Asociación del hábito de fumar con la periodontitis crónica y la artritis reumatoide / Association of smoking with chronic periodontitis and rheumatoid arthritis

Introducción: Porphyromonas gingivalis es un microorganismo presente en las periodontitis, productor de la enzima peptidil arginina desminasa, inductora de la citrulinación de proteínas que convierte en antígenos, y que son reconocidos por los anticuerpos antipéptido cíclico citrulinados, marcadores específicos de la artritis reumatoide. Estudios clínicos y epidemiológicos relacionan el hábito de fumar con la periodontitis y la artritis reumatoide. Objetivo: Evaluar la asociación entre el hábito de fumar, la periodontitis crónica y la artritis reumatoide. Métodos: Se realizó un estudio observacional, analítico, de corte transversal, de casos y controles de pacientes con diagnóstico de artritis reumatoide tratados en el Centro de Reumatología y pacientes atendidos por medicina interna en el Hospital Clínico Quirúrgico 10 de octubre de La Habana, en el periodo entre septiembre del 2017 y mayo del 2019. Se estudiaron las variables edad, sexo, hábito de fumar y estado periodontal evaluado a través del índice de enfermedad periodontal de Russell y el nivel de inserción clínica. Para identificar la asociación entre variables se empleó la prueba de ji al cuadrado y el odds ratio. Se respetaron las legislaciones éticas. Resultados: En el estudio prevaleció el grupo de 35 a 44 años y el sexo femenino. El hábito de fumar predominó en los pacientes artríticos, con manifiesto incremento de la prevalencia y gravedad de la enfermedad periodontal. Conclusiones: El hábito de fumar incrementó el riesgo de periodontitis crónica en ambos grupos, y con menos intensidad de riesgo en la artritis reumatoide.

Introduction: Porphyromonas gingivalis is a microorganism present in periodontitis, producer of the enzyme peptidyl arginine deminase that induces citrullination of proteins, turning them into antigens, which are recognized by anti-citrullinated cyclic peptide antibodies, specific markers of rheumatoid arthritis. Clinical and epidemiological studies link smoking with periodontitis and rheumatoid arthritis. Objective: To evaluate the association between smoking, the presence of chronic periodontitis and rheumatoid arthritis. Methods: An observational, analytical, cross-sectional study of cases and controls of patients with a diagnosis of rheumatoid arthritis treated at the Rheumatology Center and patients treated by Internal Medicine in 10 de Octubre Surgical- Clinic Hospital in Havana, between September 2017 and May 2019. The variables were: age, sex, smoking habit and periodontal status evaluated through the Russell Periodontal Disease Index and Level of Clinical Insertion. For the association and relationship between variables, the chi square and the odds ratio were used. Ethical legislation was respected. Results: In the study the group of 35 to 44 years old and the female sex prevailed. Smoking prevailed in arthritic patients with a remarkable increase in the prevalence and severity of periodontal disease. Conclusions: Smoking increased the risk of chronic periodontitis in both groups with less intensity of risk in rheumatoid arthritis.

Periodontitis, dislipidemia y obesidad. Su relación / Relationship between periodontitis and dyslipidemia and obesity

Introducción: Desde hace algunos años, se reporta en la literatura médica una posible asociación entre la periodontitis con otras enfermedades y condiciones sistémicas. Objetivo: Determinar la relación entre la periodontitis con las dislipidemia, obesidad o ambas. Material y Método: Estudio analítico transversal. Del universo de 9 350 individuos residentes en el municipio Plaza de la Revolución en edades entre 35 y 70 años, ambos sexos; se seleccionó una muestra probabilística utilizando el esquema muestreo aleatorio simple de 1 200 individuos que otorgaron su consentimiento para participar. Debían presentar, en su historia clínica médica, resultados de análisis complementarios para detectar dislipidemia en los últimos seis meses y como mínimo seis dientes en boca. Las variables estudiadas fueron: periodontitis, dislipidemia, obesidad y presencia de dislipidemia y obesidad en el mismo individuo. Los sujetos se clasificaron en tres grupos: con presencia de dislipidemia, obesos y ambas entidades (dislipidemia+obesidad). Resultados: La variable más encontrada fue dislipidemia (73,0 por ciento), seguida de periodontitis (62,2 por ciento). La periodontitis se encontró con mayor frecuencia en individuos que presentaban dislipidemia (48,1 por ciento), los obesos presentaron en su mayoría periodontitis, en los sujetos que presentaron dislipidemia + obesidad, la periodontitis fue más frecuente que en los que no presentaban ambas entidades unidas. Conclusiones: La periodontitis se relacionó con la dislipidemia, obesidad y ambas unidas, no así con la obesidad, aunque fue más frecuente en estos últimos que en los no obesos(AU)

Introduction: A possible association between periodontitis and other diseases and systemic conditions has been reported by the medical literature for many years. Objective: To determine the relationship between periodontitis and dyslipidemia and obesity or both of them. Material and Methods: An analytical cross-sectional study was conducted. The universe consisted of 9 350 individuals between the ages of 35 and 70 years, of both sexes who live in Plaza de la Revolución Municipality. From this universe, a sample composed of 1 200 individuals who gave their consent to participate in the study was selected by simple random sampling method. Their clinical records should include the results of complementary tests to determine dyslipidemia in the last six months; also, they should have at least six teeth in the mouth. The variables studies included: periodontitis, dyslipidemia, obesity and the presence of dyslipidemia and obesity in the same individual. The subjects were divided into three groups: with dyslipidemia, obese and with both entities (dyslipidemia+obesity). Results: The most common variable found was dyslipidemia (73,0 percent), followed by periodontitis (62,2 percent). Periodontitis was more frequently found in individuals with dyslipidemia (48,1 percent), and the majority of obese subjects had periodontitis. Periodontitis was more frequent in individuals with dyslipidemia + obesity than in the ones that did not present both entities at the same time. Conclusions: Periodontitis was associated with dyslipidemia, obesity and with both entities at the same time, but it was not associated with obesity only. However, it was more frequent in obese subjects than in non-obese ones(AU)

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

¿La periodontitis crónica modifica la morbilidad de la artritis reumatoide?: aspectos clínicos y moleculares. Una revisión sistemática / Association between chronic periodontitis and rheumatoid arthritis: a systematic review

Rheumatoid arthritis (RA) and chronic periodontitis (CP) may be related due to a bidirectional etiology. The evidence shows that CP could alter the clinical course of RA. We performed a systematic search to determine if CP alters the morbidity of RA, analyzing its clinical and molecular aspects. Of 552 initial articles found, 16 were selected for a thorough review. There is a greater prevalence of CP in patients with RA. Patients with RA have significantly higher values of periodontal clinical parameters than healthy controls. Arthritis activity is significantly greater in patients who suffer from CP and decreases with nonsurgical periodontal treatment. There is a significant relationship between the severity of CP and RA activity.

