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.

La modulación de la expresión de IL-10 por el polimorfismo IL-10-592C/A (rs1800872) es independiente de la presencia y carga bacteriana de los periodontopatógenos clásicos / Modulation of IL-10 mRNA levels in periodontal lesions by IL-10-592C/A polymorphism (rs1800872) is independent of the frequency and load of classic periodontopathic bacteria

Objetivo: Reportamos la asociación entre el polimorfismo de nucleótido simple de IL-10-592C/A (rs1800872) y la detección/abundancia relativa de los periodontopatógenos Porfiromonas gingivalis, Tenerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans. Además investigamos la influencia de los determinantes genéticos y microbiológicos en los niveles de expresión de IL-10 en lesiones periodontales. Metodología Fueron reclutados 117 pacientes con periodontitis crónica y 58 controles. Luego del examen clínico fueron obtenidas muestras microbiológicas y la presencia/carga bacteriana de especies de periodontopatógenos fue cuantificada por RT-PCR. El genotipo para IL-10-592C/A fue determinado mediante restriction fragment length polymorphism. Resultados La distribución alélica del SNP rs1800872 en la población investigada cumplió con el equilibrio de Hardy-Weinberg (p = 0,64). Como ya ha sido reportado, los sujetos polimórficos demostraron menor expresión de IL-10 y riesgo aumentado de sufrir periodontitis crónica. El polimorfismo IL-10-592C/A no demostró relación con la detección o carga bacteriana de ninguna de las bacterias investigadas, además los niveles de expresión de IL-10 no fueron influenciados por el perfil microbiológico, sino que se correlacionaron directamente con el genotipo para el polimorfismo IL-10-592C/A.

Objective: A study was conducted to investigate the possible influence of the single nucleotide polymorphism (SNP) IL-10-592 C/A on the occurrence and load of the periodontal pathogens: P. gingivalis, T. forsythia, T. denticolaand A. Actinomycetemcomitans; as well to investigate the influence of microbial and genetic factors on the modulation of local IL-10 mRNA levels. Methodology The study included 117 cases and 58 controls. After clinical examination microbiological samples were obtained and the detection/quantification of the target bacterial species was performed by RT-PCR. SNP rs1800872 was assayed by restriction fragment length polymorphism (RFLP). Results Allele distribution of rs1800872 was in Hardy-Weinberg equilibrium (P = 64). As previously reported, polymorphic subjects demonstrated decreased IL-10 expression and increased risk of suffering chronic periodontitis. IL-10-592C/A rs1800872 SNP was not associated with the detection or the bacterial load of the investigated pathogens. Moreover, the presence/load of bacteria at periodontal sites did not influence IL-10 expression, which was determined by the genetic background of the study subjects. IL-10-592C/A SNP was not associated with detection/bacterial load of pathogenic bacteria. IL-10 expression levels were determined by the genetic background and were independent of the bacterial microenvironment.

Sporadic Kindler Syndrome with a novel mutation / Sindrome de Kindler esporadica com uma mutacao nao descrita previamente

We report the case of a 28-year-old woman with Kindler syndrome, a rare form of epidermolysis bullosa. Clinically, since childhood, she had widespread pigmentary changes in her skin as well as photosensitivity and fragility of the skin and mucous membranes. The mucosal involvement led to an erosive stomatitis as well as esophageal, anal and vaginal stenoses, requiring surgical intervention. The diagnosis of Kindler syndrome was confirmed by DNA sequencing with compound heterozygosity for a nonsense/frameshift combination of mutations (p.Arg110X; p.Ala289GlyfsX7) in the FERMT1 gene.

Nós relatamos uma paciente feminina de 28 anos com Síndrome de Kindler, uma forma rara de Epidermólise Bolhosa. Clinicamente, ela apresentava alterações cutâneas pigmentares disseminadas, fotossensibilidade e fragilidade da pele e das mucosas desde a infância. O envolvimento mucoso levou à estomatite erosiva e a estenoses esofágica, anal e vaginal, as quais necessitaram de intervenções cirúrgicas. O diagnóstico de Síndrome de Kindler foi confirmado por sequenciamento de DNA, que demonstrou heterozigose composta uma combinação de mutações uma nonsense e outra frameshift (p.Arg110X; p.Ala289GlyfsX7) no gene FERMT1.

Effect of gene polymorphisms on periodontal diseases.

