Terapia probiótica multicepa como coadyuvante al tratamiento periodontal convencional / Multi-strain probiotic therapy as an adjuvant to conventional periodontal treatment

Introducción: La enfermedad periodontal comprende un conjunto de trastornos asociados a la inflamación y a la pérdida de estructuras del soporte dental de origen infeccioso multifactorial. La investigación científica expone un abanico de cepas bacterianas probióticas en el tratamiento periodontal, con propiedades en la inhibición del crecimiento de periodontopatógenos, y mejoras significativas en los parámetros clínicos, cuando se combina con el tratamiento periodontal mecánico. Objetivo: Describir el efecto de la terapia combinada entre el tratamiento periodontal mecánico tradicional y un gel probiótico multicepa, aplicado a un caso de periodontitis. Presentación de caso: Paciente femenino de 53 años de edad, procedente de la comunidad de El Portachuelo, zona rural aledaña a la ciudad de Mérida. Presentó agrandamiento gingival, enrojecimiento y dolor espontáneo en la encía palatina, con concomitantes de sangrado y exudado purulento desde hace seis meses. La realización de un examen clínico periodontal, análisis radiográfico y análisis microbiológico permitieron diagnosticar periodontitis estadio IV grado B. Se aplicó tratamiento periodontal convencional no quirúrgico en combinación con cepas probióticas de Lactobacillus rhamnosus, L acidophilus y L. plantarum, en presentación de un gel adhesivo para la aplicación supra y subgingival y en suspensión vía oral para obtener un efecto sistémico durante 45 días. Los resultados obtenidos fueron favorables con mejoramiento de los parámetros clínicos como índice de sangrado periodontal y profundidad de los sacos periodontales. Conclusiones: En concordancia con diversos estudios, se ha demostrado que la terapia probiótica puede ser usada como tratamiento coadyuvante en casos de periodontitis. Se observa una franca y rápida mejoría al utilizar terapias multicepas(AU)

Introduction: Periodontal disease comprises a set of disorders associated with inflammation and the loss of dental support structures of multifactorial infectious origin. Scientific research exposes a range of probiotic bacterial strains in periodontal treatment, with properties in inhibiting the growth of periodontal pathogens, and significant improvements in clinical parameters, when combined with mechanical periodontal treatment. Objective: Describe the effect of combined therapy between traditional mechanical periodontal treatment and a multi-strain probiotic gel, applied to a case of periodontitis. Case presentation: A 53-year-old female patient from the community El Portachuelo, a rural area next to the city of Mérida. She presented gingival enlargement, redness and spontaneous pain in the palatine gum, with concomitant bleeding and purulent exudate for six months. A clinical periodontal examination, radiographic analysis and microbiological analysis made it possible to diagnose stage IV grade B periodontitis. Conventional non-surgical periodontal treatment was applied in combination with probiotic strains of Lactobacillus rhamnosus, L. acidophilus and L. plantarum, in presentation of an adhesive gel for supra and subgingival application and in oral suspension to obtain a systemic effect for 45 days. The results obtained were favorable with improvement of clinical parameters such as periodontal bleeding index and depth of periodontal sacs. Conclusions: In accordance with several studies, it has been shown that probiotic therapy can be used as an adjuvant treatment in cases of periodontitis. A clear and rapid improvement is observed when using multi-strain therapies(AU)

Oral and maxillofacial lesions in covid 19 infection from Mosul hospital in Iraq: epidemiological study and approach to classification and treatment / Lesiones orales y maxilofaciales en COVID 19 del hospital de Mosul en Irak: estudio epidemiológico y enfoque de clasificación y tratamiento

During the COVID-19 pandemic, many manifestations of the disease appear in the oral, perioral and maxillofacial regions, either related to the virus itself or to the drugs used in the treatment. Aim: This study aims to identify the most common oral and perioral lesions in hospitalized patients with COVID-19 in the city of Mosul and their management; and also to evaluate the incidence and prevalence of these lesions. Material and Methods: Prospective study included 338 patients (138 females, 200 males) who had positive PCR results for SARS-CoV-2, with oral manifestations. All data were analyzed taking the means, frequencies, and percentage. Results: The most common lesions were colored lesions (31%) and stomatalgia (27%). The most common oral disorder and prior comorbidity combination was stomatalgia in patients with a history of hypertension. The most common associated systemic diseases were diabetes mellitus (19%) followed by hypertension (17%). Macular lesions had a higher response to drugs (40%) followed by stomatalgia (28%), in comparison with necrotic lesions (0%). Treatment of oral lesions included surgical interventions (26%) as well as conventional medical treatment (74 %). Conclusion: Oral and perioral disorders during COVID-19 are transitory and more evidence is warranted to efficiently address these comorbidities in the short term.

Durante la pandemia de COVID-19, muchas manifestaciones de la enfermedad aparecen en las regiones oral, perioral y maxilofacial, ya sea relacionadas con el propio virus o con los fármacos utilizados en el tratamiento. Objetivo: Este estudio tiene como objetivo identificar las lesiones orales y periorales más comunes en pacientes hospitalizados con COVID-19 en la ciudad de Mosul y su manejo; y también evaluar la incidencia y prevalencia de estas lesiones. Material y Métodos: Estudio prospectivo que incluyó a 338 pacientes (138 mujeres, 200 hombres) que tenían resultados positivos de PCR para SARS-CoV-2, con manifestaciones orales. Todos los datos se analizaron tomando las medias, frecuencias y porcentaje. Resultados: Las lesiones más frecuentes fueron las coloreadas (31%) y la estomatalgia (27%). La combinación de trastorno oral más común y comorbilidad previa fue la estomatalgia en pacientes con antecedentes de hipertensión. Las enfermedades sistémicas asociadas más comunes fueron la diabetes mellitus (19%) seguida de la hipertensión (17%). Las lesiones maculares tuvieron una mayor respuesta a los fármacos (40%) seguidas de la estomatalgia (28%), en comparación con las lesiones necróticas (0%). El tratamiento de las lesiones orales incluyó intervenciones quirúrgicas (26%) y tratamiento médico convencional (74%). Conclusión: Los trastornos bucales y periorales durante el COVID-19 son tran-sitorios; se necesita más evidencia para abordar de manera eficiente estas comorbilidades a corto plazo.

