Pénfigo vulgar y su manejo integral: reporte de dos casos y revisión de literatura / Pemphigus Vulgaris and its Comprehensive Management: Report of Two Cases and Literature Review

Resumen En la cavidad oral se pueden presentar lesiones en gíngiva que no están asociadas a placa bacteriana, las cuales requieren de un adecuado diagnóstico y tratamiento. La gingivitis descamativa está usualmente relacionada con desórdenes mucocutáneos, como el pénfigo vulgar (PV), donde las lesiones orales incluyendo las lesiones gingivales, pueden preceder las lesiones cutáneas. El manejo es multidisciplinario y el tratamiento incluye terapia farmacológica tópica y sistémica, se requiere un adecuado control de la placa bacteriana por parte del paciente y una estricta supervisión en el tiempo por parte del profesional para el mantenimiento y estabilidad de los tejidos gingivales. Se presentan dos casos clínicos de pacientes con diagnóstico de PV los cuales fueron manejados de manera oportuna e integral para controlar y estabilizar el factor sistémico y local.

Abstract In the oral cavity, gingiva lesions may occur that are not associated with bacterial plaque, which require adequate diagnosis and treatment. Desquamative gingivitis is usually related to mucocutaneous disorders, such as pemphigus vulgaris (PV), where oral lesions, including gingival lesions, may precede skin lesions. Management is multidisciplinary and treatment includes topical and systemic pharmacological therapy, require adequate control of dental plaque by the patient and strict supervision over time by the professional for the maintenance and stability of the gingival tissues. Two clinical cases of patients with a diagnosis of PV are presented, which were managed in a timely and integral way to control and stabilize the systemic and local factor.

Facial antibioma formation: a case report

Odontogenic infections are associated with a variety of microorganisms. antibiotics are commonly used for the management of various dental infections and have a proven role in decreasing morbidity and mortality caused by infectious diseases. the frequent and over usage of antibiotics has been associated with a number of consequences such as the selection of drug resistant strains, and the formation of antibiomas. antibiomas are characterized by the formation of a localized pathology surrounded by thick fibrous tissues in response to long term antibiotics use. an established antibioma is characterized by a tough fibrous swelling accompanied by painful or painless swelling, intermittent fever and constitutional symptoms. in this article, we are reporting the case of a facial antibioma formed due to prolonged use of antibiotics prescribed for a residual periapical infection following endodontic treatment. in addition, the association of using antibiotics in this context is discussed.

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

Eugenia uniflora Dentifrice for Treating Gingivitis in Children: Antibacterial Assay and Randomized Clinical Trial

Abstract School-age children are frequently at high risk for the onset of biofilm-dependent conditions, including dental caries and periodontal diseases. The objective of this study was to evaluate the clinical efficacy of a dentifrice containing Eugenia uniflora Linn. (Surinam cherry) extract versus a triclosan-based comparator in treating gingivitis in children aged 10-12 years. The in vitro antibacterial potential of the dentifrice was tested against oral pathogens (Streptococcus mutans, Streptococcus oralis and Lactobacillus casei). Then a phase-II clinical trial was conducted with 50 subjects aged 10-12 years, with clinical signs of gingivitis. The subjects were randomly assigned to the experimental group (n=25) and control group (n=25), in which participants used the experimental dentifrice and a triclosan-based fluoridated dentifrice (Colgate Total 12(r)), respectively. Clinical examinations assessed the presence of gingivitis (primary outcome) and biofilm accumulation (secondary outcome) using the Gingival-Bleeding Index (GBI) and Simplified Oral Hygiene Index (OHI-S), respectively, at baseline and after seven days of tooth brushing 3x/day. The data were analyzed using paired and unpaired t-test (GBI) and Wilcoxon and Mann-Whitney (OHI-S), with p≤0.05. The experimental dentifrice showed efficient antibacterial activity in vitro. In the clinical trial, a significant reduction in gingival bleeding was observed in both experimental and control groups (p<0.0001), with no statistical difference between them (p=0.178), although a small size effect was observed. Biofilm accumulation was only reduced in the control group (p=0.0039). In conclusion, E. uniflora dentifrice showed anti-gingivitis properties in children aged 10-12 years. Thus, it may be a potentially efficient and safe product to be used alternatively in preventive dental practice.