Periodontal diseases are inflammatory diseases of supporting structures of the tooth. It results in the destruction of the supporting structures and most of the destructive processes involved are host derived. The processes leading to destruction and regeneration of the destroyed tissues are of great interest to both researchers and clinicians. The selective susceptibility of subjects for periodontitis has remained an enigma and wide varieties of risk factors have been implicated for the manifestation and progression of periodontitis. Genetic factors have been a new addition to the list of risk factors for periodontal diseases. With the availability of human genome sequence and the knowledge of the complement of the genes, it should be possible to identify the metabolic pathways involved in periodontal destruction and regeneration. Most forms of periodontitis represent a life-long account of interactions between the genome, behaviour, and environment. The current practical utility of genetic knowledge in periodontitis is limited. The information contained within the human genome can potentially lead to a better understanding of the control mechanisms modulating the production of inflammatory mediators as well as provides potential therapeutic targets for periodontal disease. Allelic variants at multiple gene loci probably influence periodontitis susceptibility.

Periodontal disease: a genetic perspective

Periodontitis is a multifactorial disease that causes tooth loss. The complex pathogenesis of periodontitis implies the involvement of a susceptible host and a bacterial challenge. Many studies have provided a valuable contribution to understanding the genetic basis of periodontal disease, but the specific candidate genes of susceptibility are still unknown. In fact, genome-wide studies and screening of single-nucleotide polymorphisms have yielded new genetic information without a definitive solution for the management of periodontal disease. In this manuscript, we provide an overview of the most relevant literature, presenting the main concepts and insights of the strategies that have been emerging to better diagnose and treat periodontal disease based on biomarker analysis and host modulation.

Genetic polymorphisms in periodontal diseases: An overview.

Periodontitis is a multi-factorial disease; several risk and susceptibility factors are proposed in its natural history. Genetics is considered a susceptibility factor in relation to periodontitis. This article is a nonsystematic review of literature and focuses on the role of genetic polymorphisms in periodontal diseases.

Lack of association between the TNF-α -308 (G/A) genetic polymorphism and periodontal disease in Brazilians

This study evaluated the frequency of the tumor necrosis factor-alpha (TNF-α) -308 G/A polymorphism in Brazilians with periodontal health (PH = 51), chronic periodontitis (CP = 74) and generalized aggressive periodontitis (GAgP = 38). Human DNA was obtained from mouthwash samples and TNF-α genotyping was performed by PCR and RFLP analyses. Differences in clinical and genetic parameters among groups were sought by Kruskal-Wallis, χ² and Fisher's exact tests. The allele -308G was detected in 91.7 percent, whereas the allele -308A was found in 35.4 percent of all subjects. No significant differences were observed in the frequency of these alleles (χ² = 2.610, p > 0.05) and the genotypes G/G, G/A, and A/A (χ² = 2.547, p = 0.636) among groups. The data suggest that the TNF-α -308 G/A polymorphism is not associated with periodontitis in this Brazilian population.

Papillon Lefevre syndrome.

Papillon Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. It is transmitted as an autosomal recessive condition and consanguinity of parents is evident in about one-third of cases. Pyogenic liver abscess is an increasingly recognized complication. We report a new case of this association and review the current literature.

Porphyromonas gingivalis; prevalence and quantitation by pcr and clinical assessment of periodontal diseases in type I diabetes mellitus

The aim of this study is to assess the prevalence of periodontal diseases as well as dental caries in a group of diabetic children and adolescents and to study the subgingival microflora, Porphyromonas gingivalis [P.gingivalis]. The study was conducted on 70 type I diabetic patients, 20 healthy age-matched children and adolescents were included as a control group. Both patients and controls were subjected to periodontal examination and subgingival plaque samples for detection and quantitation of Porphyromonas gingivalis using PCR technique. Thirty eight among the seventy studied patients [54%] have been diagnosed as gingivitis [inflammation confined to the gingival], 9/70 [13%] as periodontitis [progressive destruction of periodontal ligament and alveolar bone with pocket formation], and the remaining 23 [33%] were periodontally healthy diabetics. A significantly higher percentage of Porphyromonas gingivalis positive PCR and higher DNA copies/ml were detected in periodontitis and gingivitis compared to periodontically healthy diabetics and healthy controls [P<0.05]. On comparing periodontitis and gingivitis groups, a statistically significant difference was detected [P<0.05] while periodontically healthy diabetics did not show any significant difference neither in positive PCR nor in DNA copies/ml compared to healthy controls [P<0.05]. Assessment of caries condition showed higher caries scores among diabetics than controls but this increase was statistically non significant [P>0.05]. A statistically significant difference was detected between age of the patient, disease duration, poor metabolic control and the development of periodontal disease. Periodontal diseases exist in a significant percentage of diabetic children and adolescents; higher age of the patient, longer duration of DM, and poor diabetic control are risk factors for the development of periodontitis and gingivitis; Porphyromonas gingivalis may be implicated in the development of periodontal disease. Detection and Quantitative analysis of this organism is important for the evaluation of periodontai diseases

