loss than the other sextants. Similarly, the maxillary palatal area showed higher probing depth and clinical attachment loss than the facial sites and the mandibular regions. CONCLUSIONS: From the results it can be concluded that there is variation in the periodontal tissue destruction in different areas of the oral cavity, with the maximum periodontal destruction in the maxillary palatal region. These observations emphasize the deleterious effects of smoking on the periodontal tissues.

Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fisher’s exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.

Occupational exposure to acid mists and periodontal attachment loss / Exposição ocupacional a névoas ácidas e perda de inserção periodontal

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as > 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss > 4mm at any time (prevalence ratio, PRadjusted = 2.17), past (PRadjusted = 2.11), and over 6 years of exposure (PRadjusted = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Este estudo investigou a hipótese de que a exposição ocupacional a névoas ácidas está associada positivamente à doença periodontal, avaliada através da perda de inserção periodontal. O estudo foi conduzido com 530 trabalhadores do sexo masculino de uma metalúrgica. Os dados foram obtidos por meio de entrevistas individuais e de exames clínicos odontológicos. A perda de inserção periodontal foi avaliada durante a sondagem e definida em > 4mm, em pelo menos um dente. Uma matriz de exposição ocupacional foi utilizada para avaliação da exposição. A exposição a névoas ácidas foi associada positivamente à perda de inserção periodontal > 4mm para a ocorrência da exposição em algum momento (RPajustada = 2,17), exposição passada (RPajustada = 2,11) e duração da exposição maior que seis anos (RPajustada = 1,77), independentemente da idade, consumo de álcool e tabagismo; estes resultados foram observados apenas entre os trabalhadores que não usavam o fio dental. A exposição a névoas ácidas é um fator de risco potencial para a perda de inserção periodontal e são necessários outros estudos que utilizem desenhos longitudinais e medidas de exposição mais acuradas.

Obesity and periodontal disease in diabetic pregnant women

O objetivo do presente estudo foi examinar o efeito da massa corporal prévia à gestacão (IMC - índice de massa corpórea) sobre o periodonto de pacientes com diabete mellitus gestacional (DMG). A amostra constituiu-se de 60 gestantes classificadas em 3 grupos segundo o IMC: normal, sobrepeso ou obeso. Os parâmetros de avaliacão periodontal foram sangramento gengival (SG), sangramento à sondagem (SS) e perda de insercão clínica periodontal (PI) categorizada de acordo com os seguintes valores: 1) correspondente à ausência de perda de insercão; 2) PI entre 1 e 2 mm, 3) PI entre 3 e 5 mm; e 4) PI > 6 mm. Médias das porcentagens dos dentes com SG e SS e as médias dos valores categorizados, por dente, da perda de insercão foram comparadas por meio do teste ANOVA e as diferencas entre os grupos foram estabelecidas por meio do teste post hoc de Bonferroni para comparacões múltiplas (p < 0,05). Diferencas estatisticamente significantes foram identificadas entre o grupo normal e obeso com relacão às médias percentuais da presenca de SG (52,76 n 27,99% e 78,85 n 27,44%, respectivamente) e às médias da categorizacão da PI (2,21 n 0,41 mm e 2,61 n 0,54 mm, respectivamente). Embora tenha se observado aumento no percentual médio de SS à medida do incremento do IMC, não foram observadas diferencas estatisticamente significantes entre os grupos, e a variacão foi de 55,65% a 75,31%. Pacientes com DMG e obesidade pré-gestacional apresentaram significativamente mais gengivite e perda de insercão periodontal que aquelas com IMC pré-gestacional normal. O tratamento periodontal deve ser considerado na determinacão de futuras recomendacões de controle metabólico para esse grupo especial de pacientes.

Análise da placa bacteriana subgengival em pacientes de risco à doença periodontal e sua capacidade previsora de perda de inserçäo periodontal / Microbiological analysis of subgingival plaque in risk patients of periodontal diseases and its predictive value for periodontal attachment loss

Examinou-se 104 amostras de placa bacteriana subgengival de 25 pacientes adultos com 18 a 45 anos, considerados de risco à doença periodontal, quanto à presença de bactérias periodontopáticas e valor previsor de perda de inserçäo, usando-se a técnica "slot immunoblot". As bactérias analisadas foram: P.g., P.i., T.d., A.v., S.sg. Dos 104 sítios amostrados, apenas 12 apresentaram perda de inserçäo quando este critério foi avaliado com intervalo de 6 meses, utilizando-se sonda computadorizada (Florida Probe) e um critério de "cohort" de 0,9 mm. A partir da análise dos resultados, vê-se que poucos sítios tiveram perda de inserçäo e que a quantidade de bactérias detectadas parece ter pouco ou nenhum valor previsor positivo de perda de inserçäo. O método de análise por "slot immunoblot" é pouco sensível e altamente específico para detectar perda de inserçäo em funçäo da presença de bactérias. Parece que, os métodos de análise microbiológica ainda näo säo suficientemente seguros para serem utilizados sozinhos como método de diagnóstico para prever perda de inserçäo periodontal

Tabaco y periodoncia / Tobacco and periodontics

En las últimas dos décadas una importante bibliografía demostró que uno de los factores de riesgo más importantes para el avance de la lesión periodontal es el hábito de fumar. El tabaco, con los componentes nocivos que contiene, sumados a la combustión del papel, el escaso poder de filtración del filtro y el calor generado en la boca, son los factores que contribuyen al avance de la gingivitis, al desarrollo de la G.U.N.A., el aumento de la pérdida de inserción en la periodontitis y sería un factor determinante en la periodontitis refractaria. Además, es sabido que en enfermos con lesiones periodontales y con el hábito de fumar, deberán hacerse controles más periódicos y debe incentivarse la higiene bucal

El tabaco daña la salud. Alerta para los tejidos periodontales! / Tobacco damages the health. An alert for periodontal tissues!

En este trabajo de revisión bibliográfica se encontró que diversos autores coinciden acerca del daño que las sustancias tóxicas del tabaco, provocan a los tejidos periodontales. Conocer la influencia de la nicotina sobre dichos tejidos, servirá de motivación para trabajar en prevención, mejorar el diagnóstico, conocer la limitación del tratamiento y orientar el pronóstico de la enfermedad periodontal del fumador