Inflammatory markers in the saliva of cerebral palsy individuals with gingivitis after periodontal treatment

Abstract The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1β, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1β levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1β and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1β, IL-6 and IL-8.

O impacto do lúpus eritematoso sistêmico juvenil na inflamação gengival: achados clínicos, imunológicos e microbiológicos / The impact of juvenile systemic lupus erythematosus on gingival inflammation: clinical, immunological and microbiological findings

Os objetivos desse estudo foram avaliar a expressão de citocinas no soro e fluido gengival, a produção de arginina-peptidil-deiminase (anti-PPAD) e o perfil microbiológico de pacientes com lúpus eritematoso sistêmico juvenil (LESj) e comparar com indivíduos saudáveis sistemicamente. Como objetivo secundário, avaliamos o impacto do tratamento da inflamação gengival sobre a expressão das citocinas e dos níveis de anti-PPAD. Participaram do estudo 30 pacientes com LESj (idade média: 16,2 ± 1,5 anos) e 29 sem doença sistêmica (idade média 15,5 ± 2,3 anos), ambos com gengivite. Foram coletados dados reumatológicos, periodontais, sangue, fluido gengival e biofilme intrassulcular. As citocinas foram analisadas pelo multiensaio multiplex; anti-PPAD pelo ensaio de imunoabsorção enzimática (ELISA) e níveis bacterianos pelo checkerboard DNA-DNA hybridization. Para avaliar variáveis categóricas foi utilizado o teste Qui-quadrado de Pearson; para as numéricas, o teste U de Mann-Whitney e para as correlações a estatística tau-b de Kendall. No estudo longitudinal, foi utilizado o teste de McNemar para dados qualitativos, e o de Wilcoxon para dados numéricos. No estudo transversal, o grupo teste apresentou maiores níveis de profundidade de bolsa à sondagem (PBS), nível de inserção clínica (NIC), % de placa e sangramento do que o controle. Na análise do soro, G-CSF foi significativamente maior e TNF-α significativamente menor no grupo teste. Na análise do fluido gengival, IL-1ß, IL-7, IL-8, IL-13, G-CSF, IFN-γ e MCP-1 foram significativamente maiores e IL-4, IL-12(p70) e GM-CSF significativamente menores no grupo teste. Não houve diferença significativa nos níveis de anti-PPAD entre os grupos. S. constellatus, A. actinomycetencomytans, E. saburreum, V. parvula, S. intermedius, C. showae e F. nucleatum foram significantemente mais numerosas no grupo teste e A. gerencseriae e T. denticola no grupo controle. Após o tratamento da inflamação gengival, o SLEDAI, %NIC 1-2 e NIC reduziram significantemente. Já os valores de PBS e %NIC 0 aumentaram. No soro, houve diminuição significativa da IL-4 e IL-5 e aumento significativo dos níveis de anti-PPAD após o tratamento. Já no fluido gengival, houve diminuição significativa da IL-1ß, IL-10 e MCP-1 e aumento significativo da IL-4, IL-12(p70), IL-17, GM-CSF e INF-α. Sendo assim, podemos concluir que pacientes com LESj apresentaram piores condições periodontais, PBS, NIC, % de placa e sangramento do que pacientes saudáveis sistemicamente. A análise de citocinas mostrou um aumento do G-CSF e TNF-α no soro e de IL-1ß, IL-7, IL-8, IL-13, G-CSF, IFN-γ e MCP-1 no fluido gengival dos pacientes com LESj. Foram identificados anticorpos anti-PPAD nos pacientes com LESj, o que pode servir como gatilho para a quebra da tolerância imunológica. O estudo longitudinal intervencionista demonstrou que o tratamento da inflamação gengival melhorou significantemente os parâmetros %NIC 1-2 e NIC. Houve uma pequena, porém significante, piora na PBS, a qual acreditamos não ter relevância clínica. Observamos também uma melhora significante no SLEDAI e dos níveis de IL-4 e IL-5 no soro e um aumento das citocinas IL-12, IL-17 e GM-CSF no fluido gengival. Já em relação ao anticorpo anti-PPAD, observamos um aumento significativo após o tratamento da inflamação gengival.