Evaluación de lesiones orales en pacientes intubados y su asociación con el motivo de hospitalización / Evaluation of oral lesions in intubated patients and its association with the reason of hospitalization

asistencia ventilatoria cuando la vía aérea y la consciencia están comprometidas. Los elementos utilizados en este procedimiento se encuentran en contacto directo con estructuras dentofaciales, causando diversos tipos de lesiones, principalmente bucales. Aunque existen cuidados clínicos durante procesos de intubación, hay poca información, particularmente de la zona norte del país donde se hayan evaluado las posibles asociaciones entre los motivos de consulta más frecuentes y las diversas características, tanto clínicas como no clínicas de pacientes que han sido intubados. Objetivo: Identificar las alteraciones bucodentales más frecuentes en pacientes intubados, así como explorar las posibles asociaciones de acuerdo con los motivos de intubación más frecuentes. Material y métodos: Se realizó un estudio observacional, transversal y comparativo en el cual se evaluaron alteraciones bucodentales y sistémicas de pacientes intubados. Los grupos de estudio se desarrollaron de acuerdo con el motivo de intubación y la determinación de las asociaciones fue con cada una de las alteraciones bucodentales y sistémicas. Resultados: El motivo de intubación más frecuente fue el evento cerebral vascular (EVC) y las alteraciones dentofaciales más prevalentes fueron caries, lengua saburral y cálculo dental, entre otras. Además, se encontraron diferencias significativas entre pacientes con EVC, mostrando una mayor frecuencia en tabaquismo, hipertensión arterial y diabetes mellitus, así como en la presencia de gingivitis y úlceras. Pacientes con traumatismo craneoencefálico (TCE) tuvieron mayor frecuencia en la presencia de periodontitis. Conclusión: El motivo de hospitalización y las condiciones sistémicas preexistentes pueden ser un factor de riesgo para desarrollar lesiones bucales específicas antes y durante el periodo de intubación (AU)

Introduction: Intubation is a procedure that allows ventilatory assistance when the airway and consciousness are compromised. The elements used in this procedure are in direct contact with dentofacial structures causing various types of injuries, mainly oral. Although there is clinical care during intubation processes, there is little information, particularly from the northern part of the country where the possible associations between the most frequent reasons for consultation and the various clinical and non-clinical characteristics of patients who have been intubated have been evaluated. Objective: The objectives of the present study were to identify the most frequent oral alterations in intubated patients, as well as to explore possible associations according to the most frequent reasons for intubation. Material and methods: An observational, cross-sectional and comparative study was carried out in which oral and systemic alterations of intubated patients were evaluated. The study groups were formed according to the reason for intubation and the association was determined with each of the oral and systemic disorders. Results: The most frequent reason for intubation was the vascular cerebral event (CVA) and the most prevalent dentofacial alterations were caries, coated tongue, and dental calculus, among others. In addition, significant differences were found between patients with CVA, showing a higher frequency in smoking, hypertension, and diabetes mellitus, as well as in the presence of gingivitis and ulcers. Patients with traumatic brain injury (TBI) had a higher frequency in the presence of periodontitis. Conclusion: The reason for hospitalization and pre-existing systemic conditions can be a risk factor for developing specific oral lesions before and during the intubation period (AU)

Efectividad clínica y radiográfica de las estatinas en el tratamiento de la periodontitis / Clinical and radiographic effectiveness of statins in the treatment of periodontitis

Introducción: La enfermedad periodontal es un padecimiento inflamatorio, infeccioso y multifactorial crónico, caracterizado por la inflamación de los tejidos blandos periodontales. En estadios avanzados (periodontitis), produce la destrucción progresiva de los tejidos duros periodontales, lo que conduce a la posterior pérdida de dientes, si esta no es tratada. Objetivo: Determinar la efectividad clínica y radiográfica de las estatinas en el tratamiento de la periodontitis. Métodos: Se realizó una búsqueda de la literatura hasta abril del 2019, en las bases de datos biomé dicas: PubMed, Embase, SciELO, Science Direct, Scopus, Sistema de información sobre literatura gris en Europa, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Google Académico y el Registro Central de Ensayos Clínicos Cochrane. Se definieron como criterios de selección de los estudios que fueran ensayos clínicos aleatorizados, con una antigüedad máxima de cinco años y que reportaran los efectos clínicos y radiográficos (profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto) de las estatinas en el tratamiento de la periodontitis. Se analizó el riesgo de sesgo de los estudios por el Manual Cochrane de revisiones sistemáticas de intervenciones. Resultados: La estrategia de búsqueda arrojó 19 artículos, de los cuales el 100 por ciento reportó que había diferencia en la profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto de las estatinas en el tratamiento de la periodontitis. Conclusiones: La literatura revisada sugiere que el uso de estatinas es efectivo, clínica y radiográficamente, en el tratamiento de la periodontitis(AU)

Introduction: Periodontal disease is a chronic multifactorial infectious inflammatory condition characterized by inflammation of soft periodontal tissue. In advanced stages (periodontitis) it causes progressive destruction of hard periodontal tissue, leading to eventual tooth loss if not treated. Objective: Determine the clinical and radiographic effectiveness of statins in the treatment of periodontitis. Methods: A search was carried out in the literature published until April 2019 in the biomedical databases PubMed, Embase, SciELO, Science Direct, Scopus, System for Information on Gray Literature in Europe, Latin American and Caribbean Health Sciences Literature, Google Scholar, and Cochrane Central Register of Clinical Trials. The following selection criteria were defined for the studies: randomized clinical trials published in the last five years and reporting on clinical and radiographic effects (probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth) of statins in the treatment of periodontitis. Bias risk analysis was based on the Cochrane manual of systematic reviews of interventions. Results: A total 19 papers were retrieved, of which 100 percent reported differences in the probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth of statins in the treatment of periodontitis. Conclusions: The literature review conducted suggests that the use of statins is clinically and radiographically effective in the treatment of periodontitis(AU)