Relationship between alcoholism addiction and periodontitis. an in vivo study using drinking-in-darkness protocol in rats

Periodontal disease (PD) has been considered a probable risk factor for several systemic diseases. among them, PD is presumed to be one of the possible etiologies of chronic illness of the central nervous system. In this context, poor oral health and PD is associated with substance abuse in humans. however, if periodontal lesions can produce addiction is unknown. this paper aims to evaluate the possibility that chronic periodontal injury (CPL) can cause ethanol binge intake in drink-in-darkness (DID) protocol in rats. in CPL group (n=10) experimental damage was done to the periodontal tissue of the second maxillary molar, the control group (n=9) received sham injury. forty-three days after CPL the intake of ethanol was assessed using several concentrations in DID experiment. during the DID experiment, we observed significant differences between the binge-type consumption of ethanol at the lowest concentration of 10 percent (p=0.01). differences in consumption of 20 percent ethanol are observed during a few days (p=0.04), and there are no differences in consumption at 40 percent concentration of ethanol (p=0.2). it is concluded that chronic periodontal lesion leads to alcoholism in wistar rats.

The effect of periodontal therapy on neopterin and vascular cell adhesion molecule-1 levels in chronic periodontitis patients with and without acute myocardial infarction: a case-control study

Abstract The presence of neopterin in gingival crevicular fluid (GCF) is a marker for local and acute immune activation, and the presence of vascular cell adhesion molecule (VCAM-1) in GCF is accepted as a marker for chronic vascular inflammation. Objectives This study aimed to evaluate effects of periodontal treatment on GCF levels of neopterin and VCAM-1 in patients with chronic periodontitis (CP) with acute myocardial infarction (AMI) compared with systemically healthy CP patients. Material and methods Sixty subjects (20 CP patients with AMI, 20 healthy CP patients, and 20 healthy controls) were included. GCF samples were analyzed at baseline and after 3 and 6 months, and the probing pocket depth (PD), clinical attachment level (CAL), bleeding on probing, gingival (GI) and plaque (PI) indices were recorded. We determined neopterin and VCAM-1 levels (concentration and total amount) using enzyme-linked immunosorbent assay (ELISA). No significant differences were seen between the AMI+CP and CP groups for PI, GI, GCF levels of neopterin and VCAM-1 at baseline. Results The number of teeth with 5 mm≤CAL<7 mm and CAL≥7 mm were significantly increased in the AMI+CP group at baseline. There were no significant differences between the AMI+CP and CP for PI, CAL, GCF volumes, and the AMI+CP group had the highest clinical improvement in the number of teeth with 5 mm≤CAL<7 mm at the sixth month. There were significant positive correlations between clinical periodontal inflammation and the presence of neopterin and VCAM-1 in GCF prior to and following periodontal treatment, and between the GCF volume and clinical parameters. Conclusions Data suggest that the total amount and concentration of neopterin and VCAM-1 in GCF seemed to be closely associated with periodontal disease severity in CP patients with AMI. Moreover, the results of our study demonstrate that the past periodontal status is potentially correlated between groups, with similar periodontal disease severity.

Proteínas Totales, Fosfatasa Alcalina, Prostaglandinas E2 y Lisozima como Biomarcadores Salivales en Pacientes Adultos con Periodontitis Crónica / Total Protein, Alkaline Phosphatase, Prostaglandin E2 and Lysozyme as Salivary Biomarkers in Patients with Chronic Periodontitis

RESUMEN: La periodontitis crónica es una inflamación de los tejidos que rodean y dan soporte a los dientes. Diversos biomarcadores químicos y pro inflamatorios están aumentados durante el transcurso de la enfermedad. El objetivo del estudio fue determinar los distintos niveles salivales de proteínas totales, fosfatasa alcalina, prostaglandina E2 (PGE2) y lisozima en pacientes con periodontitis crónica. Se obtuvieron muestras de saliva de 31 pacientes con periodontitis crónica y se realizó un estudio de serie de casos para la determinación cuantitativa de los biomarcadores. La concentración de proteínas totales se encontró por sobre los rangos de referencia en 22 pacientes, la actividad de la fosfatasa alcalina se vio aumentada en 9 pacientes y la concentración de PGE2 se vio por sobre los rangos de referencia en 30 pacientes. Las proteínas totales y PGE2 son biomarcadores salivales en estos pacientes con periodontitis, no así la fosfatasa alcalina y la lisozima.

ABSTRACT: Chronic periodontitis is an inflammation of tissue that surrounds and supports the teeth; during the course of the disease there is an increase of different chemical and pro-inflammatory biomarkers. The objective of the study was to determine different levels in saliva of total protein, alkaline phosphatase, lysozyme and prostaglandin E2 (PGE2) in patients with chronic periodontitis. We used saliva samples from 31 patients who had chronic periodontitis and the study was a case of series. Our results showed 22 patients with increased concentrations of protein concentration, nine patients with increased alkaline phosphatase and PGE2 concentration was above the reference range in 30 patients: The total protein and PGE2 are good salivary biomarkers in patients with periodontitis, but not the alkaline phosphatase and lysozyme.