The objectives of this study were to evaluate the expression of cytokines in serum and gingival fluid, the production of arginine-peptidyl-deiminase (anti-PPAD) and the microbiological profile of patients with juvenile systemic lupus erythematosus (jSLE) and compare with systemically healthy individuals. As a secondary objective, we evaluated the impact of treatment of gingival inflammation on cytokine expression and anti-PPAD levels. Thirty patients with jSLE (mean age: 16.2 ± 1.5 years) and 29 without systemic disease (mean age 15.5 ± 2.3 years), both with gingivitis, participated in the study. Rheumatological and periodontal data, blood, gingival fluid and intrassulcular biofilm were collected. Cytokines were analyzed by multiplex multi-assay; anti-PPAD by enzyme-linked immunosorbent assay (ELISA) and bacterial levels by checkerboard DNA-DNA hybridization. Pearson's Chi-square test was used to evaluate categorical variables; Mann-Whitney U test for numerical variables and Kendall's tau-b statistic for correlations. In longitudinal study, McNemar test was used for qualitative data, and Wilcoxon test for numerical data. In cross-sectional study, test group presented higher levels of probing depth (PD), clinical attachment level (CAL), % of plaque and bleeding than control group. In serum analysis, G-CSF were significantly higher and TNF-α significantly lower in test group. In analysis of gingival fluid, IL-1ß, IL-7, IL-8, IL-13, G-CSF, IFN-γ and MCP-1 were significantly higher and IL-4, IL-12(p70) and GM-CSF were significantly lower in test group. There was no significant difference in anti-PPAD levels between groups. S. constellatus, A. actinomycetencomytans, E. saburreum, V. parvula, S. intermedius, C. showae and F. nucleatum were significantly more numerous in test group and A. gerencseriae and T. denticola in control group. After treatment of gingival inflammation, SLEDAI, % CAL 1-2 and CAL decreased significantly. Already the values of PD and % CAL 0 increased. In serum, there was a significant decrease in IL-4 and IL-5 and a significant increase in anti-PPAD levels after treatment. In gingival fluid, there was a significant decrease in IL-1ß, IL-10 and MCP-1 and significant increase in IL-4, IL-12 (p70), IL-17, GM-CSF and INF-α. Thus, we can conclude that patients with jSLE presented worse periodontal conditions, PBS, NIC, % plaque and bleeding than systemically healthy patients. Cytokine analysis showed an increase in serum G-CSF and TNF-α and IL-1ß, IL-7, IL-8, IL-13, G-CSF, IFN-γ and MCP-1 in gingival fluid of patients with jSLE. Anti-PPAD antibodies have been identified in patients with jSLE, which may serve as a trigger for impaired immune tolerance. Longitudinal interventional study demonstrated that treatment of gingival inflammation significantly improved % CAL 1-2 and CAL parameters. There was a small, but significant worsening in PBS, which we believe has no clinical relevance. We also observed a significant improvement in SLEDAI and levels of IL-4 and IL-5 in serum and an increase in cytokines IL-12, IL-17 and GM-CSF in gingival fluid. Regarding the anti-PPAD antibody, we observed a significant increase after the treatment of gingival inflammation.

Microbiological, lipid and immunological profiles in children with gingivitis and type 1 diabetes mellitus

Abstract Objective The aim of this study was to compare the prevalence of periodontal pathogens, systemic inflammatory mediators and lipid profiles in type 1 diabetes children (DM) with those observed in children without diabetes (NDM), both with gingivitis. Material and methods Twenty-four DM children and twenty-seven NDM controls were evaluated. The periodontal status, glycemic and lipid profiles were determined for both groups. Subgingival samples of periodontal sites were collected to determine the prevalence of periodontal microorganisms by PCR. Blood samples were collected for IL-1-β, TNF-α and IL-6 analysis using ELISA kits. Results Periodontal conditions of DM and NDM patients were similar, without statistical differences in periodontal indices. When considering patients with gingivitis, all lipid parameters evaluated were highest in the DM group; Capnocytophaga sputigena and Capnocytophaga ochracea were more prevalent in the periodontal sites of DM children. “Red complex” bacteria were detected in few sites of DM and NDM groups. Fusobacterium nucleatum and Campylobacter rectus were frequently found in both groups. Similar levels of IL-1-β, TNF-α and IL-6 were detected in DM and NDM children. Conclusion Clinical and immunological profiles are similar between DM and NDM children. The presence of Capnocytophaga sputigena and Capnocytophaga ochracea were associated with gingivitis in DM children.

Enfermedades gingivales en niños y adolescentes: primera parte / Gingival diseases in children and adolescents: first part

Las características de los tejidos gingivales y periodontales son diferentes en niños y adolescentes. La clasificación actual de enfermedades gingivales incluye a las gingivitis producidas por el biofilm y a las no producidas por el biofilm de placa. Las gingivitis son reversibles. Las condiciones de riesgo individuales, de origen externo o de origen sistémico, influyen en el agravamiento. La prevención de la gingivitis está enfocada en el control de los factores de riesgo.