Type-2 Diabetes Mellitus Individuals Carry Different Periodontal Bacteria

ABSTRACT Objective: To identify etiologic microbiota associated periodontal diseases among diabetes patients and the factors related to the most commonly identified bacteria species. Material and Methods: Periodontal plaque samples from 11 diabetic participants and 13 non-diabetic controls were collected to assess their aerobic and anaerobic bacterial growth. Different distinct colonies were identified by microscopic and 16srDNA sequencing. Pearson's chi-square tests were conducted to examine any association between categorical variables. Results: The diabetic subjects revealed a more intense plaque formation with a mean plaque index of 2.4 compared to 1.8 in non-diabetics. A total of 86 bacteria were isolated from 24 plaque samples, 44 were aerobic, and 42 were anaerobic. Only aerobic isolates, 22 from diabetic patients and 22 from non-diabetic patients, were evaluated in these analyses. Bacillus spp. (B. cereus mainly) and Klebsiella spp. (K. pneumoniae, K. aerogenes, K. oxytoca) were detected markedly higher in non-diabetic individuals than in diabetic subjects (p=0.026 and p=0.021, respectively). Some bacteria were only identified in the dental plaque of diabetic individuals, namely, Bacillus mojavensis, Enterobacter cloacae, Proteus mirabilis, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus pasteuri, Streptococcus mutans, and Streptococcus pasteurianus. The presence of acid reflux and jaundice were significantly associated with the most common bacterial isolate, namely Bacillus spp., with the p-values of 0.007 and 0.001, respectively. Conclusion: Type-2 diabetes mellitus is associated with a higher amount of dental plaques. Periodontal plaque samples from diabetic and non-diabetic subjects possess differential microbial communities. Diabetic plaques contain more versatile microbes predominated by gram-positive streptococci and staphylococci.

Diabetes y enfermedad periodontal / Diabetes and periodontal disease

El objetivo de este trabajo fue establecer la relación entre el grado de enfermedad periodontal y el control metabólico de la glucemia en pacientes que padecen diabetes tipo 2. Es un estudio de tipo observacional, descriptivo, transversal. Se seleccionaron 42 pacientes con diagnóstico de diabetes mellitus tipo 2 de ambos sexos, entre 25 y 75. Se realizó odontograma y se evaluó el grado de enfermedad periodontal para determinar el grado de compensación metabólica de los pacientes se tomaron muestras de sangre venosa y se midieron los valores de hemoglobina glicosilada. Un 23,55% de los pacientes no presentaron enfermedad periodontal y el resto se dividió en leve, moderada y severa presentándose la enfermedad leve en primer orden. Los pacientes con mayor grado de enfermedad periodontal presentaron mayor número de piezas dentarias perdidas (p 0,0334). La enfermedad periodontal se distribuye de la misma manera en ambos grupos de control glucémico (p=0,1211). En el grupo estudiado, el grado de enfermedad periodontal es independiente del control glucémico de los pacientes (AU)

The objective of this work was to establish the relationship between the degree of periodontal disease and the metabolic control of glycemia in patients with type 2 diabetes. It is an observational, descriptive, cross-sectional study. 42 patients with a diagnosis of type 2 diabetes mellitus of both sexes, between 25 and 75, were selected. An odontogram was performed and the degree of periodontal disease was evaluated; venous blood samples were taken and glycosylated hemoglobin values were measured to determine the degree of metabolic compensation of the patients. 23.55% of the patients did not present periodontal disease and the rest were divided into mild, moderate, and severe, with mild disease presenting in the first order. The patients with a higher degree of periodontal disease had a higher number of missing teeth (p 0.0334). Periodontal disease is distributed in the same way in both glycemic control groups (p = 0.1211). In the group studied, the degree of periodontal disease is independent of the glycemic control of the patients (AU)

Association of Khat chewing, smoking, age and sex with periodontal status among Yemeni adults / Associação da mastigação de Khat, tabagismo, idade e gênero com a condição periodontal entre adultos iemenitas

Objective: Periodontal diseases are very common dental disease. Many risk factors may play significant role in the periodontal disease initiation and progression. This study was performed to evaluate the effects of khat chewing, smoking, age and gender on periodontal status among Yemeni adults. Material and Methods: This cross-sectional study was performed on 1231 patients attending the outpatient dental polyclinics of University of Science and Technology during the academic years 2017/2018. All completed sheets were collected throughout the year by the supervisors. Data cleaning, descriptive statistics, and inferential statistics were then performed. Results: Khat chewers were more frequent than non-chewers counterparts (60.7% vs. 39.3%). The prevalence of smoking was 25.5% (297 patients). Study results indicated that periodontitis is more associated with female gender and participants aged more than 35 years old. Results also showed that female and age older participants aged more than 35 years were significantly associated with gingival recession. Mean number of the teeth with gingival recession in male patients were higher than in females. Male gender and patients aged more than 35 years old were significantly associated with furcation involvement. Conclusion: The present study has shown females gender and age older than 35 seem to be risk factors of periodontal diseases. Males has more teeth affected by gingival recession and more furcation involvement (AU)