Association between Chronic Periodontitis and Oral/Oropharyngeal Cancer

Abstract The aim of this case control study was to assess the association between the extent and severity of chronic periodontitis and oral cavity and/or oropharyngeal cancer. The case group comprised 35 patients (mean age 56.1±8.4), diagnosed for oral and/or oropharyngeal cancer. The control group comprised 40 individuals (mean age 55.4±9.4) without diagnostic of cancer. All individuals were subjected to a periodontal examination, including bleeding on probing, plaque index, gingival index, probing pocket depth (PPD), clinical attachment loss (CAL), and decayed, extracted and filled teeth index (DMFT). The case group had significantly more sites with plaque. GI and BOP had similar values in both groups. The median PPD and CAL values were significantly higher for the case group. Chronic generalized periodontitis was predominant in 80% of patients with oral and/or oropharyngeal cancer. Eighty nine percent of the patients in the case group presented severe chronic periodontitis. There was no significant difference between groups for median values of DMFT. The extent and severity of chronic periodontitis remained as risk indicators for oral cavity and/or oropharyngeal cancer even after the adjustments for traditional confound factors, i.e. smoking and alcohol consumption.

Resumo O objetivo deste estudo caso controle foi determinar a associação entre extensão e severidade da periodontite crônica e câncer da cavidade oral e/ou orofaringe. O grupo caso consistiu de 35 pacientes (idade média 56,1±8,4), diagnosticados para câncer oral e/ou de orofaringe. O grupo controle foi composto por 40 pacientes (idade média 55,4±9,4) sem diagnóstico de câncer. Todos os pacientes foram submetidos a exame periodontal, incluindo sangramento à sondagem, índice de placa, índice gengival, profundidade de sondagem e nível de inserção clínica, além do índice de dentes cariados, perdidos e obturados (CPOD). O grupo caso tinha significativamente mais sítios com placa. Índice gengival e sangramento à sondagem mostraram valores similares em ambos os grupos. A mediana dos valores de profundidade de bolsa à sondagem e nível de inserção clínica foram significativamente maiores para o grupo caso. A prevalência de periodontite crônica generalizada foi de 80% em pacientes com câncer oral e/ou de orofaringe. Oitenta e nove por cento dos pacientes no grupo de caso apresentaram periodontite crônica severa. Não houve diferença significante entre os grupos para os valores medianos de CPOD. A extensão e severidade da periodontite crônica permaneceram como indicadores de risco para câncer oral e/ou de orofaringe mesmo após o ajuste para fatores de confundimento tradicional, isto é, fumo e consumo de álcool.

Comparison of independent and dependent culture methods for the detection of transient bacteremia in diabetic subjects with chronic periodontitis / Comparación entre métodos de cultivo independientes y dependientes para la detección de bacteriemia transitoria en individuos diabéticos con periodontitis crónica

Introduction: Oral-derived bacteremia may occur after several dental procedures and routine daily activities. Some conditions of the oral cavity may favor episodes of bacteremia. This would be the case of patients with diabetes mellitus and periodontitis, who exhibit exacerbated gingival inflammation and may be more prone to developing oral-derived bacteremia. Objective: To compare the effectiveness of an independent culture method (quantitative real-time PCR- qCR) and the most commonly used method (BacT-ALERT 3D ® ) for the diagnosis of bacteremia. Materials and methods: Blood samples were drawn from subjects with type 2 diabetes mellitus and chronic periodontitis before and after apple chewing. Samples were processed by an automated blood culture system (BacT-ALERT 3D ® ) monitored for 15 days with suitable subculture of positive cultures. In parallel, whole DNA from blood samples was purified using a commercial kit and screened by qPCR using a universal primer set of 16S rDNA for bacteria detection. Results: Blood cultures taken before apple chewing were shown to be negative by the two diagnostic methods. After chewing, two samples (11%) showed bacterial growth by BacT-ALERT 3D ® whereas qPCR did not detect the presence of bacteria in any sample. Conclusions: qPCR did not show greater effectiveness than the BacT-ALERT 3D ® in the detection of bacteremia of oral origin.

Introducción. Las bacteriemias de origen oral pueden ocurrir después de procedimientos odontológicos y de otros actos cotidianos. Algunas condiciones de la cavidad oral favorecen las bacteriemias como en el caso de pacientes con diabetes mellitus y periodontitis que presentan inflamación gingival exacerbada. Objetivo. Comparar la eficacia de un método independiente de cultivo (PCR cuantitativa) y otro dependiente (BacT-ALERT 3D ® ) en la detección de la bacteriemia. Materiales y métodos. Se tomaron muestras de sangre de individuos con diabetes mellitus de tipo II y periodontitis, antes y después de la masticación de manzana. Una alícuota se procesó por el sistema automatizado de hemocultivo (BacT-ALERT 3D ® ) y se monitorizó durante 15 días; la otra alícuota fue tratada para la extracción del ADN y procesada por RT-PCR usando un conjunto de cebadores de 16S rDNA exclusivos para bacterias. Resultados. En las muestras tomadas antes de masticar se confirmó la ausencia de bacterias mediante los dos métodos. En las muestras tomadas después de masticar la presencia de bacterias se evidenció únicamente en dos hemocultivos y en ninguna de las muestras se detectó la presencia de bacterias con el método de RT-PCR. Conclusiones. La PCR cuantitativa no mostró mayor eficacia que el BacT-ALERT 3D ® en la detección de la bacteriemia de origen oral.

Association between periodontal disease and endothelial dysfunction in smoking patients / Asociación entre enfermedad periodontal y disfunción endotelial en pacientes fumadores

Over the past two decades, there has been increasing interest inthe impact of oral health on cardiovascular disease, particularlyregarding the effects of chronic infections such as periodontitison the endothelium. The aim of this study was to evaluate inhealthy smokers whether there are any significant differences inthe frequency of endothelial dysfunction between subjects with chronic moderate to severe periodontal disease andperiodontally healthy subjects. An observational cross-sectionalstudy was conducted. The target population was adults olderthan 40 years of age. Blood tests were performed to determinevalues of CBC, glycaemia, total cholesterol, HDL-C, and LDL-C. Periodontal examinations and probing were conducted witha Florida Probe®, and standardized procedures were used tomeasure flow-mediated dilation. Out of 150 subjects [69 male(46%) and 81 female (54%)], 75 (50%) had chronicperiodontitis. The mean value for baseline flow-mediateddilation was 4.04% and the mean value for final flow-mediateddilation was 4.66%, with a 0.62% mean difference showing astatistically significant increase (p<0.001).This study found nosignificant difference in the flow-mediated dilation valuesbetween periodontally healthy subjects and those withperiodontitis, in contrast to the literature, which suggests anegative impact of periodontal disease on endothelial function.