Resumo Crianças em idade escolar apresentam, com frequência, alto risco para o desenvolvimento de doenças biofilme-dependentes, incluindo cárie e doenças periodontais. Este estudo investigou a eficácia clínica de um dentifrício contendo o extrato de Eugenia uniflora Linn. (pitanga) comparado a um dentifrício com triclosan no combate à gengivite em crianças de 10 a 12 anos. Foi avaliado o potencial antibacteriano in vitro do dentifrício sobre microorganismos da cavidade oral (S. mutans S. oralis and L. casei) e realizado um estudo clínico fase II incluindo 50 sujeitos, com sinais clínicos de gengivite, divididos aleatoriamente em dois grupos: Experimental - 25 sujeitos usaram o dentifrício contendo extrato de pitanga; e Controle - 25 sujeitos que usaram um dentifrício fluoretado contendo triclosan (Colgate Total 12(r)). Na baseline e após sete dias consecutivos de escovação, foi realizado o exame clínico para diagnóstico de gengivite (desfecho primário) e acúmulo de biofilme (desfecho secundário), utilizando o Índice de Sangramento Gengival (ISG) e Índice de Higiene Oral Simplificado (IHO-S). Os dados foram analisados utilizando o teste t pareado e não pareado (ISG) e teste de Wilcoxon e Mann-Whitney (IHO-S), com nível de significância de p≤0,05. Observou-se uma efetiva atividade antibacteriana do dentifrício experimental. No estudo clínico, observou-se redução de sangramento gengival em ambos os grupos experimental e controle (p<0,0001), não havendo diferença entre eles (p 0,178), embora com uma pequena magnitude de efeito. Apenas o grupo controle reduziu significantemente o acúmulo de biofilme (p=0,0039). Concluiu-se que o dentifrício experimental de E. uniflora mostrou-se eficaz na redução de gengivite em crianças de 10 a 12 anos. Assim, este dentifrício apresenta potencial para ser utilizado de forma eficaz e segura em odontologia preventiva.

Short-term evaluation of a green tea extract-based mouthrinse / Avaliação de curto prazo de um enxaguatório bucal à base de extrato de chá verde

Introduction: mechanical hygiene is still the best method forthe maintenance of oral health and prevention of biofilm formation. However, mouthrinses have been increasingly used as an adjunct support especially for post-operatory conditions or when periodontal conditions require. In this way, a number of mouthrinses are available, presenting different active ingredients with predominant antimicrobial action. Objectives: the aim of the present study was to evaluate the topical action of a green-tea extract-based mouthwash on gingival tissue. Materials and Methods: a longitudinal double-blind comparison was performed with two groups of patients clinically evaluated and diagnosed as suffering from gingivitis (n= 40). The patients were divided into two groups, according to the mouthrinse used: GT - green tea (concentration of 20mg/ml), and P - placebo, 0.9% saline solution. Clinical examination of the mucosa, tooth staining, plaque and gingival indices were peformed before and 15 days after the continuous use of the products twice a day. Results: no mucosal or tasting alterations were found, neither tooth staining regardless the mouthrinse used. Statistical assessment did not detect differences on gingival indexes between the groups before and after mouthrinses use; however, plaque indexes were significant lower in patients of GT group, compared to the P group. Conclusions: the use of phytotherapic products with active ingredients should be investigated for biofilm control, responsible for the onset and progression of periodontal disease, as well as other various oral pathologies. Considering the period of evaluation pro-posed in this study, relevant decrease in initial phase of plaque for-mation could be observed with the green tea mouthrinse. Further long-term evaluation studies should be carried-out in order to eluci-date its continuous effects on oral structures.