Papillon lefevre syndrome: a case report

Papillon Lefevre Syndrome is a rare autosomal recessive disorder, presented with palmoplantar hyperkeratosis with progressive periodontitis resulting in early loss of the teeth and patients eventually become edentulous in early stage of life. In this article classical clinical presentation, lab investigation and management of a patient of 20 year old man are presented

Propolis antimicrobial activity against periodontopathic bacteria

Propolis extract antimicrobial activity against periodontopathic (ATCC) bacteria was investigated ôin vitroö. Bacterial strains tested were Prevotella intermedia, Prevotella melaninogenica, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Capnocytophaga gingivalis and Fusobacterium nucleatum. Minimal inhibitory concentration (MIC) for the strains tested was determined using the method of broth dilution with the propolis extract in serial concentrations. Results showed MIC of 1 ìug/ml for Actinobacillus actinomycetemcomitans and Capnocytophaga gingivalisl; and 0.25 ìg/ml for Prevotella intermedia, Prevotella melaninogenica, Porphyromonas gingivalis and Fusobactaerium nucleatum. Some superinfectant organisms were also tested: Candida albicans susceptibility to proprolis ethanolic extract was demonstrated at a concentration of 12 ìg/ml. The MIC for Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus (wild types) was 14 ìg/ml. All periodontal pathogens and superinfectants tested were susceptible to the propolis extract. The positive suggest that the popolis extract should be further tested as an adjuvant to periodontal therapy.

Aspectos clínicos-patológicos e etiopatogenéticos da doença periodontal: consideraçöes atuais / Clinicopathological and etiopathogenetics aspects of periodontal disease: current concepts

A doença periodontal constitui uma lesäo de natureza peculiar, uma vez que os danos que ocasiona nos tecidos hospedeiros estäo diretamente relacionados à resposta imunológica destes com a microbiota do biofilme dental, estando também envolvidos com a susceptibilidade individual e influências ambientais. A gengivite e a periodontite crônicas representam as formas mais comuns dessa doença. Este trabalho aborda conceitos clínicos e etiopatogenéticos da doença periodontal inflamatória no intuito de contribuir para um maior conhecimento desta ocorrência por parte do cirurgiäo-dentista, no decorrer do exercício odontológico

La periodoncia del nuevo milenio / Periodontics of the new millenium

El nuevo paradigma de la biopatología periodontal introduce el concepto de biofilms, en lugar de la placa bacteriana. Estos son necesarios pero insuficientes para determinar el curso de la enfermedad periodontal. En la actualidad, juegan un rol importantísimo los factores de riesgo (genéticos adquiridos o medio ambiente) en el comienzo, progresión y respuesta al tratamiento de la enfermedad periodontal. Además, la periodontitis está considerada como alto riesgo para enfermedades sistémicas tales como enfermedades cardiovasculares, partos prematuros y diabetes

Factores genéticos del huésped en las enfermedades periodontales / Host genetic factors in periodontal diseases

Hasta tiempos recientes, la periodoncia estuvo orientada a determinar las noxas externas, lo que determinó un oscurecimiento de la participación de otros factores, tales como el genético. El objetivo del presente artículo es brindar al lector una visión de la combinación de la perspectiva molecular de la genética con la de la patogenia de las enfermedades periodontales

Efeitos genéticos e hereditários nas doenças periodontais / Genetic and hereditary factors in periodontal diseases

As doenças periodontais representam um grupo de doenças que manifestam características clínicas similares e possivelmente diferem na etiologia e comportamento biológico. Säo essencialmente infecçöes na origem e, seus efeitos säo dependentes das interaçöes entre as alteraçöes nos fatores do agente (placa bacteriana e seus produtos) e nas respostas do hospedeiro. A susceptibilidade do hospedeiro às doenças periodontais parece estar sob controle genético. As periodontites de início precoce (PIP), entre elas a periodontite juvenil localizada (PJL), apresentam indícios de serem transmitidas através de um modo de herança autossômica recessiva. Entretanto, ainda näo está claro se fatores genéticos influenciam as periodontites crônicas do adulto