Durante las últimas dos décadas ha venido incrementándose el interés acerca del impacto de la salud oral, sobre las enfermedades cardiovasculares. El objetivo del estudiofue evaluar si en pacientes sistémicamente sanos y con tabaquismo, se encontraban diferencias significativas en la frecuencia de disfunción endotelial entre personas con enfermedad periodontal crónica de moderada a severa y personas con salud periodontal. El diseño empleado fue unestudio observacional de corte transversal. La población blanco, pacientes adultos mayores de 40 años de edad. Se tomaron muestras de sangre para obtener los valores de cuadro hemático, glucemia, colesterol total, cHDL y cLDL. Se realizó el examen periodontal diligenciando el anexo de periodoncia de la Facultad de Odontología y de acuerdo con el instructivo. El sondaje se realizó en todos los dientes presentes en bocautilizando la sonda electrónica periodontal (Florida Probe®). La técnica y procedimientos para la vasodilatación mediada por flujo utilizados fueron los estandarizados internacionalmente. De los 150 participantes, 69 eran hombres (46 por ciento) y 81 mujeres (54 por ciento) con promedio de edad de 50.2 años. De estos, 75 pacientes (50 por ciento) correspondían al grupo deperiodontitis crónica. Al evaluar la vasodilatación mediada por flujo elpromedio inicial encontrado fue de 4.04 por ciento y el final fue de4.66 por ciento, con un 0.62 por ciento de aumento en promedio (p<0.001). Sepuede concluir que a pesar de la evidencia en la literatura que sugiere que la enfermedad periodontal impacta negativamente la función endotelial, medida por vasodilatación mediadapor flujo, el presente estudio no encontró una diferencia significativa.

Função endotelial e tratamento periodontal não cirúrgico de pacientes diabéticos com periodontite / Endothelial function and non-surgical periodontal treatment in diabetic patients with periodontitis

O objetivo desse estudo foi investigar alterações na função endotelial, além de realizar meta-análises sobre o uso de antibióticos adjuvantes ao tratamento periodontal não cirúrgico em relação aos possíveis benefícios em termos de parâmetros clínicos periodontais e controle glicêmico nos pacientes diabéticos com periodontite. Quarenta e oito pacientes foram avaliados quanto aos parâmetros periodontais e função endotelial. Desses 48, 11 não tinham doença periodontal e não eram diabéticos (grupo A), 17 tinham periodontite crônica e não eram diabéticos (grupo B), e 20 tinham periodontite crônica e diabetes mellitus tipo 2 (grupo C). Dois revisores independentes examinaram ensaios clínicos controlados em 6 bases de dados eletrônicas, registros de ensaios clínicos, resumos de reuniões e 4 principais revistas odontológicas. A vasodilatação dependente do endotélio (fluxo de hiperemia) foi significantemente menor no grupo C quando comparado com os grupos A e B, assim como foi significantemente menor no grupo B quando comparado com o grupo A (p<0,05). As meta-análises mostraram um efeito significativo favorecendo tratamento periodontal associado a antibióticos para reduções na média de profundiade de sondagem (-0,22 mm [-0,34, -0,11]) e na média de porcentagem de sangramento a sondagem (4% [-7, -1]). Não houve efeito significativo no ganho de nível de inserção clínica e redução do índice de placa. Além disso, a associação de antibióticos e tratamento periodontal não reduziu os valores de hemoglobina glicada média (-0,11% [-0,35, 0,13]), e um intervalo de previsão estimado variando de -0,45 a 0,23. Também não houve efeito significativo favorecendo o uso adjuvante de doxiciclina sub-antimicrobiana na redução média da hemoglobina glicada (-0,19% [-1,07, 0,68]). Sendo assim, pode-se concluir que a periodontite crônica está associada a diminuição da vasodilatação dependente do endotélio do indivíduo, assim como diminui ainda mais quando associada ao diabetes mellitus. O antibiótico sistêmico adjuvante ao tratamento periodontal proporciona benefícios estatisticamente significantes em termos de reduções de média de profundidade de bolsa a sondagem e o percentual de sangramento a sondagem, porém não proporciona um benefício significativo em termos de melhoria de nível de inserção clínico, índice de placa e hemoglobina glicada.

The aim of this study was to investigate alterations in endothelial function, besides performing meta-analyzes on the use of adjuvant antibiotics to non-surgical periodontal treatment in relation to the possible benefits in terms of periodontal clinical parameters and glycemic control in diabetic patients with periodontitis. Forty-eight patients were evaluated for periodontal parameters and endothelial function. Of these, 11 h ad no periodontal disease and were not diabetic (group A), 17 had chronic periodontitis and were not diabetic (group B), and 20 had chronic periodontitis and type 2 diabetes mellitus (group C). Two independent reviewers examined controlled clinical trials in 6 electronic databases, clinical trial records, meeting summaries, and 4 major dental journals. Endothelium-dependent vasodilation (hyperemia flow) was significantly lower in group C when compared to groups A and B, as well as significantly lower in group B when compared to group A (p <0.05). The meta-analyzes showed a significant effect favoring antibiotic-associated periodontal treatment for reductions in the mean probing pocket depth (-0,22 mm [-0,34; -0,11]) and the mean percentage of bleeding probing ( 4% [-7, -1]). There was no significant effect on gain of clinical attachment level and reduction of plaque index. In addition, the association of antibiotics and periodontal treatment did not reduce mean glycated hemoglobin values (-0,11% [-0,35, 0,13]), and an estimated prediction interval ranging from -0,45 to 0,23. There was also no significant effect favoring the adjuvant use of sub-antimicrobial doxycycline in the mean reduction of glycated hemoglobin (-0,19% [-1,07, 0,68]). Thus, it may be concluded that chronic periodontitis is associated with decreased vasodilatation dependent on the endothelium of the individual, as well as decreases even more when associated with diabetes mellitus. The systemic antibiotic adjuvant to periodontal treatment provides statistically significant benefits in terms of reductions of mean probing pocket depth and % of bleeding on probing, but does not provide a significant benefit in terms of improvement of clinical attachment level, plaque index and glycated hemoglobin.