Introdução: higiene mecânica ainda é o melhor método para a manutenção da saúde bucal e prevenção da formação de biofilmes. No entanto, enxagues têm sido cada vez mais usado como um suporte auxiliar especialmente para as condições pós-operatórias ou quando as condições periodontais exigem. Desta forma, um número de bochechos estão disponíveis, apresentando diferentes ingredientes ativos com predominante ação antimicrobiana. Objetivos: o objetivo do presente estudo foi avaliar a ação tópica de um bochecho à base de extrato de chá verde no tecido gengival. Materiais e Métodos: a comparação longitudinal, duplo-cego, foi realizada com dois grupos de pacientes clinicamente avaliados e diagnosticados como portadores de gengivite (n = 40). Os pacientes foram divididos em dois grupos, de acordo com o enxaguatório oral usado: CV - chá verde (concentração de 20 mg / ml), e P - placebo, solução salina a 0,9%. O exame clínico da mucosa, coloração dos dentes, índice de placa e índice gengival foram realizados antes e 15 dias após o uso contínuo dos produtos duas vezes por dia. Resultados: nenhuma alteração na mucosa ou de degustação foi encontrada, assim como não foi identificado modificação na coloração do dente. A Avaliação estatística não detectou diferenças no índice gengival entre os grupos antes e depois de usar enxaguatórios. No entanto, índice de placa inferior foi menor de forma significativa nos pacientes do grupo CV, em comparação com o grupo P. Conclusões: o uso de produtos fitoterápicos com ingredientes ativos deve ser investigado para o controle de biofilme, responsável pelo aparecimento e progressão da doença periodontal. Considerando o período de avaliação proposto, a redução correspondente na fase inicial da formação de placa pôde ser observada com o enxaguatório à base de chá verde. Além disso, estudos de avaliação de longo prazo devem ser realizados, a fim de elucidar seu efeito contínuo em longo prazo sobre as estruturas orais.

Eficacia del uso concomitante de dentífrico con Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento, enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento y terapia de raspado/alisado radicular en pacientes con gingivitis / Efficacy of concomitant use of dentifrice with 0.3 per cent Triclosan and 2.0 per cent PVM/MA copolymer, 0.05 per cent cetylpyridinium chloride mouthrinse and scaling/root planning therapy in patients with gingivitis

Introducción: La placa dentobacteriana es el principal factor etiológico en el desarrollo y progresión de la gingivitis. Comúnmente se han sugerido productos de cuidado oral como cremas dentales y/o enjuagues bucales como adyuvante en la terapia mecánica. Objetivo: Evaluar la eficacia del uso combinado de un dentífrico a base de Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento (Colgate Total 12®) y enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento (Colgate Plax®) en pacientes con gingivitis marginal crónica después de una terapia de raspado y alisado radicular comparado con un grupo control. Material y métodos: Se realizó un ensayo clínico controlado, aleatorizado y doble ciego en 50 pacientes sanos con diagnóstico sistemático de gingivitis marginal crónica. Se dividieron en grupo A experimental y grupo B control. Se evaluó índice gingival de Lõe y Silness e índice de placa de Quigley Hein modifi cado por Turesky al inicio y al fi nal del estudio; el periodo de estudio fue de seis semanas. Al inicio se realizó a cada paciente tratamiento de raspado y alisado radicular y se le instruyó sobre el uso correcto de los productos. Al concluir la sexta semana se tomaron mediciones finales bajo las mismas condiciones que las iniciales...

Introduction:Dental plaque is considered to be the main etiological factor in the development and progression of gingivitis. Oral care products such as toothpaste and mouthwash have commonly been rec-ommended as an adjunct to mechanical periodontal therapy. Objective:To evaluate the effi cacy of using a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer (Colgate Total 12®) in combination with a 0.05% cetylpyridinium chloride mouthwash (Colgate Plax®) in patients with chronic marginal gingivitis following scaling and root-planing therapy compared to a control group. Material and methods:A randomized double-blind controlled clinical study was performed on 50 systemically healthy patients diagnosed with chronic marginal gingivitis. These were divided into two groups: A (experimental) and B (control). The Lõe and Silness gingival index and the Turesky modifi ca-tion of the Quigley-Hein plaque index were recorded at baseline and after 6 weeks (the duration of the study). Patients were treated with scaling and root-planning, and all received instructions on the proper use of the oral care products. Final measurements were taken at the end of the six-week assessment under the same conditions as those at the time of the baseline assessment...

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.