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.

Gingival response in orthodontic patients: comparative study between self-ligating and conventional brackets

Orthodontic brackets contribute to the accumulation of bacterialplaque on tooth surfaces because they hinder oral hygiene.In contrast to conventional brackets, self-ligating brackets donot require additional parts to support the arches, thus improvingdental hygiene. The aim of this study was to compare thegingival response in orthodontic patients wearing self-ligatingor conventional brackets. A sample of 22 patients aged 16 to 30years was divided into two groups: Group A, treated with selfligatingbrackets (Damon system) and Group B, treated withconventional brackets (Roth technique). The following wereassessed during the treatment: Plaque Index (PI), GingivalIndex (GI) and Probing Depth (PD), and sub-gingival sampleswere taken from teeth 14/24 for microbiological observation.No statistically significant difference was found between GroupsA and B; p>0.05 (sign-ranked) or between PI, GI and PD at thedifferent times (Friedman’s Analysis of Variance), even thoughthe indices were found to increase at 14 days, particularly forself-ligating brackets. The quantity and quality of microorganismspresent were compatible with health on days 0, 28 and 56.As from day 14 there is a predominance of microbiota compatiblewith gingivitis in both groups. In the samples studied,orthodontic treatment increases bacterial plaque and inflammatorygingival response, but gingival-periodontal health canbe maintained with adequate basic therapy...

bacteriana en las superficies dentarias, debido a que dificultanla higiene oral. A diferencia de los brackets convencionales, losbrackets autoligables no requieren elementos adicionales parasujetar los arcos, lo cual favorecería la higiene dentaria. Elobjetivo del presente trabajo fue comparar la respuesta gingivalen pacientes ortodóncicos, utilizando brackets autoligablesy brackets convencionales. Se estudiaron 22 pacientes, entre 16y 30 años, divididos en dos grupos: A, tratado con bracketsautoligables, Sistema Damon) y B, tratado con brackets convencionales,Técnica de Roth. Durante el tratamiento, seevaluaron los Índices de Placa (IP), Índice Gingival (IG) y Profundidadde Sondaje (PS) y se tomaron muestras subgingivalesde las piezas 14/24 para su observación microbiológica. En laevaluación estadística no se encontraron diferencias estadísticamentesignificativa entre los grupos A y B; p>0.05 (de losrangos con signo) y ni en los IP, IG y PS en los diferentes tiemposevaluados (Análisis de varianza de Friedman), sin embargose observa un aumento en los índices a los 14 días, sobre todoen autoligables. Los microorganismos se presentaron en cantidady calidad compatible con salud el día 0, 28 y 56; a partirdel día 14 predomina microbiota compatible con gingivitis paraambos grupos. En las muestras estudiadas el tratamientoortodóncicos produce incremento de placa bacteriana yrespuesta gingival inflamatoria, pero con terapia básica adecuadapuede mantenerse la salud gingivo-lperiodontal. Losbrackets autoligables y los o convencionales, produjeronrespuesta gingival simila...

Leukotoxicity of Aggregatibacter actinomycetemcomitans in generalized aggressive periodontitis in Brazilians and their family members

OBJECTIVE: The purpose of this study was to examine the leukotoxin promoter types of Aggregatibacter actinomycetemcomitans clones in subjects with generalized aggressive periodontitis (GAgP) and in their family members (FM). MATERIAL AND METHODS: Thirty-five patients with GAgP (33.9±7.1 years), 33 of their FM (22.8±11.4 years), and 41 patients with chronic periodontitis (CP) (44.1±9.4 years) were clinically analyzed using the plaque index, gingival index, probing depth (PD), and clinical attachment level (CAL). Subgingival biofilm samples were collected from four interproximal periodontal sites (>PD and >CAL) of each patient. The presence of A. actinomycetemcomitans and its leukotoxic clone was confirmed by polymerase chain reaction (PCR). RESULTS: A. actinomycetemcomitans was observed in 23 (51.1%) GAgP patients and 16 (30.1%) CP patients. Thirty-seven (94.8%) patients showed minimally leukotoxic strains and 2 (5.1%) showed highly leukotoxic strains. In the FM group, 10 (30.3%) had aggressive periodontitis (AgP), 12 (36.3%) had CP, 11 (33.3%) were periodontally healthy or had gingivitis, and 12.2% were A. actinomycetemcomitans positive. Greater full mouth PD and CAL were observed in GAgP patients positive for the bacteria than those negative for it (p<;0.05), and the presence of A. actinomycetemcomitans positively correlated with GAgP (Odds ratio, 3.1; confidence interval, 1.4-7.0; p=0.009). CONCLUSIONS: The presence of A. actinomycetemcomitans was associated with the clinical condition of GAgP, with most patients exhibiting a generalized form of the disease and minimally leukotoxic clones. Most of the relatives of GAgP patients presented either CP or AgP. .