La enfermedad periodontal como factor de riesgo de enfermedades cardiovasculares / Periodontal disease as a risk factor for cardiovascular diseases

Los eventos cardiovasculares inducidos por aterosclerosis constituyen causade muerte y discapacidad en el mundo, la enfermedad periodontal tiene una altaprevalencia. Estudios realizados en los últimos años, señalan que estas entidades mantienen una estrecha relación. Objetivos: Relacionar la presencia y gravedad de enfermedad periodontal en un grupo de estudio y control. Identificar la presencia de factores de riesgo aterogénicos en ambos grupos. Método: Estudio descriptivo de corte transversal, desarrollado en la consulta de Estomatología del Instituto de Cardiología y Cirugía Cardiovascular de La Habana (grupo estudio con diagnóstico de cardiopatía inducida por aterosclerosis) y la Consulta dePeriodoncia de la Facultad de Estomatología de La Habana (grupo control, sin este diagnóstico), durante los meses de enero a junio del 2013. Los grupos estaban formados por 85 pacientes cada uno, de ambos sexos y entre 35 y 70 años. Las variables estudiadas fueron presencia y gravedad de enfermedad periodontal y factores de riesgo de aterosclerosis. Resultados: Se encontraron diferencias significativas en el estado periodontal de ambos grupos de pacientes y solo significación en cuanto a la dislipidemia y tabaquismo. Conclusiones: Se asoció la presenciay severidad de enfermedad periodontal con la presencia de enfermedadcardiovascular inducida por aterosclerosis. Ambos grupos mostraron pocas diferencias en relación a los factores de riesgo de aterosclerosis presentes, solo fueron significativas en cuanto a la dislipidemia y tabaquismo, el cual mostró resultados similares cuando se estudió su práctica regular en algún momento de la vida.

Cardiovascular disease induced by atherosclerosis is an important cause ofdead and invalidism in the world, periodontal disease has high prevalence.Studies made in the last years agrees in those diseases have relations.Objectives: In study and control groups relational cardiovascular disease andperiodontal disease. In both populations determine the presence of the factorsof risk for the atherosclerosis. Methodology: se carries out a descriptive traversestudy in stomatology consult of Cardiovascular Institute (in 85 patientsdiagnosed Cardiovascular disease induced by atherosclerosis) and StomatologyFacultad (85 patients within this diagnosis), from January to June 2013. Thestudied variables were and periodontal disease presence and severity andsomething factors of risk for the atherosclerosis. Resulted: The periodontaldisease were more frequent and severity in the study group. Only found differencesbetween dislipidemia and smoking. Conclusions: Was associated thepresence and severity of periodontal disease with cardiovascular diseaseinduced by atherosclerosis.

Comportamento dos sistemas peroxidase e antioxidante, e produtos de peroxidação lipídica na saliva total de pacientes com diabetes mellitus 2 antes e após tratamento periodontal não cirúrgico / Peroxidase and antioxidant systems and lipid peroxidation products behavior in type 2 diabetes mellitus patients whole saliva before and after periodontal treatment

O estresse oxidativo (EO), fenômeno decorrente do desequilíbrio entre a geração de espécies reativas de oxigênio (ERO) e/ou depleção antioxidante (AO), está envolvido na patogênese de diversas doenças e desordens, incluindo o diabetes mellitus tipo 2 (DM2) e a doença periodontal. Uma das conseqüências da geração excessiva das ERO é a destruição tecidual promovida pela peroxidação lipídica, e para combater estes efeitos deletérios, o organismo desenvolveu mecanismos de defesa, como os AO e peroxidases. Objetivos: Avaliar o comportamento dos marcadores de EO na saliva total (SALT) de pacientes com ou sem DM2, portadores ou não de periodontite crônica generalizada (PCG); e verificar e comparar o efeito do tratamento periodontal não-cirúrgico (TPNC) sobre esses marcadores entre os pacientes. Materiais e Métodos: 121 pacientes participaram deste estudo e foram alocados em 4 grupos: diabéticos com PCG (DMPC), diabéticos sem PCG (DM), pacientes sistemicamente saudáveis com PCG (PC) e pacientes sistemicamente saudáveis e sem periodontite (C). Os índices de Placa (IP), nível clínico de inserção (NCI), profundidade clínica de sondagem (PCS) e sangramento à sondagem (SS) foram coletados para a avaliação dos parâmetros clínicos periodontais. Foram também coletadas amostras de sangue periférico e SALT para analisar respectivamente a hemoglobina glicada (HbA1c) e os marcadores de EO, superóxido dismutase (SOD), estado total de antioxidante (TAS) e substâncias reativas do ácido tiobarbitúrico (TBARS) e peroxidase salivar (SPO). As coletas foram realizadas no baseline e após 30 dias do tratamento, previamente à avaliação e reavaliação clínica. Os pacientes DMCP e PC passaram por TPNC, e os DM e C, receberam apenas orientação de higiene oral e profilaxia. Resultados: No baseline, os grupos DMPC e PC apresentaram

valores significativamente maiores dos parâmetros clínicos PCS, SS, IP e NCI quando comparados aos grupos DM e C (p<0.05). Após o TPNC, todos esses parâmetros mostraram melhoras significativas (p<0,05). A HbA1c foi significativamente maior no grupo DMPC quando comparado com DM no baseline (p<0,05), no entanto, o TPNC não promoveu melhora significativa após 1 e 3 meses de acompanhamento glicêmico, ainda que, a redução percentual (0,4%) observada possa ser considerada importante. Quanto aos marcadores, no grupo DMPC os valores de TBARS foram significativamente menores comparados aos grupos DM, PC e C (p<0.05), e os de SPO foi significativamente maior em relação aos grupos PC e C (p<0.05), com correlação negativa entre TBARS e SPO (r=-0.35; p=0.002), enquanto que os valores de TAS e SOD não mostraram diferenças significativas entre os grupos estudados (p>0.05). Após o TPNC, os níveis de TBARS aumentaram significativamente, e os de SPO diminuíram significativamente apenas no grupo DMPC (p<0.05 e p<0.05), ao passo que os valores de SOD e TAS permaneceram inalterados nos dois grupos. Conclusão: No baseline, os valores de TBARS e de SPO estiveram alterados nos pacientes DMPC com resultados que mostram correlação inversa entre TBARS/SPO, e após o TPNC houve nova alteração. O comportamento dos marcadores de EO na saliva mostrou a busca pelo ponto de equilíbrio por diversas vias e que este pode ser alterado pelo uso de medicamentos, como a metformina.