Objetivo: As doenças periodontais são patologias dentárias com alta prevalência. Diversos fatores de risco podem desempenhar papel significativo no início e progressão das doenças periodontais. Este estudo foi realizado para avaliar os efeitos da mastigação de khat, tabagismo, idade e gênero na condição periodontal de adultos iemenitas. Material e Métodos: Este estudo transversal foi realizado em 1231 pacientes atendidos nas policlínicas odontológicas ambulatoriais da Universidade de Ciência e Tecnologia durante os anos acadêmicos de 2017/2018 através de um questionário para coleta de dados préestabelecido. Todas os questionários preenchidos foram coletados ao longo do ano pelos supervisores. A apuração dos dados, estatística descritiva e estatística inferencial foram realizadas. Resultados: os mastigadores de Khat foram mais frequentes do que as não-mastigadores (60,7% vs. 39,3%). A prevalência de tabagismo foi de 25,5% (297 pacientes). Os resultados do estudo indicaram que a periodontite está mais associada ao gênero feminino e aos participantes com mais de 35 anos de idade. Os resultados também mostraram que participantes do gênero feminino e acima de 35 anos foram significativamente associadas à recessão gengival. O número médio de dentes com recessão gengival em pacientes do gênero masculino foi maior que no feminino. O gênero masculino e os pacientes com mais de 35 anos de idade foram significativamente associados ao envolvimento da furca. Conclusão: O presente estudo mostrou que o gênero feminino e a idade acima de 35 anos parecem ser fatores de risco para doenças periodontais. Pacientes do gênero masculino têm mais dentes afetados pela recessão gengival e mais envolvimento de furca.(AU)

Periodontal disease and its impact on general health in Latin America. Section II: Introduction part II

Abstract: The epidemiological data on gingivitis and periodontitis in Latin America are scarce, as the majority of the Latin American studies have analyzed probing depth instead of clinical attachment loss. Reported data have shown high variations in results between different Latin American countries, with the main causes of these differences being the clinical case definition and methodological strategies used. In general, data have revealed that the prevalence of periodontal disease is higher in Latin Americans than in populations in the USA or Europe. Regarding its relations with other diseases and conditions, some Latin American studies have focused on the association between periodontitis and adverse pregnancy outcomes, or poor glycemic control in diabetic patients; however, these studies have reported controversial results. In Chile, reports have indicated that periodontal treatment significantly reduced the preterm birth rate; however, no association between periodontitis and perinatal outcome was found in Brazil. For diabetes mellitus, Brazilian studies have reported controversial findings; however, a Chilean interventional study reported significant reductions in the glycosylated hemoglobin levels after periodontal treatment. Although epidemiological data for Latin America are scarce, the information available at present is useful for establishing national policies on health promotion, prevention, and treatment of periodontal disease. Therefore, dental schools must play a key role in educating professionals who are highly trained in the promotion, prevention, early diagnosis and treatment of periodontal disease, with an approach to risk, and strong biopsychosocial and ethical components. Thus, future Latin American dentists would be able to face the challenge of decreasing the prevalence of periodontal diseases by leading interdisciplinary health teamwork.

Obesity, salivary glands and oral pathology / Obesidad, glándulas salivales y patología oral

Abstract Obesity has reached pandemic proportions in recent years. Not only adults suffer from the disease, but increasingly children and young people. One of the main causes of overweight and obesity is excessive food intake, in particular heavily processed carbohydrates. Obesity alters multiple organs, including the salivary glands, bringing functional alterations with it. Among researchers, the relation between obesity and tooth decay, periodontal disease and xerostomia is being debated. More and more scientific reports are drawing attention to the changes in the microflora of the oral cavity during obesity. All changes are closely related to the morphological and functional alterations of the salivary glands. This article review presents the current points of view regarding the impact of obesity on the health of the salivary glands, and how changes their functions influence other structures in the oral cavity.

Resumen La obesidad ha alcanzado proporciones pandémicas en los últimos años. No solo los adultos padecen la enfermedad, sino también cada vez más niños y jóvenes. Una de las principales causas del sobrepeso y la obesidad es la ingesta excesiva de alimentos, en particular los carbohidratos altamente procesados. La obesidad altera múltiples órganos, incluidas las glándulas salivales, y trae consigo alteraciones funcionales. Entre los investigadores, se está debatiendo la relación entre la obesidad y la caries dental, la enfermedad periodontal y la xerostomía. Cada vez más informes científicos están llamando la atención sobre los cambios en la microflora de la cavidad oral durante la obesidad. Todos los cambios están estrechamente relacionados con las alteraciones morfológicas y funcionales de las glándulas salivales. Esta revisión del artículo presenta los puntos de vista actuales sobre el impacto de la obesidad en la salud de las glándulas salivales, y cómo los cambios en sus funciones influyen en otras estructuras de la cavidad oral.

Knowledge, attitudes, practices and oral health status in adolescents of the city of Córdoba, Argentina

Adolescence is a critical period in the appropriation of knowledge, attitudes and health practices. objective: to analyze the experience of caries in relation to the level of knowledge, to attitudes and oral health practices in adolescents. materials and methods: an analytical cross-sectional study was carried out in 52 adolescents attending the provincial dental Institute in the city of Córdoba, Argentina. the study included a clinical dental examination and a self-administered survey. all participating subjects provided an informed consent signed by their parents or guardians. the DMFT index and relative frequency of responses were calculated. Indices of "knowledge", "attitudes" and "practices" were created. Spearman's rank correlation coefficient between indices and a linear regression model with respect to the DMFT index were applied. results: mean age was 16.57±2.27 years. female subjects accounted for 57.7 percent of participants. between 92 percent and 96 percent of adolescents acknowledged that the presence of bacteria and a lack of oral hygiene could promote tooth decay. ninety-six per cent reported using toothbrush and toothpaste, 32 percent reported using fluoride toothpaste, and only 19 percent used dental floss. the DMFT index was 4.7±4.0; component C 4.4±2.9. there was a significant correlation between the indices of knowledge and attitudes about oral health (p<0.05). the linear regression analysis showed as main predictors the questions: "does brushing teeth prevent cavities?" and "how important is it for you to clean your teeth?" conclusion: although participants have information on some oral health care practices, it is necessary to design strategies that involve the participation of young people, with contents that take into account the interests and characteristics of the target population.