Use of Fusidic Acid for Desquamative Gingivitis Treatment: 1-Year Follow-Up

This study evaluated retrospectively the effect of fusidic acid on the management of desquamative gingivitis (DG). The study population consisted of 15 patients with DG. Patients were requested to make topical application of 2% fusidic acid ointment 4 times a day for 6 weeks. Clinical assessments were recorded at baseline, at 6 weeks and 12 months after beginning the therapy. Patients' examination involved lesion size area, pain score and impact on daily activities. All patients presented lesions in maxilla; in 9 patients (60.0%) lesions were predominately at the anterior region and 6 (40.0%) at the posterior region of maxilla. Treatment significantly (p<0.05) reduced the pain intensity (from 5.4±1.12 to 1.16±0.97) and its periodicity (from 53.33% with pain>3 x/week to 13.33%), and the lesion size in 72.47% (±4.12) immediately after 6 weeks of treatment. Improvements were sustained for 12 months compared to baseline (p<0.001). It also reduced the impact of disease in daily activities (eating and oral hygiene performance), and improved the emotional condition of patients, who reported better social relationships and habits. Topical application of fusidic acid may be a possible alternative local palliative therapy for desquamative gingivitis treatment.

Este estudo avaliou retrospectivamente o efeito do ácido fusídico sobre o manejo da gengivite descamativa (DG). A população do estudo consistiu de 15 pacientes com DG. Os pacientes foram solicitados a fazer aplicação tópica de pomada de ácido fusídico 2% 4 vezes ao dia, durante 6 semanas. As avaliações clínicas foram registradas no início do estudo, em 6 semanas e 12 meses após o início da terapia. O exame dos pacientes envolveu tamanho da área da lesão, intensidade da dor e impacto nas atividades diárias. Todos os pacientes apresentaram lesões na maxila; em 9 pacientes (60,0%) as lesões foram predominantemente na região anterior e em 6 (40,0%) na região posterior da maxila. O tratamento significantemente (p<0,05) reduziu a intensidade da dor (de 5,4±1,12 para 1,16±0,97) e a sua periodicidade (de 53,33% com dor>3x/semana para 13,33%), e o tamanho da lesão em 72,47% (±4,12) imediatamente após 6 semanas de tratamento. As melhorias foram sustentadas por 12 meses, quando comparado aos valores iniciais (p<0,001). Também reduziu o impacto da doença nas atividades diárias (alimentação e desempenho de higiene oral), e melhorou a condição emocional dos pacientes, que relataram melhores relações e hábitos sociais. A aplicação tópica de ácido fusídico pode ser uma alternativa para terapia local paliativa no tratamento de gengivite descamativa.

Rare Case of Scorbutic Gingivitis.

Scorbutic Gingivitis was a condition of great prevalence among sailors of the yesteryears. With added advancement and diet consciousness the condition is a rarity now. Although scurvy is prevalent in population below poverty line, in this patient having scorbutic gingivitis, it was ironic that the patient starved due to religious belief and not due to circumstances. Vitamin C is the vitamin with the second largest daily requirement and plays a vital role in a host of metabolic reactions. Its lack produces a panorama of signs and symptoms, many of which present primarily or originally in the mouth. This case report of a rare case of Scorbutic gingivitis was diagnosed and treated in Department of Periodontology and reviews the case itself and the recent literature on this potentially fatal condition.

Utilização de corticosteroide tópico oclusivo para o tratamento da gengivite descamativa: uma opção eficaz / Use of occlusive corticosteroid for the treatment of desquamative gingivitis: an effective option

A gengivite descamativa é uma manifestação dolorosa de algumas desordens autoimunes. O tratamento requer a utilização de corticosteroides tópicos, havendo maior eficácia se for administrado por terapia oclusiva. O objetivo deste estudo é demonstrar a eficácia da terapia oclusiva com corticosteroides no tratamento da gengivite descamativa. Foram selecionados 10 pacientes com quadro clínico de gengivite descamativa com diagnóstico prévio da condição associada. Os pacientes foram instruídos a utilizar moldeiras de silicone com corticosteroide tópico, havendo regressão total em oito pacientes após 30 dias. A terapia oclusiva com corticosteroide tópico é uma opção eficaz para o tratamento da gengivite descamativa. Entretanto, nos casos mais graves, a associação com a medicação sistêmica poderá resultar em melhor controle da doença.

The desquamative gingivitis is a painful manifestation of some autoimmune disorders. Treatment requires the use of topical corticosteroids, with greater efficacy if administered by occlusive therapy. The aim of this study is to demonstrate the efficacy of occlusive therapy with corticosteroids in the treatment of desquamative gingivitis. We selected 10 patients with clinical desquamative gingivitis with a previous diagnosis of associated condition. Patients were instructed to use silicone trays with topical steroids, with complete regression in eight patients after 30 days. The occlusive therapy with topical steroids is an effective option for the treatment of desquamative gingivitis. However, in severe cases, the association with systemic medication may result in better disease control.