Oxidative stress (OS), resulting phenomenon from reactive oxidative species (ROS) and/or antioxidant (AO) depletion imbalance, is involved in many diseases and disorders pathogenesis, including type 2 diabetes mellitus (T2DM) and periodontal disease. One of the ROS excessive generation consequences is the tissue destruction promoted by lipid peroxidation. To strike ROS deleterious effects, the organism developed several defense mechanisms, such as AO and peroxidase systems. Objectives: To evaluate the OS markers behavior in whole saliva (WS) of patients who has or not T2DM, with or without generalized chronic periodontitis (GCP); and to verify and to compare non-surgical periodontal treatment (NSPT) effect on these markers. Material and Methods: 121 patients participated of this study and were allocated in 4 groups: diabetics with chronic periodontitis (DMPC), diabetics periodontally heathy (DM), sistemically healthy with chronic periodontitis (PC) and sistemically and periodontally healthy patients (C). Plaque index (PI), clinical attachment level (CAL), probing depth (PD) and bleeding on probing (BOP) were collected for periodontal clinical paramethers. Peripheral blood and WS samples were collected respectively for glycated hemoglobin (HbA1c) and OS markers, such as superoxide dismutase (SOD), total antioxidant status (TAS), thiobarbituric acid reacting substances (TBARS) and salivary peroxidase (SPO), assessment. Collections were performed at baseline and 30 days after treatment, previously to clinical evaluation and reevaluation. GCP patients (DMPC and PC)

were submitted to NSPT, and those with periodontal health (DM and C) received oral hygiene instructions and prophilaxys only. Results: At baseline, DMPC and PC patients showed PD, BOP, PI and CAL higher levels when compared to DM and C groups (p<0.05). After NSPT, all these clinical parameters had significant improvement (p<0.05) in both groups. HbA1c medians were significantly higher in DMPC when compared to DM, at baseline, however, the NSPT did not improved after 1 and 3 months of glicemic control, though percentual reduction (0.4%) observed at clinical point of view might be considered important. As to laboratorial analysis, in DMPC group, TBARS levels were significantly decreased compared to DM, PC and C (p<0.05), and SPO activity were significantly higher than PC and C (p<0.05), with negative correlation between TBARS and SPO (r=-0.35; p=0.002), while TAS levels and SOD activity did not show any significant differences...

Association between erectile dysfunction and chronic periodontitis: A clinical study.

Background: In recent years, evidence has come forth supporting the notion that localized infectious diseases such as periodontal disease may indeed influence a number of systemic diseases. Erectile dysfunction (ED) and chronic periodontitis have common risk factors such as diabetes mellitus, cardiac diseases and smoking etc. Aim: The aim was to evaluate the periodontal status of the subjects suffering from ED and to find association between vasculogenic ED and chronic periodontitis, if any. Study Design: A total of 53 subjects suffering from vasculogenic ED were enrolled for the study and were divided into three groups on the basis of severity of ED. Materials and Methods: The clinical (probing pocket depth) and radiographic parameters (alveolar bone loss) were recorded and periodontal status of three groups was evaluated, compared and an attempt was made to find an association between ED and chronic periodontitis. Karl Pearson’s correlation was used to assess an association between the two conditions. Statistical Analysis: One‑way ANOVA and Scheffe’s test were used to find the significant difference of chronic periodontitis with severity of ED. Karl Pearson’s correlation was used to find an association between chronic periodontitis and ED. Results: Statistically significant mean differences of 1.73 mm, 0.56 mm and 1.17 mm were recorded when comparison was made among Group I and III, Group I and II and Group II and III, respectively. Mean differences in bone loss among three groups were also statistically significant. Both the diseases were positively correlated to each other. Conclusion: It may be concluded that chronic periodontitis and ED are associated with each other. However, further large scale studies with confounder analysis and longitudinal follow‑up are warranted to explore the link between these two diseases.

Avaliação de marcadores inflamatórios séricos em indivíduos com diabetes mellitus tipo 2 após tratamento periodontal intensivo não-cirúrgico: estudo clínico randomizado / Evaluation of serum inflammatory markers in individuals with type 2 diabetes mellitus after intensive non-surgical periodontal therapy: a randomized clinical trial effects

O objetivo deste trabalho foi comparar os efeitos sorológicos e clínicos de dois protocolos de terapias periodontais em indivíduos com diabetes tipo 2 (DMT2) e periodontite crônica. Foram analisados 36 pacientes, randomizados em dois grupos: um grupo recebeu terapia intensiva de raspagem e alisamento radicular (INT; n=18) e outro recebeu apenas raspagem supragengival (SUP; n=18). Os grupos foram avaliados quanto aos parâmetros clínicos periodontais e marcadores inflamatórios séricos, antes e após 6 meses do tratamento periodontal. O exame clínico periodontal avaliou: placa visível (IP), índice gengival (IG), supuração (SUPUR), profundidade clínica de sondagem (PCS) e nível clínico de inserção (NCI). Amostras sanguíneas foram obtidas para análise de marcadores inflamatórios e hemoglobina glicada (HbA1c). Os marcadores de inflamação avaliados foram: interleucina (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, fator estimulador de colônias granulocitárias (G-CSF), fator estimulador de colônias de granulócitos-macrófagos (GM-CSF), interferon- (IFN-), proteína quimiotática de monócito-1 (MCP-1), proteína inflamatória de macrófago-1 (MIP-1) e fator de necrose tumoral (TNF-), através do imunoensaio multiplex (Bioplex). Ambas as terapias resultaram na melhora de quase todos os parâmetros clínicos periodontais (p<0,05), com exceção do NCI (p=0,09) no grupo SUP. Não houve diferença significativa para os níveis de IL-1, IL-4, IL-5, IL-10, IL-13, MIP-1 e TNF- (p>0,05), após tratamento, em ambas as terapias. Houve redução significativa de IL-6 (p=0,01), IL-12 (p=0,04) e MCP-1 (p=0,02) no grupo INT e de GCS-F nos grupos SUP (p=0,04) e INT (p=0,01). Os níveis de IL-2, IL-7, IL-8, IL-17, GM-CSF e IFN- não foram detectados. A terapia INT tem um efeito benéfico na redução dos níveis séricos de IL-6, IL-12 e MCP-1, na redução de PCS em sítios profundos e no ganho de inserção quando comparado à terapia supragengival em um período de 6 meses...