Distribution of serotype-specific genotypes of aggregatibacter actinomycetemcomitans in Brazilian patients with down syndrome with different periodontal conditions / Distribución de los serotipos genotipos específicos de aggregatibacter actinomycetemcomitans en los pacientes brasileños con síndrome de down con diferentes condiciones periodontales

This study evaluated the occurrence of highly or minimally leukotoxic strains of Aggregatibacter actinomycetemcomitans (Aa) from patients with Down syndrome and the distribution of the different serotype-specific genotypes of this microorganism. Sixty-seven patients with Down syndrome were subjected to dental, periodontal and radiographic evaluations. Samples of subgingival biofilm were collected and plated onto TSBV agar and characteristic colonies of A. actinomycetemcomitans were identified by biochemical methods. The occurrence of this bacterium was also evaluated directly in the clinical specimens by PCR. The presence of 530 bp deletion in the promoter region was also determined by PCR in order to evaluate distribution of highly or minimally leukotoxic strains. A. actinomycetemcomitans was detected in 11.1 percent by culture and 22.2 percent by PCR from periodontally healthy subjects, 100 percent of the patients with Down syndrome with aggressive periodontitis, 50 percent and 75 percent of patients with chronic periodontitis by culture and PCR respectively. Only two patients with aggressive periodontitis were colonized by highly leukotoxic Aa. Serotype-specific genotypes a and c were the most prevalent. The results suggest the role of peculiar characteristics of Aa and patients with Down syndrome in the development of periodontitis and the influence of peculiar characteristics of the population in this process.

Este estudio evaluó la presencia de cepas altamente o mínimamente toxicas de Aggregatibacter actinomycetemcomitans (Aa) de los pacientes con síndrome de Down y la distribución de los serotipos genotipos específicos de este microrganismo por cultivo y PCR. Sesenta y siete pacientes con síndrome de Down fueron sometidos a un tratamiento dental y evaluaciones clínicas. Las muestras de biofilme subgingival fueron recogidas y cultivadas en agar TSBV y colonias características de Aa fueran identificadas mediante métodos bioquímicos. La presencia de esta bacteria se evaluó también directamente en las muestras clínicas por PCR. Los aislados y las muestras clínicas también se probaron con el fin de evaluar la distribución de serotipos de genotipos específicos por PCR, mientras que la presencia de delección de 530 bp en la región promotora del gen ltxC también fue determinado por PCR con el fin de evaluar de distribución de las cepas altamente o mínimamente toxicas. Aa fue aislado en 11,1 por ciento y 22,2 por ciento por PCR de pacientes periodontalmente sanos; en todos los pacientes con síndrome de Down con periodontitis agresiva, y en 50 por ciento y 75 por ciento de los pacientes con periodontitis crónica por cultivo y PCR, respectivamente. Sólo dos pacientes con periodontitis agresiva fueron colonizados por cepas altamente tóxicas. Los serotipos y genotipos específicos a y c fueron los más frecuentes. Los resultados sugieren una asociación de las peculiares características de Aa con las características de los pacientes con síndrome de Down en el desarrollo de la periodontitis.

Presence and antimicrobial profile of Gram-negative facultative anaerobe rods in patients with chronic periodontitis and gingivitis