Comparison of the antigingivitis and antiplaque efficacy of the herboral [herbal extract] mouthwash with chlorhexidine and listerine mouthwashes: a clinical study

The study was done to compare the anti gingivitis and antiplaque efficacy of Herboral with CHX and Listerine and to assess the side effects of the mouthwashes, if any. It was a single-centre, double-blind, parallel group and oral hygiene controlled clinical trial. 60 participants were equally divided into 3 groups: Herboral, CHX, and Listerine. These groups were asked to rinse with their respective mouthwash 2 times daily for 15 days. Gingivitis was evaluated by using Loe and Silness index [1963], and plaque was evaluated by using the Turesky modification of the Quiely Hein index [1970]. The evaluation was carried out at the end of 15 days, 1 month, and 3 months. Intragroup comparison for plaque and gingival scores was done using [t] test. Intergroup comparison was done using ANOVA and Tukey test. At the end of 15 days, all three mouth rinses were effective in reducing the mean scores [gingivitis/ plaque]: Herboral [0.34/1.0], Chlorhexidine [0.22/1.18] and Listerine [0.86/1.67]. At the end of 30 and 90 days the plaque and gingival scores had increased in all the three groups, more in the Listerine group. The use of CHX showed brown staining, whereas Listerine gave a burning sensation. As an antiplaque and antigingivitis agent, the Herboral mouthwash is as effective as Chlorhexidine [CHX] and more effective than Listerine

Avaliação clínica de bochechos com extratos de Aroeira (Schinus terebinthifolius) e Camomila (Matricaria recutita L. ) sobre a placa bacteriana e a gengivite / Clinical evaluation of mouthwash with extracts from aroeira (Schinus terebinthifolius) and chamomile (Matricaria recutita L. ) on plaque and gingivitis

A presente pesquisa objetivou avaliar clinicamente o efeito de bochechos à base de extratos das plantas medicinais, aroeira (Schinus terebinthifolius) e camomila (Matricaria recutita L.), sobre o controle da placa bacteriana e o tratamento da gengivite. Para tanto, foi realizado um ensaio clínico randomizado, duplo cego, intervencionista, envolvendo 59 indivíduos adultos atendidos na Clínica do Curso de Odontologia da Universidade Estadual da Paraíba (UEPB). A amostra foi constituída por pacientes portadores de gengivite crônica. A referida amostra foi selecionada aleatoriamente e dividida em três grupos: bochecho com Clorexidina (grupo controle positivo); bochecho com Camomila (grupo teste 1); bochecho com Aroeira (grupo teste 2). Durante a primeira visita do paciente, e, previamente à realização dos bochechos, todos foram orientados quanto à higiene bucal e submetidos ao procedimento de raspagem e alisamento radicular (RAR) da boca toda em uma única sessão. Os bochechos foram realizados a partir do primeiro atendimento clínico até o 15º dia após o início do tratamento, na frequência de duas vezes ao dia. Para avaliação da condição periodontal da amostra realizada no 1º, 7º e 15º dias foram aplicados os Índices de Sangramento Gengival (ISG) e de Placa (IP). Os pacientes foram reavaliados 7 e 15 dias após o início do uso do respectivo bochecho. Os resultados apontaram que o IP e o ISG apresentaram redução significativa nos três grupos. Quanto ao IP, o bochecho de camomila obteve a maior redução de acúmulo de placa e o bochecho de aroeira, a menor redução. Para os índices de sangramento, os resultados foram equivalentes, de forma que não foram consideradas diferenças estatisticamente significativas entre os bochechos. Foram considerados satisfatórios os bochechos a base de Camomila (Matricaria recutita L.) e Aroeira (Schinus terebinthifolius) na redução do quadro de inflamação gengival da amostra, sendo o bochecho de Camomila (Matricaria recutita L.) o que apresentou melhor desempenho na redução do índice de placa bacteriana.