The objective of this study was to compare the serological and clinical effects of two periodontal therapies in individuals with type 2 diabetes (T2DM) and chronic periodontitis. 36 patients were analyzed, randomized into two groups: one group received intensive t of scaling and root planing (INT, n=18) and another received only supragingival scaling (SUP, n=18). The groups were evaluated for periodontal parameters and serum inflammatory markers before and after 6 months of periodontal treatment. The periodontal parameters assessed were: visible plaque (PI), gingival index (GI), suppuration (SUP), probing pocket depth (PPD) and clinical attachment level (CAL). Blood samples were obtained for analysis of inflammatory markers and glycated hemoglobin (HbA1c). The inflammatory markers evaluated were: interleukin (IL)- 1 , IL- 2, IL -4, IL -5, IL -6, IL -7 , IL-8 , IL-10 , IL-12 , IL-13 , IL -17, granulocyte colony-stimulated factor (G -CSF), colony stimulating factor granulocyte-macrophage (GM -CSF), interferon - (IFN - ), monocyte chemotactic protein-1 (MCP-1) , macrophage inflammatory protein-1 (MIP-1 ) and tumor necrosis factor (TNF- ) through a multiplex immunoassay (Bioplex). Both therapies resulted in improvement of almost all periodontal clinical parameters (p<0.05), with the exception of the NCI in SUP group. There was no significant difference for (IL )- 1 , IL- 4, IL -5, IL-10 , IL-13 , MIP- 1 and TNF- after treatment for both therapies (p>0.05). A significant reduction was observed in IL-6 (p=0.01), IL-12 (p=0.04) and MCP-1 (p=0.02) levels for INT group and in GCS- F levels for SUP (p=0.04) and INT (p=0.01) groups. The levels of IL-2, IL -7, IL-8 , IL-17, GM- CSF and IFN- were not detectable. The INT therapy has a beneficial effect in reducing serum levels of IL-6, IL-12 and MCP-1, in reducing PPD of deep sites and in attachment gain when compared to SUP therapy considering a period of 6 months...

Influência do diabetes mellitus do tipo 2 na expressão dos receptores ativados por protease do tipo 1 (PAR1) e do tipo 2 (PAR2) em pacientes com periodontite crônica / Influence of diabetes mellitus type 2 in the expression of protease-activated receptor type 1 (PAR1) and type 2 (PAR2) in patients with chronic periodontitis

O receptor ativado por protease do tipo 1 (PAR1) parece estar associado ao reparo periodontal, enquanto o tipo 2 (PAR2) com a inflamação periodontal. Esses receptores podem ser ativados pelas proteases gingipaina, uma protease secretada pela Porphyromonas gingivalis, um importante periodontopatógeno, e pela proteinase-3 de neutrófilos (P3), que é liberada por neutrófilos quando expostos a um estímulo inflamatório. Uma vez que o diabetes é reconhecido como um fator de risco importante para a doença periodontal, o objetivo deste estudo foi investigar a expressão de PAR1 e de PAR2 e de seus ativadores, gingipaina e P3 no fluido gengival (FG) de pacientes diabéticos com periodontite crônica, antes e após tratamento periodontal não cirúrgico. Amostras de FG e os parâmetros clínicos, como profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletados de pacientes sistemicamente saudáveis e de pacientes com diabetes mellitus do tipo 2 (DMT2) com periodontite crônica , no baseline e após o tratamento periodontal não cirúrgico. As expressões gênicas de PAR1, PAR2, gingipaina e P3 no FG foram quantificadas por qPCR. Os parâmetros clínicos melhoraram significativamente após a terapia periodontal (p <0,01). O diabetes levou ao aumento da expressão de PAR1 no fluido gengival e na presença da periodontite crônica diminuiu significativamente a expressão de PAR1, PAR2 e P3 (p<0,05). Além disso, o tratamento periodontal não cirúrgico em diabéticos resultou no aumento da expressão de PAR1 e de PAR2 (p<0,05). Dentro dos limites do presente estudo, sugerimos que os PARs podem estar associados com a inflamação periodontal em diabéticos.

Protease activated receptor type 1 (PAR1) seems to play a role in periodontal repair, while PAR2 is associated with periodontal inflammation. These receptors can be activated by gingipain, a protease released from Porphyromonas gingivalis, an important periodontal pathogen, and neutrophil proteinase-3 (P3), which is released by neutrophils when exposed to an inflammatory stimulus. Since diabetes is known risk factor to periodontal disease, the aim of this study was to investigate PAR1 and PAR2 mRNA expression at the gingival crevicular fluid (GCF) in diabetic patients with chronic periodontitis, before and after non-surgical periodontal treatment. GCF samples and clinical parameters consisting of measuring probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were collected from systemically healthy patients and patients with type 2 diabetes mellitus with chronic periodontitis, at baseline and after nonsurgical periodontal treatment. PAR1 and PAR2, as well the expression of the activators gingipain and P3 at the GCF were quantified by qPCR. The clinical parameters improved significantly after periodontal therapy (p <0.01). Diabetes led to increased expression of PAR1 in the GCF, and the presence of chronic periodontitis significantly decreased the expression of PAR1, PAR2 and P3 (p <0.05). Moreover, non-surgical periodontal treatment in diabetics resulted in increased expression of PAR1 and PAR2 (p <0.05). Within the limits of this study, we suggest that PARs may be associated with periodontal inflammation in diabetics.