La periodontitis crónica es una enfermedad infecciosa multifactorial hacen parte de la microflora subgingival. En los últimos años se han realizado estudios para valorar la presencia de bacilos Gramnegativos anaerobios facultativos (enterobacterias) y suimportancia en el desarrollo y rogresión de la periodontitis crónica. El objetivo de este estudio fue determinar la presencia de enterobacterias en pacientes con periodontitis crónica y gingivitis y conocer la susceptibilidad antimicrobiana de los aislamientosclínicos. Se realizó un estudio observacional y descriptivo en elque se incluyeron 64 pacientes con periodontitis crónica y 22 pacientes con gingivitis. Las muestras tomadas en el surco gingival con conos de papel se depositaron en caldo tioglicolato, seincubaron durante 4 horas a 37 oC y se resembraron finalmente en Agar MacConkey. En la identificación de las bacterias se utilizó el sistema API-20E (Biomerieux, France) y la susceptibilidadantimicrobiana se realizó por el método de difusión en disco. En los dos grupos se identificaron 29 especies enterobacterianas, 7 en el grupo con gingivitis y 22 en el grupo con periodontitis crónica. En el grupo de periodontitis crónica las especies masfrecuentes fueron: K. oxytoca n=5, S. liquefaciens n=4 y K.pneumoniaey E. coli con n=3. En el grupo con gingivitis, Erwiniasp tuvo la mayor frecuencia (n=2). Los aislamientos clínicos presentaron níveles muy bajos de sensibilidad a los B-lactamicosampicilina y amoxicilina/ ac.clavulanico, 17.2 y 27.6 por ciento, y la mayor sensibilidad a ciprofloxacina. En conclusión, la alta frecuencia de enterobacterias en pacientes con periodontitis debe conducir a la prevención y a desarrollar terapias mecánicas y antimicrobianas en las cuales se tengan en cuenta, como parte del tratamiento periodontal, los perfiles antimicrobianos reportados.

Effect of cetylpyridinium chloride with xylitol on the formation of biofilm anddevelopment of gingivitis

Aim: To assess the effect of the combination of cetylpyridinium chloride and xylitol on the formation of dental biofilm and development of experimental gingivitis. Methods: A crossover, double-blind, placebo-controlled study was conducted and divided into two phases of 21 days each with a time interval of 10 days between them. A modified experimental gingivitis model was used and 31 volunteers were randomly divided into 2 groups. The volunteers performed daily mouthwashes twice a day with the test solution containing cetylpyridinium combined with xylitol or a placebo solution. On day 0 and day 21 of each phase the Plaque Index (PI) and Gingival Index (GI) of each volunteer were measured. During this phase, the volunteers brushed their teeth with standard toothbrushes and dentifrice, protecting the third quadrant with a toothshield. After brushing, the toothshield was removed and the mouthwash was used. Results: The PI values observed in the Test Group at baseline and on day 21 were 0 (0.00 – 0.03) and 0 (0.22-0.48) respectively, and in Control Group 0 (0.00 – 0.03) and 1 (0.45 – 0.81) (inter-group analysis - McNemar test, p<0.05). For GI, the values obtained in the Test Group were 0 (0.00 – 0.03) and 1 (0.48 – 0.71), at baseline and day 21 and in Control Group 0 (0.00 – 0.03) and 1 (0.58 – 0.84) (inter-group analysis - McNemar test, p>0.05). Conclusions: The test solution had a positive effect on dental biofilm control. However, it was not capable of preventing the development of experimental gingivitis.

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

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

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

Oral colonization by Streptococcus mutans and its association with the severity of periodontal disease in adults

Background: Streptococcus mutans (S. mutans) is associated with the onset of caries. Since root exposure in patients affected by periodontitis leads to higher caries rates, progressively more severe forms of periodontal disease might associate with elevated counts of S. mutans. Aim: To determine whether increasingly destructive forms of periodontal disease are associated with higher counts of S. mutans in untreated patients. Methods: 206 subjects aged 20-75 were classified into three groups according to the severity of periodontal disease: 1) gingivitis, 2) chronic slight periodontitis and 3) chronic moderate or chronic severe periodontitis. S. mutans counts (cfu/mL) were obtained by direct counting on selective agar plates from saliva samples. A cumulative proportional logistic regression model was adjusted for S. mutans counts. Results: The model failed to show differences by gender, but periodontal diagnosis had a significant effect on S. mutans counts depending on age. While in the group with moderate and severe periodontitis the probability of having high counts of S. mutans significantly increased with age, the probability remained unchanged in individuals with chronic slight periodontitis or gingivitis. Conclusion: High S. mutans levels appear directly co-associated with increased severity of periodontal disease at older ages in untreated patients.

Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12 percent chlorhexidine gluconate

In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12 percent chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4 percent) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47 percent), Candida albicans (35.3 percent), Klebsiella pneumoniae (5.9 percent), enteropathogenic Escherichia coli (5.9 percent), and Stenotrophomonas maltophilia (5.9 percent). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80 percent) when compared with patients with normal oral mucosa (33.3 percent). In conclusion, the results of the present study suggest that the prophylactic use of 0.12 percent chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition, the present findings suggest a possible relationship between coagulase-negative staphylococci and the development of oral mucositis.