Case-control study of oral disease indexes in individuals with head and neck cancer after antineoplastic therapy / Estudo caso-controle de índices de doenças bucais em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

ABSTRACT Objective To evaluate the oral health of patients with head and neck cancer after antineoplastic treatment, and to compare them with patients with no history of cancer. Methods A total of 75 patients, divided into Study Group, composed of individuals after antineoplastic treatment (n=30), and Control Group, with individuals with no history of cancer (n=45), aged 37 to 79 years. The oral health status was evaluated through the index of decayed, missing or filled permanent teeth (DMFT), community periodontal index and evaluation of the use and need of prosthesis. All of these items were evaluated according to the criteria recommended by the World Health Organization. The statistical analysis was descriptive and used the Pearson's χ2 test. Results The community periodontal index was higher in the Study Group when compared to the Control Group (p<0.0001). The need for an upper (p<0.001) and lower (p<0.0001) prostheses was higher in the Study Group. Also, the use of upper prosthesis was higher in the Study Group (p<0.002). The missing or filled permanent teeth index between the two groups (p>0.0506) and the use of lower prosthesis (p>0.214) did not present a relevant statistical difference. Conclusion Periodontal disease and edentulism are the most significant changes in individuals who received antineoplastic therapy for head and neck cancer as well as greater need for oral rehabilitation.

RESUMO Objetivo Avaliar a saúde bucal de pacientes com câncer de cabeça e pescoço após tratamento antineoplásico, e compará-los com pacientes sem histórico de câncer. Métodos Foram avaliados 75 pacientes, divididos em Grupo de Estudo de indivíduos após tratamento antineoplásico (n=30) e Grupo de Controle de indivíduos sem histórico de câncer (n=45), com faixa etária de 35 a 79 anos. A condição de saúde oral foi avaliada pelo índice de dentes permanentes cariados, perdidos e obturados (CPOD), pelo índice periodontal comunitário e por uma avaliação de uso e necessidade de prótese, conforme critérios preconizados pela Organização Mundial da Saúde. A análise estatística foi descritiva e realizada por meio do teste do χ2 de Pearson. Resultados O índice periodontal comunitário foi maior no Grupo de Estudo quando comparado ao controle (p<0,0001). A necessidade de prótese superior (p<0,001) e inferior (p<0,0001) foi maior no Grupo de Estudo. O uso de prótese superior foi maior no Grupo de Estudo (p<0,002). O índice de dentes permanentes cariados, perdidos e obturados entre os dois grupos (p>0,0506) e o uso de prótese inferior (p>0,214) não apresentaram diferença estatística relevante. Conclusão A doença periodontal e o edentulismo são as alterações mais significativas em indivíduos que receberam terapia antineoplásica de câncer de cabeça e pescoço, assim como maior necessidade de reabilitação oral.

Periodontal parameters in prediabetes, type 2 diabetes mellitus, and non-diabetic patients

Abstract The aim of the present study was to compare the clinical and radiographic periodontal parameters in prediabetes, type 2 diabetes mellitus (T2DM), and non-diabetic patients. Forty-one patients with prediabetes (Group 1), 43 patients with T2DM (Group 2), and 41 controls (Group 3) were included. Demographic data were recorded using a questionnaire. Full-mouth clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [CAL], missing teeth [MT]) and radiographic (marginal bone loss [MBL]) parameters were measured on digital radiographs. In all groups, hemoglobin A1c (HbA1c) levels were also measured. P values less than 0.05 were considered statistically significant. The mean age and HbA1c levels of participants in Groups 1, 2, and 3 were 53.4±3.5, 60.1 ± 0.6, and 56.6 ± 2.5 years and 6.1%, 8.4%, and 4.8%, respectively. The mean duration of prediabetes and T2DM in patients from Groups 1 and 2 were 1.9 ± 0.3 and 3.1 ± 0.5 years, respectively. PI, BOP, PD, MT, CAL, and MBL were significantly higher in Groups 1 (p < 0.05) and 2 (p < 0.05) than in Group 3. There was no statistically significant difference in these parameters in Groups 1 and 2. Periodontal parameters were worse between prediabetes and T2DM patients compared with controls; however, these parameters were comparable between prediabetes and T2DM patients.

Déterminants de la maladie parodontale en milieux hospitaliers à Kinshasa

Contexte : L'étiologie des maladies parodontales est multifactorielle. Le mode de vie, les facteurs socio-économiques, la réponse de l'hôte ainsi que l'environnement sont autant des déterminants qui influencent le développement et la progression de cette pathologie. L'identification de ces facteurs étiologiques dans un milieu hospitalier est un acquit important dans la prise en charge parodontale.Objectif : Déterminer des habitudes de vie et des paramètres cliniques ayant une influence sur le développement et la sévérité de la maladie parodontale en milieux hospitaliers de Kinshasa. Matériel et méthodes : C'était une étude analytique transversale menée auprès des patients âgés de douze ans et plus ayant consulté les services dentaires des institutions hospitalo-confessionnelles de la ville de Kinshasa au cours de la période allant de janvier à août 2015. La consommation du tabac, du sucre, de boissons sucrées et alcoolisées, les antécédents médicaux, le diabète, l'âge, le genre, l'obésité et la pression artérielle sont des variables qui ont été analysées pour identifier les déterminants des maladies parodontaux. Le Dutch Periodontal Screening Index (DPSI) a été utilisé pour évaluer le statut parodontal des patients. Les tests t de Student et de khi carré ont été appliqués pour comparer respectivement les moyennes et les pourcentages. L'analyse de régression logistique a été utilisée pour identifier les déterminants indépendants associés à la parodontite. Les Odds ratio et leurs intervalles de confiance à 95% ont été calculés pour déterminer la force d'association entre les variables dépendante et indépendantes (p < 0,05).Résultats : Sur les 642 patients examinés, 374 étaient du genre féminin. La moyenne d'âge des patients examinés était de 38,1 ± 16,3 ans avec des extrêmes allant de 12 à 92 ans. Quatre-vingt-huit virgule cinq pour cent (88,5%) des patients examinés avaient au moins un niveau secondaire. 16,7% de la population de l'étude présentaient au moins une parodontite modérée de DPSI 3+. A l'issue de l'analyse multivariée, le risque associé à la susceptibilité et la sévérité de maladie parodontale était multiplié par 5,4 (IC95%, p = 0,0001) pour les sujets âgés > 50 ans, par 3,7 (IC95%, p = 0,046) pour les sujets du genre masculin, par 2 (IC95%, p = 0,006) pour ceux qui consommaient journalièrement de boissons sucrées, par 4,26 (IC95%, p = 0,001) chez les sujets diabétiques et par 3,39 (IC95%, p = 0,025) chez les hypertendus. Ces variables indépendantes étaient liées à la variable dépendante par l'équation y = 4,2x + 1,08.Conclusion : La progression de la maladie parodontale vers la forme sévère était modulée par des nombreux facteurs notamment le vieillissement, le genre, le diabète, la consommation de boissons sucrées et l'hypertension artérielle