Efeito da severidade da doença periodontal sobre a expressão do Receptor Ativado por Protease do Tipo 2 (PAR-2) / Effect of the severity of periodontal disease on the expression of Protease Activated Receptor Type 2 (PAR-2)

Pesquisas recentes investigando o receptor ativado por protease do tipo 2 (PAR-2) sugerem uma associação entre este receptor e a inflamação periodontal. Além disso, é sabido que a gingipaína, protease bacteriana secretada por um importante periodontopatógeno, Porphyromonas gingivalis (Pg), tem a capacidade de ativar o PAR-2. Ademais, um estudo anterior do grupo, verificou que quanto mais profunda a bolsa periodontal, maior era a expressão do receptor PAR-2. No entanto, não é sabido se a expressão de PAR-2 é proporcional a severidade de doença periodontal e a quantidade de gingipaína expressa na bolsa periodontal. Desta forma, o presente estudo, verificou no fluido gengival a correlação entre a expressão gênica de PAR-2 (Real Time-PCR) com os parâmetros clínicos periodontais, e a expressão gênica da protease gingipaína em pacientes com periodontite crônica severa e moderada, antes e após o tratamento periodontal não-cirúrgico. A expressão de PAR-2 e da protease gingipaína foi estatisticamente maior nos pacientes do grupo periodontite crônica severa (PS) em comparação com os pacientes do grupo periodontite crônica modera (PM) e controle (C). Além disso, o tratamento periodontal levou à redução significativa (p<0.05) da expressão de PAR-2 nos pacientes com periodontite crônica moderada. Em conclusão, dentro dos limites do presente estudo, nós demonstramos que a severidade da doença periodontal e a expressão de gingipaína influenciaram a expressão de PAR-2 no fluido gengival de pacientes com periodontite crônica.

Recent studies investigating the protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. In addition, it is known that gingipain, a bacterial protease secreted by an important periodontopathogen, Porphyromonas gingivalis (Pg), has the ability to activate PAR- 2. Furthermore, a previous study from our group found that the deeper the periodontal pocket, the higher the expression of the PAR-2 receptor. However, it is not known whether the expression of PAR-2 is associated to the severity of periodontal disease and the amount of gingipain expressed in the periodontal pocket. Thus, the present study verified, in the gingival fluid, the correlation between the PAR-2 gene expression (Real Time-PCR) with the clinical periodontal parameters, and the gene expression of the gingipain protease in patients with moderate and severe chronic periodontitis before and after non-surgical periodontal treatment. PAR-2 expression and gingipain protease were statistically more expressed in patients of the severe chronic periodontitis group (PS) compared with those in the moderate chronic periodontitis group (PM) and control group (C). Furthermore, periodontal treatment led to a significant reduction (p <0.05) in the expression of PAR-2 in patients with moderate chronic periodontitis. In conclusion, within the limits of the present study, we demonstrated that the severity of periodontal disease and the expression of gingipain influenced the PAR-2 expression in the gingival fluid of patients with chronic periodontitis.

Relações entr / Relation between cytokines, chemokines, and maturation of dendritic cells, in smokers and non-smokers, diagnosed with chronic periodontitis

A periodontite crônica (PC) é a principal forma de doença periodontal destrutiva e resulta da interação entre bactérias e resposta inflamatória do hospedeiro, podendo ser afetada por fatores ambientais como o fumo. o objetivo do estudo foi avaliar a expressão de citocinas e quimiocinas, assim como a densidade de células dendríticas (CDs) imaturas e maduras, e densidade do infiltrado inflamatório no tecido gengival de indivíduos não-fumantes (NF) e fumantes (F), diagnosticados com periodontite crônica. O estudo foi aprovado pelo COEP-UFMG (423/11) e foram recrutados 24 indivíduos NF e 21 F...

Relación entre los niveles de compuestos volátiles sulfurados con los niveles de RANKL y OPG en pacientes con periodontitis crónica moderada o severa: estudio transversal / Relationship between the levels of volatile sulfur compounds with the levels of RANKL and OPG in patients with moderate or severe periodontitis: A cross sectional study

Antecedentes: El efecto de los Compuestos Volátiles Sulfurados (CVS) sobre los tejidos periodontales, específicamente a nivel del eje RANKL/OPG, no ha sido dilucidado y en la actualidad existe escasa literatura al respecto publicada. Objetivo: Evaluar si los CVS medidos en la cavidad oral de pacientes con periodontitis crónica moderada a severa se relacionan con la expresión de RANKL y OPG a nivel de fluido gingival crevicular (FGC). Método: Se realizó un estudio transversal con 71 pacientes derivados de la Unidad de Diagnóstico de la Clínica Odontológica Docente Asistencial de la Universidad de los Andes. Posterior a la realización de un examen periodontal completo se tomaron muestra de los niveles de CVS de la boca de los pacientes mediante un monitor de sulfuros y muestras de FGC para evaluar los niveles de RANKL y OPG mediante test de ELISA. Los datos obtenidos fueron analizados mediante test de correlación de Spearman. Resultados: Al evaluar la correlación de los niveles de CVS con los niveles de RANKL, OPG y la razón RANKL/OPG, se observó un R de 0.098 con un p value = 0.41; -0.084 con un p value= 0.48 y 0.067 con un p value = 0.57 respectivamente. Conclusiones: El presente estudio no pudo demostrar si existe una relación entre los niveles de CVS con la expresión de RANKL y OPG en el FGC de pacientes con periodontitis crónica.

Background: The effect of the Volatile Sulfur Compounds (VSC) on the periodontal tissues, specifically at the RANKL/OPG level has not been elucidate and there is little literature published on this subject. Aim: To explore if the VSC levels measured in the oral cavity of patients with moderate or severe chronic periodontitis are correlated with the expression of RANKL and OPG at the gingival fluid level (GF). Method: A cross-sectional study was conducted with 71 patients referred by the Universidad de los Andes’s dentistry diagnosis department. After undergoing full-mouth periodontal exam, levels of CVS were recorded using a sulfur monitor and then GF was extracted to assess RANKL and OPG levels with ELISA. Data was analyzed with Spearman correlation test. Results: The correlation (R) between the VSC and the GF levels was 0.098 with a p value = 0.41; -0.084 with a p value = 0.48 y 0.067 with a p value = 0.57 respectively. Conclusions: This study could not demonstrate if there is a relation between the VSC levels and the expression of RANKL and OPG in the GF in patients with chronic periodontitis.