Tendo em vista o potencial de morbidade das complicações orais em pacientes com leucemia, este estudo avaliou as alterações clínicas e microbiológicas que ocorrem na mucosa bucal de crianças com leucemia linfoblástica aguda (LLA), submetidas à quimioterapia antineoplásica e administração profilática do gluconato de clorexidina 0,12 por cento. A amostra foi constituída de 17 crianças de 2 a 12 anos, as quais foram submetidas a exame clínico da mucosa oral para a detecção de lesões bucais. Além disso, foi coletado material biológico das mucosas labial e jugal para análises microbiológicas. A mucosite oral foi observada em apenas 5 (29,4 por cento) pacientes. A análise microbiológica revelou a presença de um número reduzido de microorganismos potencialmente patogênicos, como estafilococos coagulase-negativos (47 por cento), Candida albicans (35,3 por cento), Klebsiella pneumoniae (5,9 por cento), Escherichia coli enteropatogênica (5,9 por cento) e Stenotrophomonas maltophilia (5,9 por cento). Pacientes com mucosite oral apresentaram uma maior freqüência de estafilococos coagulase-negativos (80 por cento) quando comparados aos pacientes que exibiam mucosa oral normal (33,3 por cento). Em conclusão, os resultados do presente estudo sugerem que o uso profilático do gluconato de clorexidina 0,12 por cento reduz a freqüência de mucosite oral e de patógenos orais em crianças com LLA. Além disso, os presentes achados sugerem uma possível relação entre estafilococos coagulase-negativos e o desenvolvimento de mucosite oral.

Antimicrobial resistance of aerobes and facultative anaerobes isolated from the oral cavity

OBJECTIVES: This study evaluated the resistance to antimicrobials of aerobes and facultative anaerobes isolated from patients wearing complete dentures, patients with gingivitis and periodontitis, and periodontally health subjects. MATERIAL AND METHODS: Three hundred and four isolates were tested. The minimal inhibitory concentrations of the drugs were evaluated through the agar dilution method using Mueller-Hinton agar. RESULTS: The most active antimicrobial drugs were the carbapenems (meropenem and imipenem), and resistance to these drugs was restrict to 1.6-2.3 percent of the isolates, as well as ciprofloxacin and rifampin. Microbial resistance to ampicillin, amoxicillin/clavulanic acid, cefoxitin, cephalothin, amikacin, chloramphenicol and nalidixic acid was particularly high. In most cases, the resistance to β-lactams was mediated by the production of hydrolytic enzymes, especially in gram-negative enteric rods, while enterococci did not evidence production of these enzymes. The association amoxicillin/clavulanic acid was not effective in 28.3 percent of the tested isolates. CONCLUSIONS: The results of this investigation confirmed that the oral cavity of patients with periodontitis and gingivitis, and particularly edentulous patients wearing complete dentures could harbor microorganisms with several antimicrobial resistance markers, and these microorganisms are frequently implicated in multiresistant, systemic, oral or nosocomial infections.

Occurrence of Aggregatibacter actinomycetemcomitans in Brazilian indians from Umutina Reservation, Mato Grosso, Brazil

Aggregatibacter actinomycetemcomitans is associated with periodontal disease, especially localized aggressive periodontitis, produces a potent leukotoxin and its distribution is influenced by ethnic characteristics of the population. Objective: Using culture and polymerase chain reaction (PCR) techniques, this study evaluated the occurrence of this microorganism and the distribution of leukotoxic strains isolated from Indians belonging to the Umutima Reservation, Mato Grosso, Brazil. MATERIAL AND METHODS: Forty-eight native Brazilians with gingivitis and 38 with chronic periodontitis, belonging to Umutina, Paresi, Bororo, Bakairi, Kayabi, Irantxe, Nambikwara and Terena ethnicities, were studied. Subgingival, supragingival and saliva samples of each patient were collected and transferred to VMGA III medium and to ultra pure Milli Q water. Bacteria were grown on TSBV agar and incubated in anaerobiosis (90 percent N2 + 10 percent CO2) at 37ºC for 72 h. The presence of the ltx promoter was determined by PCR, and a 530 bp deletion in the promoter was evaluated by using specific primers. RESULTS: A. actinomycetemcomitans was isolated from 8.33 percent of saliva, supragingival and subgingival samples from patients with gingivitis and from 18.42 percent of saliva and supragingival biofilm, and 26.32 percent subgingival biofilm from patients with chronic periodontitis. By PCR, the bacterial DNA was detected in 8.33 percent of saliva, supragingival and subgingival biofilms from patients with gingivitis and from 23.68 percent of saliva, 28.95 percent supragingival biofilm and 34.21 percent subgingival biofilm from patients with periodontitis. All strains were grouped as non-JP2 clones based on the absence of deletion in the leukotoxin promoter. Differences among the microbial and clinical parameters in patients were analyzed by using the Mann-Whitney, Chi-square or Fisher's exact tests. CONCLUSIONS: The present results suggest that A. actinomycetemcomitans ...