This study aimed to clinically evaluate the effect of mouthwash with extracts from the medicinal plants aroeira (Schinus terebinthifolius) and chamomile (Matricaria recutita L.) on plaque control and gingivitis treatment. Thus, a randomized, double-blind interventional clinical trial was conducted, involving 59 adults treated at the Clinics of the Dentistry Program of Univ Estadual da Paraíba (UEPB). The sample consisted of patients with chronic gingivitis. This sample was randomly selected and divided into three groups: mouthwash with chlorhexidine (positive control group), mouthwash with chamomile (test group 1); mouthwash with aroeira (test group 2). During the first visit, and prior to rinses, all patients were instructed in oral hygiene and subjected to scaling and root planing procedure (SRP) of the whole mouth in one single session. Rinses occurred from the first clinical appointment to the 15th day after the beginning of treatment, twice a day. To evaluate the periodontal condition of the sample on the 1st, 7th and 15th days, Gingival Bleeding Index (GBI) and Plaque Index (PI) were used. The patients were reassessed at 7 and 15 days after the beginning of the respective rinses. Results indicated that PI and GBI significantly decreased in all three groups. As to PI, chamomile mouthwash led to the greatest reduction in plaque buildup, while aroeira mouthwash resulted in the smallest reduction. For bleeding rates, results were equivalent so that statistical differences among rinses were not considered significant. Mouthwashes with chamomile (Matricaria recutita L.) and aroeira (Schinus terebinthifolius) were considered satisfactory in reducing gingival inflammation in the sample; in addition, mouthwash with chamomile (Matricaria recutita L.) showed the best performance in reducing the plaque index.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Efectividad del uso tópico de Salvia officinalis en la disminución del índice gingival en sujetos con gingivitis / Effectiveness of topical use of Salvia officinalis in the gingival index decrease in subjects with gingivitis

Introducción: La gingivitis es el problema periodontal de mayor prevalencia en la población, por lo que deben buscarse más alternativas de tratamiento y prevención. Objetivo: Evaluar efecto del uso de Salvia officinalis en disminución del índice gingival modificado (IG) en alumnos de Odontología de la Universidad del Desarrollo diagnosticados con gingivitis, año 2010. Sujetos y Método: Fue realizado un estudio cuantitativo, ciego, experimental del tipo ensayo clínico controlado con placebo, sobre la acción de extracto de S. officinalis en dentífrico y colutorios para gingivitis inducida por placa bacteriana, en 33 alumnos de odontología de la Universidad del Desarrollo, Concepción; 13 mujeres y 20 hombres entre 21 y 29 años. Fueron divididos en tres grupos; placebo, colutorio y dentífrico. Luego del inicio del tratamiento fueron citados a los 7, 14 y 28 días, finalizando el tratamiento el día 14. Resultados: En el control no se encontró diferencias significativas (p=0.061) la primera semana, mientras que en los grupos con colutorio o dentífrico si hubo diferencias significativas (p=0.000 y p=0.002). La última semana al retirar el placebo, el IG se mantuvo, por otro lado en los grupos con S. officinalis no continuó el descenso. La disminución del IG fue mayor para los grupos colutorio y dentífrico que para el control. Discusión: El uso de S. officinalis es efectivo en la disminución del IG. El colutorio y dentífrico logran disminuir con mayor rapidez el IG. El colutorio logró la mayor disminución del IG.

Background: Gingivitis is the most prevalent periodontal problem in people, so we need to find new alternatives for treatment and prevention. Aim: To evaluate the effects of Salvia officinalis in the declining modified gingival index (GI) in dentistry students of the Universidad del Desarrollo diagnosed with gingivitis, year 2010. Subjects and Methods: This was a quantitative study, blinded, experimental type of placebo-controlled clinical trials on the action of extract of S. officinalis in toothpaste and mouthwash for plaque-induced gingivitis in 33 dental students from Universidad del Desarrollo, Concepción; 13 women and 20 men between 21 and 29 years old, were divided into three groups: placebo, mouthwash and toothpaste. After the first appointment we call the patients every 7, 14 and 28 days, we ended the treatment at day 14. Results: In the control group there was no significant difference (p=0.061) the first week, while groups with mouthwash and toothpaste, there were significant differences (p=0.00). The last week, as we remove the placebo, the GI was maintained. On the other hand, in groups with S. officinalis the drop did not continue. The decrease of GI was higher in groups with mouthwash and toothpaste than in the control group. Discussion: The use of S. officinalis is effective in reducing the GI. The mouthwash and toothpaste decrease more rapidly the IG. The mouthwash achieved the greatest reduction of IG.