A influência do estresse na instalação e progressão das doenças periodontais / The influence of stress on installation and progression of periodontal disease

Objetivo: revisar o estresse como fator predisponente à instalação e desenvolvimento da doença periodontal, avaliando seus mecanismos biológicos e aspectos psicossociais. Material e métodos: uma revisão da literatura sobre o assunto foi realizada nas bases de dados PubMed e Scielo, utilizando as palavras-chave: estresse psicológico, doenças periodontais e cortisol. Resultados: a relação entre o estresse e a doença periodontal tem sido estudada desde a metade do século passado e apresenta-se de variadas formas clínicas, representando grandes impactos negativos em dimensões humanas e sociais. A maioria dos estudos publicados até o momento evidencia como os mecanismos do estresse influenciam a doença periodontal alterando a resposta inflamatória, imunológica e promovendo mudanças comportamentais. Conclusão: o estresse tem sido apontado como um possível fator de risco que infl uencia a instalação e a progressão das doenças periodontais. Contudo, os resultados obtidos ainda não estão defi nitivamente entendidos e estabelecidos.

Objective: to review stress as predisposing factor to installation and development of periodontal disease evaluating its biological mechanism and psychosocial aspects. Material and methods: a literature review about the subject was made through PubMed and Scielo databases using the keywords "psychological stress", "periodontal disease", and "cortisol". Results: the relation between stress and periodontal disease has been studied since the second half of the last century. The condition of stress is presented with various clinical forms and represent a negative impact in human and social dimension. It is discussed that the physiopathology mechanism of stress influences periodontal disease modifying infl ammatory and immunological responses and promote behavior changes. Conclusion: stress has been linked as the possible risk factor that infl uences installation and progression of periodontal disease. However the results are not yet definitively understood and established.

Tratamiento de las repercusiones sinérgicas en presencia de enfermedad periodontal en el paciente con diabetes: revisión de la literatura / Treatment of the synergistic effects of periodontaldisease in patients with diabetes. literature review

Introducción: La interacción de las enfermedades periodontales serelacionan con el medio ambiente, huésped, factores microbianos ysusceptibilidad genética. En esta patología la interacción de las bacteriasy el sistema inmunológico dan como resultado una producción elevada de mediadores infl amatorios como las interleucinas IL-1, IL-6 y el TNF-α que destruirán el tejido conectivo y óseo. La diabetes por sí misma ya sea tipo 1 o 2 va a tener repercusiones a nivel de los diferentes órganos de la economía como los riñones, sistema nervioso,ojos, sistema circulatorio y de ahí al periodonto. Cuando el paciente nose encuentra en control sistémico, los efectos adversos van aumentandoy se provoca una sinergia entre la alteración glucémica y la afectaciónperiodontal. Se ha descrito la relación del efecto benéfi co del tratamientoperiodontal en el control glucémico en pacientes diabéticos y no diabéticos. Conclusión: El tratamiento periodontal no quirúrgico demostró reducir los valores de los parámetros periodontales así como los valores séricos de glucosa en ayuno y hemoglobina glucosilada y coadyuvar en el control glucémico.

Introduction: The interaction of periodontal disease is related to theenvironment, host, microbial factors and genetic susceptibility. In thiscondition, the interaction of bacteria and the immune system result inincreased production of infl ammatory mediators such as IL-1, IL-6interleukins, and TNF-α that will destroy connective tissue and bone.Diabetes itself either type 1 or 2 will have repercussions at the levelof the diff erent organs of the economy as it is kidneys, nervous system,eyes, circulatory system and hence the periodontium. When the patientis not in controlling systemic adverse eff ects are increased and synergybetween periodontal health and glycemic involvement provoked. It hasbeen reported regarding the benefi cial eff ect of periodontal treatmenton glycemic control in diabetic and non-diabetic patients. Conclusion:The non-surgical periodontal treatment was shown to reduce the valuesof periodontal parameters and serum fasting glucose and glycatedhemoglobin and assist in glycemic control.