Microbiological status of periodontal diseases in Lagos, Nigeria / Estatus microbiológico de las enfermedades periodontales en Lagos, Nigeria

OBJECTIVES: The dynamic nature of oro-facial infections made it imperative to study the epidemiology of gingivitis and periodontitis which are significant clinical conditions in the Nigerian environment. METHODS: The clinical and microbiological features of 162 patients with periodontal diseases (gingivitis 68, periodontitis 94) were analysed. The advantage of routine antibiotic susceptibility testing for oral pathogens in patients' management was investigated. RESULTS: The incidence of periodontal diseases was more in females than males with a ratio of 0.53 though the difference was not significant. A high incidence of gingivitis (55.9%) occurred within the first 29 years with a cluster of cases (48.6%) between 10 and 29 years of age with incidence tending to decline with advancing age. Though the incidence of periodontitis was highest amongst adults over 40 years (42.6%), the incidence of 8.5% in children below 10 years of age was high. Polybacterial aetiology was characteristic; aerobes were the predominant flora in gingivitis with a preponderance of Streptococcus spp, while anaerobes predominated in periodontitis with such species as Porphyromonas, Prevotella, Fusobacterium and Actinobacillus. Significant reduction in duration of treatment was obtained when patients were treated based on susceptibility results as opposed to empirical knowledge (p < 0.05). CONCLUSION: The diversity of microbial aetiology of periodontal infections may put much demand on routine laboratory investigations for patient management, but it may be necessary to weigh the benefit ofadditional cost against the cost oftreatment failure associated with antibiotic resistance in bacteria.

OBJETIVOS: La naturaleza dinámica de las infecciones orofaciales hizo imperativo el estudio de la epidemiología de la gingivitis y la periodontitis -condiciones clínicas significativas en el medio ambiente nigeriano. MÉTODOS: Las características clínicas y microbiológicas de 162 pacientes con enfermedades periodontales (gingivitis 68, periodontitis 94) fueron analizadas. Se investigó la ventaja de la prueba de rutina de la susceptibilidad antibiótica para los patógenos orales en el tratamiento de los pacientes. RESULTADOS: La incidencia de las enfermedades periodontales fue mayor en las mujeres que en los hombres con una proporción de 0.53, aunque la diferencia no fue significativa. Una alta incidencia de gingivitis (55.9%) ocurrió dentro de los primeros 29 años de edad con un grupo de casos (48.6%) entre 10 y 29 años de edad, tendiendo la tendencia a disminuir con el progreso de la edad. Aunque la incidencia de la periodontitis fue más alta entre adultos mayores de 40 años (42.6%), la incidencia de 8.5% en los niños de 10 años de edad fue alta. La etiología fue característica. Los aerobios fueron la flora predominante en la gingivitis, con preponderancia de Streptococcus spp, mientras que los anaerobios predominaron en la periodontitis con especies tales como Porphyromonas, Prevotella, Fusobacterium y Actinobacillus. Se obtuvo una reducción significativa de la duración del tratamiento cuando los pacientes fueron tratados a partir de los resultados de la susceptibilidad, en vez del conocimiento empírico (p < 0.05). CONCLUSIÓN: La diversidad de la etiología microbiana puede causar una demanda excesiva de las investigaciones de rutina de los laboratorios para el tratamiento de los pacientes, pero puede ser necesario sopesar el beneficio del costo adicional frente al costo del fracaso del tratamiento asociado con la resistencia antibiótica de las bacterias.

Clinical status and detection of periodontopathogens and Streptococcus mutans in children with high levels of supragingival biofilm

Knowledge about the presence of some important oral pathogens is an important step in better identifying children at risk for periodontal and/or caries diseases in later life. The purpose of this study was to detect the presence of Streptococcus mutans (Sm), Aggregatibacter actinomycetemcomitans (Aa), Campylobacter rectus (Cr), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Tannerella forsythia (Tf) in gingival biofilm samples from 196 children, and to assess whether any of these pathogens are more associated with gingival inflammation extension and the Decayed/Missing/Filled teeth (DMFT/dmft) index. The subjects presented plaque index greater than 80 percent and were divided in 3 groups according to the bleeding index (BI): I) Low bleeding (< 30 percent), II) Medium bleeding (31 - 59 percent) and III) High bleeding (> 60 percent). The presence of each pathogen was determined by PCR. The prevalence of Sm was 71.9 percent and the mean dmft/DMFT was 6.68. The prevalence in low, medium and high bleeding groups was 43.5 percent, 34.5 percent and 46.7 percent for Aa; 43.5 percent, 37.9 percent, and 36.7 percent for Cr; 99.1 percent, 100 percent, and 96.7 percent for Pg; 56.5 percent, 56.9 percent, and 66.7 percent for Pi; and 58.3 percent, 60.3 percent, and 56.7 percent for Tf, respectively. Pg (99.0 percent) was the most prevalent periodontal pathogen detected followed by Tf (58.7 percent), Pi (58.2 percent), Aa (41.3 percent) and Cr (40.8 percent). Our study indicated that in this high plaque index population studied, a high prevalence of Sm and high mean DMFT were observed. In addition, the presence of Pi was associated with the presence of inflammation (P < 0.05) whereas Cr was associated with periodontal health (P < 0.05).

Resistance to tetracycline and β-lactams and distribution of resistance markers in enteric microorganisms and pseudomonads isolated from the oral cavity

This study evaluated the occurrence of enteric bacteria and pseudomonads resistant to tetracycline and β-lactams in the oral cavity of patients exhibiting gingivitis (n=89), periodontitis (n=79), periodontally healthy (n=50) and wearing complete dentures (n=41). Microbial identification and presence of resistance markers associated with the production of β-lactamases and tetracycline resistance were performed by using biochemical tests and PCR. Susceptibility tests were carried out in 201 isolates of enteric cocci and rods. Resistance to ampicillin, amoxicillin/clavulanic acid, imipenem, meropenem and tetracycline was detected in 57.4 percent, 34.6 percent, 2.4 percent, 1.9 percent and 36.5 percent of the isolates, respectively. β-lactamase production was observed in 41.2 percent of tested microorganisms, while the most commonly found β-lactamase genetic determinant was gene blaTEM. Tetracycline resistance was disseminated and a wide scope of tet genes were detected in all studied microbial genus.

Ocorrência de Aggregatibacter actinomycetemcomitans no biofilme subgengival de crianças com idade de 6 a 12 anos / Occurrence of Aggregatibacter actinomycetemcomitans in subgengival biofilm of children aged 6-12 years old

O presente estudo avaliou as condições gengivais, sócio-econômicas e a ocorrência de A. actinomycetemcomitans em 233 crianças com idade entre 6 e 1 2 anos, em Araçatuba-São Paulo. Na avaliação clínica periodontal foram utilizados os índices de placa e de sangramento a sondagem. A coleta dos espécimes clínicos de biofilme subgengival foi realizada com cones de papel absorvente, que foram introduzidos no interior dos sulcos gengivais sadios ou inflamados, durante 1 minuto, e transferidos para tubos contendo 3ml de VMGA III e para criotubos com 300µl de água ultrapura. As amostras foram cultivadas em ágar TSBV, em anaerobiose, a 37°C, por 3 dias. A presença desse microrganismo também foi avaliada através de PCR com iniciadores específicos. As condições sócio-econômicas da população estudada foram avaliadas por meio de questionário específico. A maioria das crianças estudadas apresentou gengivite. Verificou-se que a baixa renda familiar e o número de crianças na família estão estatisticamente associados com a gengivite nessas crianças, sendo que a ocorrência de A. actinomycetemcomitans não mostrou correlação com as condições gengivais ou sócio-econômicas da população alvo.

The present study evaluated gingival, socioeconomic conditions and the occurrence of Aggregatibacter actinomycetemcomitans in 233 children from 6 to 12 years-old in Araçatuba-São Paulo. In the periodontal evaluation the plaque index and bleeding on probing index were used. Subgingival biofilm samples were taken through sterile paper points, which were transfered to VMGA III or to criotubes with 300µl of ultrapure water. Microbial isolation was carried out using TSBV agar and the occurrence of A. actinomycetemcomitans was also determined by mean of PCR using specific primer pairs. The socio-economic conditions were evaluated by specific questionaire. The vast majority of studied children exihibited gingivitis and it was statistically correlated low income, family's children number and the gingival status of the patients. The occurence of A. actinomycetemcomitans did not show any correlation between gingival or socio-economic conditions and target population.