Comparative efficacy of two daily use mouthrinses: randomized clinical trial using an experimental gingivitis model

Two antimicrobial agents, a fixed combination of essential oils (EOs) and 0.07 percent cetylpyridinium chloride (CPC) are found in commercially available mouthrinses, Listerine® Antiseptic and Crest® Pro HealthTM, respectively. Both mouthrinses have been shown to control dental plaque and gingivitis in short and longer term studies. The aim of this study was to determine the comparative effectiveness of these two mouthrinses using a 2-week experimental gingivitis model. Qualified subjects were randomly assigned to one of three mouthrinse groups: a fixed combination of EOs, 0.07 percent CPC, or negative control (C) rinse. Following baseline clinical assessments and a dental prophylaxis, subjects began a two-week period in which they rinsed twice daily with their assigned rinse and abstained from any mechanical oral hygiene procedures or other oral care products. Subjects were reassessed at the end of the two-week period. One hundred and forty-seven subjects were randomized and 142 completed this study. After two weeks use, the EOs rinse was superior (p < 0.011) to the CPC rinse in inhibiting the development of gingivitis, plaque, and bleeding, with 9.4 percent and 6.6 percent reductions compared to CPC for gingivitis and plaque, respectively. Both rinses were superior to the negative control rinse (p < 0.001). This study demonstrates that the essential oil-containing mouthrinse has superior antiplaque/antigingivitis effectiveness compared to the 0.07 percent CPC-containing mouthrinse without mechanical oral hygiene influence.

Efecto antiinflamatorio de la enoxolona en un modelo exvivo de mucosa gingival humana / Antiinflammatory effect of enoxolone in an exvivo model of human gingival mucosa

Introducción. Este estudio tenía por finalidad precisar las modalidades de utilización y el mecanismo de acción antiinflamatoria de la enoxolona contenida en un dentífrico y en una solución bucal. Material y método. Por medio de un modelo de encía humana mantenida con sobrevida, se pudo inducir una reacción inflamatoria mediante la aplicación de mediadores proinflamatorios (SP y LPS) y realizar, en doble ciego contra placebo, una evaluación de los parámetros histológicos y bioquímicos (IL8) de la inflamación previa aplicación del dentífrico. Para la solución bucal, la evaluación bioquímica se realizó por dosificación del IL 1. Resultados. El dentífrico generó una disminución significativa del edema, de la dilatación de los capilares y de la excreción del IL8. La solución generó una disminución de la excreción del IL l. Discusión. La enoxolona ejerce un efecto antiinflamatorio, cualquiera sea el vehículo utilizado.

Gingival overgrowth and drug association: A review.

Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

effect of Frankincense in the treatment of moderate plaque-induced gingivitis: a double blinded randomized clinical trial

Extract of Boswellia Serrata species has been used in the Indian traditional medicine in the treatment of various inflammatory diseases. The present study was designed to evaluate anti-inflammatory effects of Frankincense in the treatment of gingivitis, which is a periodontal tissue inflammatory disease. This double blind randomized placebo controlled trial was carried out among high school female students with moderate plaque-induced gingivitis. Based on either administration of 0.1 gram of Frankincense extract or 0.2 gram of its powder or placebo and whether the patients undergone scaling and root planning [SRP] or not, they were randomly assigned to 6 groups. The primary efficacy outcome was changes in Gingival Index [Loe and Sillness] and the secondary outcomes were alteration in plaque index [Sillness and Loe], bleeding index [Cowell] and probing pocket depth [WHO probe]. All indices were measured in the 0, 7th and 14th days of the study. Seventy five patients ranged of 15-18 years old were enrolled. At the end of the study, the indices in all groups showed significant decreases in comparison to the first day [p<0.05], except for the bleeding index in the group without SRP and drug therapy [p=0.111]. More precise analysis of data revealed that SRP in association with Frankincense application [either extract or powder] can lead to remarkable decrease in inflammatory indices in comparison to the groups without SRP and drug therapy [p<0.001]. In addition, no significant difference was observed between powder or extract therapy [p>0.05] and between patients received either SRP or treatment alone [p=0.169]. Frankincense, a safe and low-cost herbal medicine, may be feasibly applied to improve inflammation based disease of gingival as an adjunct to the conventional mechanical therapy

Primary herpetic gingivostomatitis in an adult patient using an orthodontic appliance / Gingivoestomatitis herpética primaria en un paciente adulto utilizando un aparato ortodóntico

The present article describes a clinical case of an adult patient using an orthodontic appliance, who returned to the dental office after the placement of orthodontic mini-implants, complaining of aphthas. By means of clinical and case history evaluation the diagnosis of primary herpetic gingivostomatitis was reached. The treatment was prescription of an antiviral agent associated with a chlorhexidine-based oral mouthwash. One week after their onset, there was complete regression of the lesions.

El presente artículo describe un caso clínico de un paciente adulto utilizando un aparato de ortodoncia, que regresó a la consulta dental después de la colocación de mini-implantes ortodónticos, quejándose de aftas. Por medio de la evaluación clínica y de historia del caso, el diagnóstico de gingivoestomatitis herpética primaria fue realizado. El tratamiento fue la prescripción de un agente antiviral asociados con un enjuague bucal con clorhexidina. Una semana después de su inicio, se produjo regresión completa de las lesiones.

Efeitos clínicos e microbiológicos do óleo de copaíba (copaifera officinalis) sobre bactérias formadoras de placa dental em cães / Clinical and microbiological effects of copaiba oil (copaifera officinalis) on dental plaque forming bacteria in dogs

O potencial de uso do óleo de copaíba (Copaifera officinalis) na prevenção da doença periodontal, eliminando seu agente etiológico, foi avaliado em 18 cães sem raça definida, distribuídos homogeneamente em três grupos: teste, (contendo óleo de copaíba) controle positivo e controle negativo. Os tratamentos ocorreram três vezes ao dia, durante oito dias. Ao nono dia, os animais receberam aplicação tópica de fucsina básica 0,5 por cento para evidenciação do biofilme. Mudanças na halitose e gengivite foram avaliadas diariamente por inspeção visual. Adicionalmente, foram realizados testes laboratoriais de inibição de aderência de Streptococcus mutans e ensaio antimicrobiano de difusão em ágar, sobre bactérias formadoras de placa dental. Os resultados da placa evidenciada apontaram áreas de cobertura microbiana nos dentes de 53,4±8,8 por cento, 28,5±5,4 por cento, e 22,3±5,3 por cento para os grupos negativo, positivo e teste, respectivamente, indicando diferença entre o controle negativo e os demais grupos (P<0,05). Quanto à melhora nos aspectos clínicos, halitose e gengivite, o grupo teste respondeu melhor quando comparado ao grupo controle negativo (P<0,05). A análise dos ensaios de difusão e inibição de aderência mostrou superioridade do grupo da copaíba (teste) em relação aos outros grupos (P<0,05). Os resultados sugerem o uso do óleo de copaíba na prevenção da doença periodontal e como um possível substituto da clorexidina na terapia antimicrobiana oral.

The copaiba oil (Copaifera officinalis) potential was evaluated in preventing periodontal disease and reducing its etiology. For that 18 mongrel dogs were homogeneously distributed in three groups: test (copaiba oil), positive control (chlorexidine) and negative control. The treatments were carried out three times a day, during eight days. On the 9th day, the animals were tested with a 0.5 percent basic solution of fuchsin for the detection of biofilm. Changes in halitosis and gingivitis were daily observed. In addition, the following laboratory tests were done: inhibition of the adherence of Streptococcus mutans, and plaque forming bacteria antimicrobial assays by the agar diffusion method. The results of the fuchsin test showed that dental plaque reached areas of 53.4±8.8 percent, 28.5±5.4 percent, and 22.3±5.3 percent in the negative control, positive control, and test groups, respectively, showing differences between dogs from the negative control group and dogs from the other two groups (P<0.05). Furthermore, halitosis and gingivitis decreased in the copaiba group animals when compared with the negative group (P<0.05). The results of the attachment inhibition and agar diffusion tests showed that copaiba induced better effects against the microorganisms as compared to the results of the other groups (P<0.05). These findings suggest that copaiba oil may effectively replace chlorexidine for oral antimicrobial therapy and prevention of periodontal disease.