Associação entre estresse e doenças periodontais ­ Estudo transversal / Association between stress and periodontal diseases ­ cross-sectional study

Objetivo: avaliar a extensão das doenças periodontais e sua associação com o estresse. Material e métodos: utilização de dois instrumentos de avaliação psicológica ­ o Inventário de Sintomas de Estresse e a Escala de Reajustamento Social ­ e na aferição de parâmetros clínicos periodontais por meio de profundidade de sondagem periodontal (PS), nível de inserção clínica (NIC), índice de placa (IP) e índice gengival (IG). O Inventário de Sintomas de Estresse incluiu todos os pacientes no estado de alerta. Já a Escala de Reajustamento Social classificou os pacientes em dois grupos: portadores de estresse leve (70%) e estresse moderado severo (30%). Os dados clínicos foram categorizados em: IP ≥ 60% dos sítios; IG ≥ 25% dos sítios; e NIC ≥ 4 mm. Resultados: as avaliações de estresse foram comparados aos dados clínicos periodontais, por meio de análises estatísticas descritivas e inferências, não apresentando resultado significativo (p > 0,05) entre os índices periodontais e os indicadores do grau de estresse do paciente periodontal. Conclusão: os pacientes periodontais são indivíduos que já apresentam acometimento por estresse psicológico e que o grau do estresse psicológico aferido não infl uenciou na extensão das doenças periodontais.

Objective: to evaluate the extention of periodontal diseases and its association with stress. Material and methods: use of two instruments of psychological evaluation ­ the Inventory of Stress Symptoms and the Social Readjustment Scale ­ and in the measurement of periodontal clinical parameters by probing pocket depth (PD), clinical attachment loss (CAL), Plaque index (PI) and gingival index (GI). The Inventory of Stress Symptoms included all patients on alertness status. The Social Readjustment Scale classified the patients into two groups: patients with mild stress (70%) and moderate-severe stress (30%). Clinical data were categorized as: presence of PI ≥ 60% of sites; IG ≥ 25% of sites; and CAL ≥ 4 mm. Results: the stress evaluations were compared to periodontal clinical data by means of descriptive statistics and inferences, and did not present signifi cant results (p > 0.05) between the periodontal indices and the indicators of the degree of stress of the periodontal patient. Conclusion: periodontal patients are individuals who already suffer from psychological stress and that the degree of psychological stress measured did not infl uence the extent of periodontal diseases.

Risk factors for periodontal diseases among Yemeni type II diabetic patients: a case-control study

BACKGROUND: chronic periodontal diseases are one of diabetes mellitus complications. The present study aims to compare the periodontal status of type II diabetic patients to a control group and assess the role of risk factors in both groups. MATERIALS AND METHODS: A case-control study was conducted of 270 individuals (132 type II diabetics and 138 non-diabetics). Full mouth periodontal examination including plaque index, gingival bleeding, gingival recession, clinical attachment loss (CAL), tooth mobility, furcation involvement and the number of missing teeth. The case group was subdivided according to glycosylated hemoglobin (HbA1c) status (poorly controlled HbA1c >8 and well controlled HbA1c≤8) Likewise, the duration of diabetes mellitus as short or long duration (DM≤10 or >10). The diabetic group was also subdivided according to smoking and Khat chewing habits. RESULT: The severity of periodontal disease among type II diabetic patients were significantly higher compared to the control group regarding the plaque index 2.6 (1.6-4.3), bleeding on probing 3.5 (2.3-13.0), gingival recession 2.0 (1.2-3.4), furcation involvement 4.0 (2.3-6.7), clinical attachment loss 5.7 (3.1-10.5), tooth mobility 2.0 (1.2-3.4), and number of missing teeth 4.4 (2.3-8.5). In addition, poorly controlled type II DM and long duration had higher CAL and number of missing teeth than well-controlled DM and short duration. No significant differences were found between smokers/nonsmokers and Khat chewers/non-chewers among the diabetic group. CONCLUSION: Type II diabetic patients have severe periodontal destruction and tooth loss compared to non-diabetic people and there were no differences within the diabetic group in regards to smoking and Khat chewing habits.(

Ação odontológica na triagem neonatal direcionada ao hipotireoidismo congênito / Dental action in the neonatal screening directed to congenital hypothyroidism

O hipotireoidismo congênito é um distúrbio endócrino caracterizado pela diminuição dos níveis séricos dos hormônio da glândula tireóide. Este afeta o metabolismo do cálcio, e, portanto, a formação dos ossos e dentes. É comum nestes pacientes anomalias de formação dentária, atraso na erupção dentária, hipodesenvolvimento do côndilo mandibular e macroglossia. Somados, estes fatores podem ainda levar a uma má-oclusão e ao desenvolvimento inadequado das funções orais. Diante do exposto, Avaliou-se através deste estudo as condições clínicas orais e promoveu-se o atendimento odontológico dos pacientes com esta disfunção endócrina vinculados ao serviço de triagem neonatal do Hospital Universitário da Universidade Federal de Sergipe. Trata-se de um projeto de extensão em que foram atendidos 205 pacientes com idade entre 01 mês e 14 anos, no período de fevereiro à novembro de 2016, os quais passaram por uma avaliação clínica e receberam orientações preventivas. A partir do exame clínico, observou-se que 20% dos pacientes apresentavam alguma necessidade de tratamento odontológico, sendo esses, agendados e encaminhados para a realização do procedimento clínico odontológico. Com os dados obtidos foi possível concluir que é essencial dar aos responsáveis e pacientes as informações necessárias para a prevenção de doenças bucais, estando elas correlacionadas ou não com o Hipotireoidismo Congênito. Além disto, a realização de tratamento clínico, preventivo e curativo nesses pacientes, agregou a Odontologia ao plano multiprofissional já existente representado pelo programa de triagem neonatal do HU ­ UFS.(AU)

Congenital hypothyroidism is an endocrine disorder characterized by a decrease in the serum levels of thyroid gland hormones. This affects the metabolism of calcium, and therefore the formation of bones and teeth. It is common on those patients dental formation anomalies, delayed dental eruption, hypo development of the mandibular condyle and macroglossia. In addition, these factors may also lead to malocclusion and inadequate development of oral functions.In view of the above, this study was chosen as oral clinical conditions and it was promoted in the dental care of patients with this endocrine dysfunction linked to the neonatal screening service of the University Hospital of the Federal University of Sergipe. It is an extension project in which 205 patients aged between 1 month and 14 years were attended, in the period of February to November of 2016, who underwent a clinical evaluation and received preventive guidance. From the clinical examination, it was observed that 20% of the patients had a need for dental treatment, and they were scheduled and sent to perform a dental procedure. With the obtained data, it was possible to conclude that it is essential to give the responsible ones and patients the necessary information for the prevention of oral diseases, being they correlated or not with Congenital Hypothyroidism. In addition, performing clinical, preventive and curative treatment in these patients, added the Dentistry to the existing multiprofessional plan represented by the neonatal screening program of the HU ­ UFS.(AU)

Influence of periodontal treatment on rheumatoid arthritis: a systematic review and meta-analysis / Influência do tratamento periodontal na artrite reumatoide: revisão sistemática e metanálise

ABSTRACT Objective: To evaluate the influence of periodontal treatment on rheumatoid arthritis activity. Methods: MEDLINE/PUBMED, The Cochrane Library, Clinical Trials, SciELO and LILACS were searched for studies published until December 2014. Included articles were: prospective studies; including patients older than 18 years, diagnosed with periodontitis and rheumatoid arthritis submitted to non-surgical periodontal treatment; with a control group receiving no periodontal treatment; with outcomes including at least one marker of rheumatoid arthritis activity. Methodological quality of the studies was assessed using PEDro scale. Quantitative data were pooled in statistical meta-analysis using Review Manager 5. Results: Four articles were included. Non-surgical periodontal treatment was associated with a significant reduction of DAS28 (OR: -1.18; 95% CI: -1.43, -0.93; p < 0.00001). Erythrocyte sedimentation rate, C-reactive protein, patient's assessment of rheumatoid activity using visual analogical scale, tender and swollen joint counts showed a trend toward reduction (not statistically significant). Conclusions: The reduction of DAS 28 in patients with rheumatoid arthritis after periodontal treatment suggests that the improvement of periodontal condition is beneficial to these patients. Further randomized controlled clinical trials are necessary to confirm this finding.

RESUMO Objetivo: Avaliar a influência do tratamento periodontal sobre a atividade da doença na artrite reumatoide. Métodos: Pesquisaram-se as bases de dados Medline/PubMed, The Cochrane Library, Clinical Trials, SciELO e Lilacs em busca de estudos publicados até dezembro de 2014. Incluíram-se estudos prospectivos que avaliaram pacientes com mais de 18 anos diagnosticados com periodontite e artrite reumatoide submetidos a tratamento periodontal não cirúrgico; os estudos deveriam ter também um grupo controle não submetido a tratamento periodontal. Os resultados dos estudos deveriam contar com pelo menos um marcador da atividade da doença na artrite reumatoide. A qualidade metodológica dos estudos foi avaliada com a escala PEDro. Reuniram-se os dados quantitativos em uma metanálise estatística com o uso do Review Manager 5. Resultados: Incluíram-se quatro artigos. O tratamento periodontal não cirúrgico esteve associado a uma redução significativa no DAS-28 (OR: -1,18; IC 95%: -1,43 a -0,93; p < 0,00001). A velocidade de hemossedimentação, a proteína C-reativa, a avaliação da atividade reumatoide pela escala visual analógica e as contagens de articulações sensíveis e inchadas apresentaram uma tendência de redução (não estatisticamente significativa). Conclusões: A redução no DAS-28 em pacientes com artrite reumatoide após tratamento periodontal sugere que a melhoria na condição periodontal é benéfica a esses pacientes. São necessários mais ensaios clínicos randomizados controlados para confirmar esse achado.

Cuidados preventivos periódicos em pacientes com risco a doenças periodontais: alcoolismo e tabaco / Preventive care for patients with risks for periodontal disease (alcoholism and tobbaco) ­ a case report

O objetivo desse estudo foi demonstrar novas modalidades de tratamento e a atualização de condutas de diagnóstico clínico e laboratorial da doença periodontal. Em um período de seis meses, esse estudo acompanhou a condição periodontal de um paciente do sexo masculino, com 35 anos de idade, na tentativa de associar a condição sistêmica do mesmo com os fatores modifi cadores e de risco das doenças periodontais, levando em consideração a perda de inserção e a ausência de profundidades de sondagem significativas, por meio de um relato de caso. O álcool e a nicotina modulam as funções imunológicas do hospedeiro (o uso crônico ou agudo esporádico de álcool pode estar ligado à combinação da diminuição da resposta inflamatória), diminuindo as funções dos neutrófi los, monócitos e, consequentemente, reduzindo a resposta imune. O alcoolismo e o tabaco estão associados à gravidade da doença periodontal, porém, com uma terapia de suporte e manutenção adequada, pode-se reduzir ou até mesmo impedir a progressão da doença, preservando assim parâmetros clínicos compatíveis com a saúde periodontal. Além disso, os resultados mostram que o paciente necessita de um acompanhamento contínuo, podendo ter recaídas no controle da relação doença periodontal, alcoolismo e tabaco.

The objective of this study was to demonstrate new treatment modalities and to update the clinical and laboratory diagnosis of periodontal disease. In a six-month period, this study followed the periodontal condition of a 35-year-old male patient in an attempt to associate his systemic condition with the modifying and risk factors of periodontal diseases, taking into account the loss of insertion and absence of signifi cant probing depths, by means of a case report. Alcohol and nicotine modulate the host's immune functions (chronic or acute sporadic use of alcohol may be linked to a combination of decreased infl ammatory response), decreasing the function of neutrophils, monocytes, and consequently reducing the immune response. Alcoholism and tobacco are associated with the severity of periodontal disease, but with adequate supportive and maintenance therapy, disease progression can be reduced or even prevented, thus preserving clinical parameters consistent with periodontal health. In addition, the results show that the patient needs continuous follow-up, and may have recurrences in the control of periodontal disease, alcoholism and tobacco control. Key words: