Is the use of Lactobacillus reuteri probiotic efficient as adjunctive therapy in the treatment of periodontitis? A systematic review / O uso do probiótico Lactobacillus reuteri como terapia adjuvante no tratamento da periodontite é eficaz? Uma revisão sistemática

Objective: This systematic review had the purpose to validate the probiotic Lactobacillus reuteri as adjuvant therapy in the periodontal treatment of periodontitis, by the analysis of randomized controlled trial, controlled clinical trial, and observational studies. Material and Methods: Search keys related to the subject were defined, and the following databases were used as search strategies: MEDLINE via PubMed, Scopus, Web of Science, Cochrane Central Controlled Trials Registry, and EMBASE. The data selection and study were performed by two independent evaluators: first, they selected the article by title and abstract and subsequently qualified according to the bias risk analysis. A narrative synthesis has been performed based on the data obtained from the best-quality articles. After data extraction, their heterogeneity was analyzed, and a meta-analysis was performed. Results: In general, the results of the meta-analysis were positive for the use of probiotics as an adjuvant treatment. Considering the limitations of the comparisons between the analyzed articles studied, the conclusion was that probiotics may provide supplementary benefits to the treatment of periodontitis, with improvement in bleeding on probing rates and probing depth (AU)

Objetivo: Esta revisão sistemática teve como objetivo validar o uso do probiótico Lactobacillus reuteri como terapia adjuvante no tratamento periodontal da periodontite, por meio da análise de ensaios clínicos randomizados, ensaios clínicos controlados e estudos observacionais. Material e Métodos: Chaves de busca relacionadas ao assunto foram definidas, e as seguintes bases de dados foram utilizadas como estratégias de busca: MEDLINE via PubMed, Scopus, Web of Science, Cochrane Central Controlled Trials Registry e EMBASE. A seleção dos dados e o estudo foram realizados por dois avaliadores independentes: primeiro, selecionaram o artigo pelo título e resumo e posteriormente qualificaram de acordo com a análise de risco de viés. Uma síntese narrativa foi realizada com base nos dados obtidos dos artigos de melhor qualidade. Após a extração dos dados, sua heterogeneidade foi analisada e uma meta-análise foi realizada. Resultados: Em geral, os resultados da meta-análise foram positivos para o uso de probióticos como tratamento adjuvante. Considerando as limitações das comparações entre os artigos analisados estudados, concluiu-se que os probióticos podem trazer benefícios complementares ao tratamento da periodontite, com melhora nas taxas de sangramento à sondagem e na profundidade de sondagem (AU)

Métodos de diagnóstico molecular en la práctica odontológica / Molecular diagnostic methods in dental practice

El diagnóstico molecular, mediante la aplicación de técnicas molecu- lares, ha permitido estudiar microorganismos presentes en el inicio y progresión de la caries dental, enfermedad periodontal, y en los fracasos endodónticos. Las técnicas moleculares permiten la detección y cuan- tificación del material genético del ácido desoxirribonucleico (DNA), ácido ribonucleico (RNA) o proteínas, lo que posibilita el estudio del genoma completo o secuencias de DNA específicas. Estas técnicas surgen como una necesidad de detectar microorganismos de difícil o lento crecimiento en cultivos; la técnica más utilizada es la reacción en cadena de la polimerasa (PCR) que permite la amplificación de peque- ños segmentos de material genético al utilizar cebadores, por lo que es un método económico, preciso, sensible y rápido para la detección de microorganismos. El presente artículo de revisión bibliográfica servirá para informar sobre los avances de las técnicas moleculares utilizadas para el diagnóstico en la práctica odontológica (AU)

Molecular diagnosis, through the application of molecular techniques, has made it possible to study microorganisms present in the onset and progression of dental caries, periodontal disease, and endodontic failures. Molecular techniques allow the detection and quantification of the genetic material of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) or proteins, allowing the study of the complete genome or specific DNA sequences, they arise as a need to detect difficult or slow growing microorganisms in cultures. The most widely used technique is the polymerase chain reaction (PCR) that allows the amplification of small segments of genetic material using primers, it is an economical, precise, sensitive and fast method for the detection of microorganisms. This bibliographic review article will serve to report on the advances in molecular techniques used for diagnosis in dental practice (AU)

Hipertensão arterial sistêmica autorrelatada em pacientes atendidos no curso de Odontologia da Unigranrio e sua relação com parâmetros periodontais e CPOD / Self-reported systemic arterial hypertension in patients treated at Unigranrio's Dentistry course and its relationship with periodontal parameters and DMFT

Objetivo: Avaliar a frequência de hipertensão arterial sistêmica e sua associação com parâmetros periodontais e do índice de dentes cariados, perdidos, obturados (CPOD) em indivíduos atendidos na clínica do Curso de Odontologia da Unigranrio. Materiais e métodos: Noventa e cinco indivíduos de ambos os sexos foram incluídos no estudo entre março e maio de 2021. Os participantes responderam a questionários anamnésicos, tiveram sua pressão arterial sistêmica aferida e foram examinados para obtenção do índice CPOD e de parâmetros periodontais. Resultados: A frequência de hipertensão arterial sistêmica na população estudada foi 23,15%. Em pacientes com periodontite, essa prevalência foi 27%, e, em pacientes com gengivite, 19%. Pacientes com periodontite tiveram médias superiores de pressão arterial sistólica (PAS) e diastólica (PAD) comparado ao grupo com gengivite (p<0,0001). Foram identificadas correlações significativas positivas entre PAS e bolsas periodontais moderadas (rho=0,356) e profundas (rho=0,342), perda de inserção avançada (rho=0,538), CPOD (rho=0,365) e quantidade de dentes ausentes (rho=0,477), p < 0,001. A PAD apresentou correlações significativas (p < 0,001) positivas com bolsas periodontais moderadas (rho=0,331) e profundas (rho=0,283), perda de inserção avançada (rho=0,465), CPOD (rho=0,361) e dentes ausentes (rho=0,348). Conclusões: A frequência de hipertensão arterial sistêmica autorrelatada é relativamente alta na população estudada e, em especialmente, dentre as pessoas com periodontite. Pressão arterial sistólica e diastólica são correlacionadas positivamente com parâmetros periodontais indicadores de severidade de doença, assim como piores escores do CPOD.

Aim: The study evaluated the prevalence of systemic arterial hypertension and its association with periodontal parameters and decayed-missing-filled teeth (DMFT) index in individuals treated in a Dental School clinic. Material and methods: Ninety-five individuals of both genders were included in the study in the period between March and May 2021. All participants answered anamnestic questionaries, had their systemic blood pressure measured, and were examined to obtain the DMFT and periodontal parameters. Results: The prevalence of systemic arterial hypertension in the study population was 23.15%. In periodontitis individuals, that prevalence was 27%, and, in gingivitis patients, 19%. Patients with periodontitis have higher mean systolic (SBP) and diastolic (DBP) blood pressure compared with gingivitis individuals (p<0.0001). Significant positive correlations were found between SBP and moderate (rho=0.356) and deep (rho=0.342) periodontal pockets, severe attachment loss (rho=0.538), DMFT (rho=0.365), and amount of missing teeth (rho=0.477), p ? 0.001. The DBP showed significant (p?0.001) positive correlations with moderate (rho=0.331) and (rho=0.283) deep periodontal pockets, severe attachment loss (rho=0.465), DMFT (rho=0.361), and missing teeth (rho=0.348). Conclusions: The prevalence of systemic arterial hypertension is relatively high in the study population and, in particular, among individuals with periodontitis. Systolic and diastolic blood pressure are positively correlated with periodontal parameters that indicate the severity of disease, as well as with worse DMFT scores.

Una díada de riesgo: periodontitis y COVID-19 / A risk dyad: periodontitis and COVID-19

RESUMEN Fundamento: La COVID-19 es una pandemia causada por el virus SARS-CoV-2 y su asociación con la periodontitis podría tener resultados adversos. Objetivo: Evaluar la asociación entre la periodontitis y los resultados adversos de la COVID-19. Desarrollo: Se realizó una revisión bibliográfica en Google Académico, SciELO y PubMed Central con los descriptores SARS-CoV-2, COVID-19, periodontitis y enfermedad periodontal consultados en el DeCS. Se seleccionaron artículos a texto completo en español e inglés, principalmente de revistas arbitradas por pares. La periodontitis se asocia significativamente a la gravedad de la COVID-19. Los probables mecanismos que vinculan a la periodontitis con la COVID-19 grave son el favorecimiento de la replicación viral, la inflamación por disfunción inmune, la disbiosis con infección bacteriana sobreañadida y la presencia de comorbilidades. La toma de medidas de bioseguridad e higiene en la atención de los pacientes podría contribuir a un curso clínico más favorable de la COVID-19. Conclusiones: La periodontitis parece asociarse con resultados desfavorables de la COVID-19, lo que recalca la importancia de la atención estomatológica de estos pacientes.

ABSTRACT Background: COVID-19 is a pandemic caused by SARS-CoV-2 virus and its association with periodontitis could have adverse outcomes. Objective: To evaluate the association between periodontitis and adverse outcomes of COVID-19. Methodology: A literature review was performed in Google Scholar, SciELO and PubMed Central with the descriptors SARS-CoV-2, COVID-19, periodontitis and periodontal disease consulted in DeCS. Full-text articles in Spanish and English were selected, mainly from peer-reviewed journals. Results: Periodontitis is significantly associated with COVID-19 severity. Probable mechanisms linking periodontitis with severe COVID-19 are favoring viral replication, inflammation due to immune dysfunction, dysbiosis with superimposed bacterial infection, and the presence of comorbidities. Taking biosecurity and hygiene measures in patient care could favor a more favorable clinical course of COVID-19. Conclusions: Periodontitis appears to be associated with unfavorable COVID-19 outcomes, emphasizing the importance of stomatologic care of these patients.

Evaluation of pain perception on periodontal probing in patients with dental plaque induced gingivitis and chronic periodontitis - a cross sectional study, part I / Evaluación de la percepción del dolor al sondaje periodontal en pacientes con gingivitis inducida por placa dental y periodontitis crónica: un estudio transversal, parte I

Background: Probing of periodontal pockets is an essential part in the diagnosis of periodontal disease. Fifteen to seventy seven percent of untreated periodontal patients experience pain during probing. Hence the aim of this study is to evaluate the pain perceived by patients with gingivitis and periodontitis during periodontal probing. The goals of this study were to compare the patients' pain perception when using a conventional UNC15 probe and a manual pressure sensitive periodontal probe, and to relate the clinical features of gingivitis and periodontitis to the discomfort associated with periodontal probing. Material and Methods: A total of 475 subjects were recruited into the study. The subjects were initially divided into two groups ­ Group ­ A (Gingivitis group - 275 patients) and Group ­ B (Chronic Periodontitis group -200 patients) according to the AAP 1999 Classification. These two groups were further subdivided into two groups each (Gingivitis ­ Conventional Probe ­ GCP, Gingivitis ­ Manual Pressure Sensitive Probe ­ GMPS, Periodontitis - Conventional Probe ­ PCP, Periodontitis ­ Manual Pressure Sensitive Probe ­ PMPS) using a computer generated program of random numbers. Results: A significant difference was noted in pain perception when pressure sensitive probe was used compared to conventional UNC-15 probe. Reduced Bleeding on Probing and Pain scores were noted in Chronic periodontitis subjects with use of pressure sensitive probe, which was statistically significant (p<0.001). Conclusion: Dentistry has changed its focus towards painless dentistry. In this context, the present study presents data towards use of manual pressure sensitive probes, which offers an advantage of low cost when compared to more advanced computerized systems with reduced pain during periodontal examination. It could result in a positive attitude of the patients towards continuous supportive periodontal therapy thereby monitoring periodontal health.

Antecedentes: El sondaje de los sacos periodontales es una parte esencial en el diagnóstico de la enfermedad periodontal. Del quince al setenta y siete por ciento de los pacientes periodontales no tratados experimentan dolor durante el sondaje. De ahí que el objetivo de este estudio fué evaluar el dolor percibido por pacientes con gingivitis y periodontitis durante el sondaje periodontal. Los objetivos de este estudio fueron comparar la percepción del dolor de los pacientes al usar una sonda UNC15 convencional y una sonda periodontal sensible a la presión manual, y relacionar las características clínicas de la gingivitis y la periodontitis con la incomodidad asociada con el sondaje periodontal. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron inicialmente en dos grupos - Grupo - A (grupo de Gingivitis - 275 pacientes) y Grupo - B (grupo de Periodontitis Crónica - 200 pacientes) de acuerdo con la Clasificación AAP 1999. Estos dos grupos se subdividieron en dos grupos cada uno (Gingivitis - Sonda convencional - GCP, Gingivitis - Sonda manual sensible a la presión - GMPS, Periodontitis - Sonda convencional - PCP, Periodontitis - Sonda manual sensible a la presión - PMPS) usando un programa generado por computadora de datos aleatorios. números. Resultados: Se notó una diferencia significativa en la percepción del dolor cuando se usó una sonda sensible a la presión en comparación con la sonda UNC-15 convencional (p<0,001). Conclusion: La odontología ha cambiado su enfoque hacia una odontología sin dolor. En este contexto, el presente estudio presenta datos hacia el uso de sondas manuales sensibles a la presión, que ofrece una ventaja de bajo costo en comparación con sistemas computarizados más avanzados con reducción del dolor durante el examen periodontal. Podría resultar en una actitud positiva de los pacientes hacia la terapia periodontal de apoyo continuo, monitoreando así la salud periodontal.

Relación entre la enfermedad periodontal y complicaciones en el Embarazo / Relationship between periodontal disease and complications in pregnancy

Resumen La periodontitis es una enfermedad multifactorial caracterizada por una respuesta inflamatoria desarrollada por el huésped frente a los microorganismos de la biopelícula bacteriana. El proceso localizado en la cavidad oral puede influir en el huésped a nivel sistémico provocando resultados adversos en el embarazo como parto prematuro, hipertensión materna y bajo peso del niño al nacer. Objetivo: Analizar el estado actual del conocimiento sobre los mecanismos probables que vinculan la periodontitis con resultados adversos en el embarazo. Material y métodos: Se efectuó una revisión de la literatura y una búsqueda de artículos publicados durante el periodo comprendido entre los años 2016 y 2021 en las bases de datos MEDLINE, PUBMED, SciELO, LILACS, idioma inglés y/o español. Las búsquedas se realizaron utilizando los siguientes términos: Periodontitis, mediadores de inflamación, complicaciones del embarazo, parto prematuro. Resultados: Se analizaron un total de 24 publicaciones, incluidas revisiones de la literatura, revisiones sistemáticas, estudios de cohorte, estudios de casos y controles y estudio observacionales, que cumplieron con los criterios de inclusión. Conclusión: La periodontitis es un factor de riesgo evitable por lo que se recomienda intensificar las medidas de prevención y tratamiento, en embarazadas y en mujeres en edad fértil.

Abstract Periodontitis is a multifactorial disease characterized by an inflammatory response developed by the host against the microorganisms of the bacterial biofilm. The localized process in the oral cavity can influence the host systemically causing adverse pregnancy outcomes such as premature delivery, maternal hypertension, and low birth weight. Objective: To analyze the current state of knowledge about the probable mechanisms that link periodontitis with adverse pregnancy outcomes. Material and methods: A literature review and a search for articles published during the period between 2016 and 2021 was carried out in the MEDLINE, PUBMED, SciELO, LILACS, English and / or Spanish databases. Searches were conducted using the following terms: Periodontitis, inflammatory mediators, pregnancy complications, preterm delivery. Results: 24 publications were analyzed, including literature reviews, systematic reviews, cohort studies, case-control studies, and observational studies, which met the inclusion criteria. Conclusion: Periodontitis is an avoidable risk factor, therefore it is recommended to intensify prevention and treatment measures in pregnant women and women of childbearing age.

Oral health and quality of life of the geriatric patient: contexts of autonomy / Salud bucal y calidad de vida del paciente geriátrico: contextos de autonomía

Background: The state of oral health plays an important role in the concept of frailty among the elderly, as they tend to suffer from poor oral health conditions. Objective: The aim of our systematic review is to study the impact of oral health on the quality of life of the geriatric patient in different contexts of autonomy. Material and Methods: A systematic literature review was carried out of which the selection of articles, with publication date between 2008 and 2020 was conducted through computer platforms. The studies were analyzed and evaluated respecting the previously established inclusion criteria. The review corpus consisted of 16 articles, which presented methodological quality. Results: Oral health has an impact on the quality of life of the elderly, both in the context of institutionalization and at a community level. Oral health has an effect on the quality of life of the elderly, namely in the dimensions of physical pain, physical disability, psychological discomfort, functional limitation, psychological and social disability. The higher the level of dependency the lower the oral health which has the greatest impact on quality of life. The presence of periodontitis, dental caries, edentulism, oral lesions and unsuitable dental prostheses result in a worse perception of quality of life. Conclusion: The evidence found in this study reveals that the state of oral health among the elderly influences their quality of life, regardless of the context of autonomy, indicating the need for oral health policies aimed at this specific population.

Fundamento: El estado de salud bucal juega un papel importante en el concepto de fragilidad entre los ancianos, ya que tienden a padecer de malas condiciones de salud bucal. Objetivo: El objetivo de nuestra revisión sistemática es estudiar el impacto de la salud bucal en la calidad de vida del paciente geriátrico en diferentes contextos de autonomía. Material y Métodos: Se realizó una revisión sistemática de la literatura, se seleccionó artículos con fecha de publicación entre 2008 y 2020 a través de plataformas informáticas. Los estudios fueron analizados y evaluados respetando los criterios de inclusión previamente establecidos. El corpus de revisión estuvo compuesto por 16 artículos, que presentaron calidad metodológica. Resultados: La salud bucal tiene impacto en la calidad de vida de los ancianos, tanto en el contexto de institucionalización como a nivel comunitario. La salud bucal tiene un efecto sobre la calidad de vida de los ancianos, concretamente en las dimensiones de dolor físico, discapacidad física, malestar psicológico, limitación funcional, discapacidad psicológica y social. Cuanto mayor es el nivel de dependencia, menor es la salud bucal, lo que tiene un mayor impacto en la calidad de vida. La presencia de periodontitis, caries dental, edentulismo, lesiones bucales y prótesis dentales inadecuadas redundan en una peor percepción de la calidad de vida. Conclusión: Las evidencias encontradas en este estudio revelan que el estado de salud bucal de los ancianos influye en su calidad de vida, independientemente del contexto de autonomía, indicando la necesidad de políticas de salud bucal dirigidas a esa población específica.

Evaluation of homeopathy effects associated with conventional periodontal therapy in randomized treatment of diabetic and non-diabetic patients with periodontitis

Periodontitis and Diabetes Mellitus type 2 (DMII) are chronic diseases treated by conventional practices and traditional medicine. In many cases, when conventional medicine cannot offer a satisfactory treatment, increases the demand for alternative therapies in chronic conditions. The aim of this study randomized was to compare and evaluate for one year clinical and serologic parameters the effects of homeopathy as an adjunct of conventional periodontal therapy in individual with periodontitis and DMII. Materials and Methods:85 individuals, of both genders, between 35 and 70 years old, participated in this randomized study, which 70 were eligible in Institute of Endocrinology and Diabetes of Rio de Janeiro-Brazil. They were divided into two groups G-1: individuals with periodontitis without systemic conditions and G-2: individuals with periodontitis and DMII. Both groups received homeopathic treatment and were evaluated in clinical and laboratorial examinations. The medication used was chosen based on the similarity principle, following the Berberis 6CH protocol (2 tablets, 2 times a day for 45 days), Mercurius Solubilis / Belladona / Hepar Sulfur-6CH (2 tablets, 3 times a day for 15 days) and a Pyrogenium 200CH biotherapeutic (single weekly dose, 2 weeks). Medications are prescribed in diluted low concentration doses for all signs and symptoms, while biotherapy is used for chronic stimulation Results:Both groups showed significant improvements throughout the study,clinical and laboratorial, at 1 year baseline: reductions in total cholesterol, triglycerides, glucose, glycated hemoglobin, uric acid and CPR. Statistical and descriptive analyzes were performed. The data obtained after laboratory analysis were tabulated and then submitted to the SPSS 17.0 software for Windows (SPSS Inc., Chicago, IL) and significance level with p <0.05. For most of parameters, G-1 performed better than G-2 (p<0.05).Conclusion:After 1 year follow-up this clinical trial suggest that homeopathy therapy, as an adjunct of periondontal treatment, improves local and systemic parameters and can provide better health condition.

Quantification of sphingosine-1-phosphate (S1P) in patients with periodontitis stage II grade B / Cuantificación de esfingosina 1 fosfato en pacientes con periodontitis estadío II grado B

Abstract The aim of this study was the quantification of Sphingosine-1-phosphate (S1P) in periodontal pockets of patients with periodontitis. This is an observational, descriptive, case-control study. Thirty subjects were selected: 15 controls and 15 cases. A periodontal study was conducted following the parameters of AAP 2017 for the diagnosis of periodontal diseases. A sample of saliva and gingival crevicular fluid was obtained from each subject and then analyzed with the Human S1P Elisa kit (MyBioSource #MBS2516132) accordingly to the manufacturer's instructions, in order to verify the presence of S1P and quantify it´s concentration when founded. Results showed a significant difference (p=0.05) between cases and controls. In the case of saliva samples, the concentration of S1P was higher than the ones found in the control group (72.94 ng/mL and 45.12 ng/mL). For GCF, a higher amount of S1P was found in patients with POD (20.09 ng/mL and 15.20 ng/mL). This work raises a possible route of bone metabolism, inflammatory process, and identification of periodontitis through oral quantification of S1P, however, future studies are needed.

Resumen El propósito de este estudio fue la cuantificación de Esfingosina-1-Fosfato (S1P) en las bolsas periodontales de pacientes con periodontitis. Estudio observacional, descriptivo de casos y controles. 30 sujetos fueron seleccionados de los cuales 15 controles y 15 casos. Se realizó un estudio periodontal completo siguiendo los parámetros establecidos por la AAP en 2017 para el diagnóstico de las enfermedades periodontales. Se tomaron muestras de saliva y de líquido crevicular gingival de cada sujeto estudiado y se analizaron con el ELISA kit humano para S1P (MyBiosource #MBS2516132) y de acuerdo con las instrucciones del fabricante, se realizó para cuantificar la presencia d S1P en las muestras estudiadas. Los resultados mostraron diferencia significativa (p=0.05) entre casos y controles. En el caso de las muestras de saliva, la concentración de S1P en controles fue mayor (72.94 ng/mL y 45.12 ng/mL). Para Líquido crevicular gingival, se encontró mayor cantidad de S1P en los pacientes con periodontitis (20.09 ng/mL y 15.20 ng/mL). Este estudio plantea una posible ruta de metabolismo óseo, proceso inflamatorio e identificación de la Periodontitis a través de la cuantificación oral de S1P, sin embargo se necesitan estudios futuros.

Terapêutica adjuvante na modulação da resposta imune no tratamento da doença periodontal: uma revisão de literatura / Adjuvant therapeutic in the modulation of the immune response in the treatment of periodontal disease: a literature review

Introdução: A Doença Periodontal tem caráter multifatorial, já que depende de condições microbiológicas, imunogenéticas e sistêmicas do hospedeiro. Representa inflamação crônica das estruturas de suporte e proteção dental. Desencadeia uma complexa estimulação imunológica, bem como a produção de citocinas inflamatórias, que mediam a destruição óssea e de tecido conjuntivo, provocando perda dental e complicações à distância. A compreensão da etiopatogênese, permitiu os conceitos de modulação, que referem-se às modificações dos aspectos danosos da resposta inflamatória. Objetivo: O presente artigo tem como objetivo realizar uma revisão dos estudos sobre as principais terapêuticas adjuvantes na modulação da resposta imune frente à doença periodontal. Revisão de Literatura: Foi realizada uma revisão da literatura, onde foram selecionados artigos científicos em inglês, publicados entre os anos 2005 a 2020, por meio das bases de dados PubMed e ScienceDirect. No decorrer das buscas, foram utilizadas as palavraschaves "Inflamation", "Periodontal Disease", "Subantimicrobial Dose of Doxycycline", "Periodontal Disease", "Host Response Modulation". Resultados e Conclusão: A literatura é bem promissora em relação à terapia de controle complementar da doença periodontal. Dessa forma, novas pesquisas nessa área podem trazer inúmeros beneficos aos pacientes, sendo, assim, um novo caminho para o contorno da resistência bacteriana(AU)

Introduction: Periodontal disease has a multifactorial character, depending on the host's microbiological, immunogenetic and systemic conditions. It represents chronic inflammation of dental support and protection structures. It triggers a complex immune stimulation, as well as the production of inflammatory cytokines, which mediate bone and connective tissue destruction, causing tooth loss and complications at a distance. The understanding of etiopathogenesis allowed the concepts of modulation, which refers to the modifications of the harmful aspects of the inflammatory response. This article has the escape of conducting a review of studies on the main mechanisms of modulation against periodontal disease. Objective: This article aims to rev iew the studies on the main modulation mechanisms in the face of periodontal disease. Literature Review: A literature review was carried out in which scientific articles were selected in English, published between 2005 and 2020, through the PubMed and ScienceDirect databases. During the searches, the keywords "Inflammation", "Periodontal Disease", "Subantimicrobial Dose of Doxycycline", "Periodontal Disease", "Host Response Modulation". Results and Conclusion: The literature is very promising with complementary control therapy for periodontal disease. Thus, new research in this area can bring countless benefits to patients, thus being a new way to bypass bacterial resistance(AU)

Association among gestational diabetes mellitus, periodontitis and prematurity: a cross-sectional study

ABSTRACT Objective: Gestational diabetes mellitus (GDM) causes maternal and infant morbidity. Periodontitis is associated with adverse pregnancy outcomes. The aim of this study was to evaluate periodontal status, prematurity and associated factors in pregnant women with and without GDM. Subjects and methods: This observational cross-sectional study included 80 pregnant women with GDM (G1 = 40) and without GDM (G2 = 40). Demographic and socioeconomic status, systemic and periodontal health condition, prematurity and newborns' birth weight were analyzed. For bivariate analysis, Mann-Whitney U-test, t test and Chi-squared test were used. Binary logistic regression analyzed independent variables for periodontitis and prematurity (p < 0.05). Results: Patients from G1 presented lower socioeconomic status, higher weight and body mass index (BMI). Prematurity (G1 = 27.5%; G2 = 2.5%; p < 0.05) and severe periodontitis percentages (G1 = 22.5%; G2 = 0; p = 0.001) were higher in G1 than in G2. Logistic regression analysis showed that household monthly income (OR = 0.65; 95% CI 0.48-0.86; p = 0.003) and maternal BMI (adjusted OR = 1.12; 95% CI 1.01-1.25; p = 0.028) were significant predictors of periodontitis during the third trimester of pregnancy. Presence of GDM remained in the final logistic model related to prematurity (adjusted OR = 14.79; 95% CI 1.80-121.13; p = 0.012). Conclusions: Pregnant women with GDM presented higher severity of periodontitis, lower socioeconomic status, higher overweight/obesity and a 10-fold higher risk of prematurity. Socioeconomic-cultural status and BMI were significant predictors for periodontitis, and GDM was a predictor to prematurity.

Periodontitis and its associated factors in patients at the faculty of southern Brazil: a cross - sectional study

To verify the presence of periodontitis, its severity, and their association with associated factors based on medical records of patients who attended the Dental Clinic of the Faculty of Southern Brazil over 4 years. This is a cross-sectional study, which included 422 medical records of patients aged ≥ 18 years. The clinically analyzed data were: plaque index (PI),bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Sociodemographic data, dental hygiene, harmful habits and chronic systemic diseases were described. Statistical analysis of binary logistic regression was used to verify the relationship between the severity of periodontitis and the exposure variables. The older adults [odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.23-4.54 ­41 to 55 years and OR = 3.0; 95% CI: 1.49-6.09 ­56 to 87 years], and men (OR = 1.9; 95% CI: 1.18-3.14) showed higher chances of periodontitis severity. Smokers (OR = 3.54; 95% CI: 2.05-6.12), those with hypertension (OR = 2.11; 95% CI: 1.23-3.63) and with diabetes (OR = 2.10; 95% CI: 1.08-4.12) showed higher chances of developing advanced periodontitis. Advanced or severe periodontitis occurred in one-third of the patients. The findings showed that men, older adults, with systemic arterial hypertension, diabetes mellitus, and smokers are more susceptible to severe periodontitis.

Design and evaluation of dental pastes Containing anti-inflammatory drugs

Abstract Periodontitis is an oral disease associated with inflammation and pain with swollen and bleeding gums. In the present study, dental pastes containing NSAIDs, namely, diclofenac sodium and nimesulide (1 % w/w) were prepared to treat periodontitis. Dental pastes of diclofenac sodium and nimesulide (1 % w/w) were prepared with/without mucoadhesive hydrocolloid polymers such as sodium carboxy methyl cellulose (NaCMC), hydroxyl ethyl cellulose (HEC) and methyl cellulose (MC) by conventional trituration method. The pH, drug content, viscosity, tube spreadability and tube extrudability of these prepared dental pastes were measured. These dental pastes of diclofenac sodium and nimesulide (1 % w/w) were characterized by FTIR analyses for drug-excipient compatibility. The in vitro drug releases from these dental pastes in 6.4 pH phosphate buffer solution displayed sustained release over longer period and the drug release rate was found to be decreased when the concentration of mucoadhesive polymer was increased. These dental pastes displayed good adhesion to the oral mucosa revealing more retention time in mouth when tested for ex vivo mucoadhesion using bovine cheek pouch. The stability study results reveal that the DC3 and NC3 dental paste formulations were found stable enough over a longer period in different storage conditions. The present study revealed that the prepared mucoadhesive dental pastes of diclofenac sodium and nimesulide (1 % w/w) had good adhesion with the oral mucosa to maintain consistent release of drugs over prolonged time.

Estresse e periodontite: avaliação da inervação simpática no periodonto e da resposta adrenérgica após infecção por Porphyromonas gingivalis / Stress and periodontitis: evaluation of sympathetic innervation in the periodontium and the influence of adrenergic signaling on Porphyromonas gingivalis infection

O estresse agrava a doença periodontal por vários mecanismos, sendo a estimulação do sistema nervoso simpático (SNS) um deles. A literatura mostra que a estimulação de receptores ß-adrenérgicos (ß-AR) aumenta a angiogênese em ossos longos, e a expansão microvascular agrava a periodontite. Ainda, catecolaminas aumentam a virulência de periodontopatógenos e agem na resposta imune. Assim, o objetivo deste trabalho foi avaliar: (1) a inervação simpática no periodonto e a influência da ativação do SNS na vascularização periodontal em camundongos e (2) a influência do sistema adrenérgico nos fatores de virulência de Porphyromonas gingivalis (Pg) e na resposta imunológica a este patógeno in vivo (Galleria mellonella). Na primeira parte, camundongos receberam injeção intraperitoneal de solução salina (PBS) ou isoproterenol (ISO; agonista não seletivo ß adrenérgico) por 1 mês, para detecção in situ de tirosina hidroxilase, neuropeptídeo Y, transportador de norepinefrina (NET) e endomucina em mandíbulas. Expressão de mRNA de Vegf-a, Il-1ß, Il-6, Adrb2 e Rankl foi quantificada 2 h após administração de ISO/PBS em mandíbula e tíbias, que serviram como controle positivo. Diferentemente das tíbias, não houve alteração na expressão dos genes analisados em mandíbula. Por outro lado, NET foi mais expresso no osso alveolar do que na tíbia, sendo detectado nos osteoblastos, osteócitos e células do ligamento. Embora o padrão de inervação e a expressão de Adrb2 sejam semelhantes entre mandíbula e tíbia, o tratamento com ISO não influenciou no número e área de vasos positivos para endomucina. Na segunda parte, investigamos a influência adrenérgica na resposta imune de G. mellonella durante infecção por Pg utilizando norepinefrina (NE; agonista α e ß adrenérgico) e ISO. Pg também foi cultivada na presença de ISO (PgISO) ou NE para avaliação da ação direta dos compostos na bactéria. ISO sistêmico protegeu as larvas da infecção por Pg, aumentando o número de hemócitos e reduzindo a contagem de células de Pg na hemolinfa, exclusivamente pelo ß-AR. Diferentemente, NE aumentou mortalidade, diminuiu o número de hemócitos. Apenas PgISO aumentou a morte das larvas, apesar de ambos, NE e ISO, terem aumentado a expressão de fatores de virulência na bactéria in vitro. ISO circulante, concomitante com PgISO, reduziu parcialmente a mortalidade das larvas. A influência do estresse na doença periodontal envolve diversas vias que alteram os dois pilares da periodontite (microbiota e sistema imune). No entanto, a ação na resposta do hospedeiro parece ser superior, uma vez que a estimulação ß-AR em osso alveolar saudável não alterou a produção de citocinas pró-inflamatórias ou microvascularização e a modulação da resposta imune em G. mellonella por compostos adrenérgicos foi mais importante para o desfecho da infecção que sua ação direta sobre a bactéria.

Stress aggravates periodontitis, and one possible mechanism is the activation of sympathetic nervous system (SNS). The literature shows that stimulation of ß-adrenergic receptors (ß-AR) induces angiogenesis in long bones, and microvasculature amplification was linked to periodontitis severity. Moreover, catecholamines increase the virulence of some periodontopathogenic bacteria in vitro and influences the innate immunity. Thus, the aim of this study was (1) evaluate the presence and influence of the SNS in the stimulation of periodontal vasculature, and (2) the influence of the adrenergic system on Porphyromonas gingivalis (Pg) virulence and on the immunological response to this pathogen in vivo (Galleria mellonella larvae). For the first part, mice received isoproterenol (ISO, a non-selective ß-AR agonist) or saline (PBS) for 1 month, for in situ analysis of tyrosine hydroxylase, neuropeptide Y, norepinephrine transporter (NET) and endomucin in the mandibles. Vegfa, Il-1ß, Il-6, Adrb2 and Rankl mRNA expression was assessed 2 hours after PBS/ISO treatment for mandibles and tibia, that served as positive control. We observed that, differently from the tibia, the expression of these genes did not alter on the mandible. However, NET expression was detected in osteoblasts, osteocytes, and periodontal ligament fibroblasts, and were higher expressed when compared to the tibias from the same animals. Although the pattern of sympathetic innervation and Adrb2 expression were similar between tissues, ISO treatment did not increase the area or number of endomucin+ vessels. For the second part, we addressed the adrenergic signaling influence on G. mellonella immune system during Pg infection using norepinephrine (NE, α- and ß-AR agonist), ISO and octopamine (insect's endogenous hormone). Pg was also cultivated in the presence of ISO (PgISO) or NE to investigate the direct action of the ligands on bacterial virulence. Systemic administration of ISO protected the larvae from Pg infection by increasing hemocyte density accompanied by reduction of Pg load in hemolymph, in a ß-AR manner. In contrast, NE increased mortality, with decreased hemocyte count and no influence on the other parameters. Only PgISO increased larvae death, despite of ISO and NE increased virulence in vitro. The concomitant injection of systemic ISO partially reversed the toxicity of the PgISO. The influence of stress on periodontitis involves different pathways, that alter the two pillars of disease's pathogenesis (microbiota and immune system). However, the influence on the host's inflammatory response seems to overcome the other players, since ß-AR activation on healthy alveolar bone didn't alter cytokines production or microvasculature. Besides, the modulation of innate immunity by adrenergic signaling in G. mellonella was more important for the disease's outcome than it's direct action on the bacteria.

Evaluation of Antimicrobial Photodynamic Therapy as an Adjuvant in Periodontal Treatment in Individual with Down Syndrome

Abstract Objective: To evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT), associated with scaling and root planing in the non-surgical periodontal treatment of individuals with Down Syndrome. Material and Methods: A controlled, randomized, split-mouth study was conducted. A total of 8 participants diagnosed with Down Syndrome aged 17-38 years of both sexes with clinical periodontitis were included in the study. Participants were treated at least three times: at the baseline, Plaque Index (PI), Bleeding on Probing (BOP), and Probing Pocket Depth (PPD) were obtained. After one week, conventional scaling and root planing were performed, and two quadrants were randomly selected for aPDT application. The reassessment was obtained one month after the aPDT application. The significance level was set at 5%. Analyses were performed considering a 95% confidence interval. Results: In the intergroup evaluation, no statistically significant differences were observed (p>0.05). In the intragroup evaluation, no statistically significant variations were observed in relation to the PI (p>0.05) and PPD (p>0.05); however, a statistically significant reduction in the BOP was observed between the test group (p=0.013) and control group (p=0.015). Conclusion: The use of aPDT as adjuvant therapy did not promote additional benefits in decreasing PI and PPD after 1 month of treatment. However, a significant reduction in the BOP was observed in the intragroup evaluation.

Self-Reported Periodontal Disease and its Association with Dental Anxiety in Lagos, Nigeria

ABSTRACT Objective To determine the relationship between dental anxiety and self-reported periodontal status. Material and Methods The study was conducted among 263 patients at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Self-assessed gingival and periodontal disease was measured using the validated periodontal disease self-report surveillance questionnaire. The Modified Dental Anxiety Scale (MDAS) was used for evaluating dental anxiety. Student's t-test was used to test for association between categorical variables. P-value < 0.05 was considered to be statistically significant. Results Seventy-seven (29.3%) participants had high dental anxiety, while 49 (18.6%) had very high dental anxiety. The prevalence of periodontal disease was higher among those with very high dental anxiety (77.6%), while female respondents had a significantly higher proportion of self-reported periodontitis (34.1%). There was a significantly higher prevalence of very high dental anxiety among respondents who had never visited the dentist (23.2%). Similarly, females (19.4%), middle-class respondents (30.8%), and those with a primary level of school education (23.5%) had a higher prevalence of high dental anxiety, even though the association was not significant. Conclusion The prevalence of self-reported periodontal disease among the respondents with very high dental anxiety was higher than in those with high dental anxiety and those without dental anxiety, but the difference was not significant.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.

Association of matrix metalloproteinase-1-1607 1G/2G single nucleotide polymorphism genotypes with periodontitis in Iraqi population / Associação entre genótipos de polimorfismo de nucleotídeo único de metaloproteinase-1-1607 1G/2G da matriz e periodontite em população iraquiana

Objective and background: Periodontitis is an inflammatory disease which is characterized by a progressive loss in the matrix of soft and hard tissue of periodontium particularly the collagen fibers which are cleaved by matrix Metalloproteinase (MMP). Indeed, increased activity of MMP mediates progression of periodontal diseases but population-based genetic variations could determine the susceptibility to the disease. The aim was to investigate association between MMP-1-1607 polymorphism with periodontitis among Iraqi individuals. Subjects and methods: The design of this study was a case-control for Iraqi individuals who were divided into two groups; periodontitis group (cases) and those with healthy periodontium (Control). For each subject, clinical periodontal parameters and demographic characteristics were recorded and venous blood was withdrawn for genetic analysis of MMP-1 by using PCR technique and DNA sequencing. Results: Analysis of MMP-1-1607 genotypes, by Hardy-Weinberg equilibrium, showed significant differences in the total sample. The most predominant MMP-1-1607 genotype among Controls was 1G/2G which was significantly different from periodontitis cohorts. Overall, 13 SNP were detected in periodontitis group versus 17 SNP in Control group. In addition, the periodontitis group showed a significant negative association between the probing pocket depth and MMP-1-1607. Conclusion: Results suggested that polymorphisms in MMP-1-1607 1G/2G may play a protective role and decreasing the susceptibility to periodontitis. (AU)

Introdução e objetivo: A periodontite é uma doença inflamatória caracterizada pela perda progressiva da matriz dos tecidos moles e duros do periodonto, particularmente as fibras de colágeno clivadas pelas metaloproteinases da matriz (MMPs). De fato, o aumento da atividade de MMPs medeia a progressão das doenças periodontais, mas as variações genéticas baseadas na população podem determinar a suscetibilidade à doença. O objetivo foi investigar a associação entre o polimorfismo MMP-1-1607 e periodontite em indivíduos iraquianos. População e método: O desenho deste estudo foi um caso-controle com indivíduos iraquianos, os quais foram divididos em dois grupos: grupo periodontite (casos) e indivíduos com periodonto saudável (controle). Para cada sujeito, os parâmetros clínicos periodontais e as características demográficas foram registrados, e o sangue venoso foi coletado para análise genética de MMP-1 por meio da técnica de PCR e sequenciamento de DNA. Resultados: A análise dos genótipos MMP-1-1607, pelo equilíbrio de Hardy-Weinberg, mostrou diferenças significativas na amostra total. O genótipo MMP-1-1607 mais predominante entre os controles foi 1G/2G, o qual foi significativamente diferente das coortes de periodontite. No geral, 13 SNP foram detectados no grupo periodontite versus 17 SNP no grupo controle. Além disso, o grupo periodontite mostrou uma associação negativa significativa entre a profundidade da bolsa de sondagem e MMP-1-1607. Conclusão: Os resultados sugerem que polimorfismos em MMP-1-1607 1G/2G podem desempenhar um papel protetor e diminuir a suscetibilidade à periodontite. (AU)

Periodontitis may induce gut microbiota dysbiosis via salivary microbiota / 国际口腔科学杂志·英文版

The aim of this study was to identify whether periodontitis induces gut microbiota dysbiosis via invasion by salivary microbes. First, faecal and salivary samples were collected from periodontally healthy participants (PH group, n = 16) and patients with severe periodontitis (SP group, n = 21) and analysed by 16S ribosomal RNA sequencing. Significant differences were observed in both the faecal and salivary microbiota between the PH and SP groups. Notably, more saliva-sourced microbes were observed in the faecal samples of the SP group. Then, the remaining salivary microbes were transplanted into C57BL6/J mice (the C-PH group and the C-SP group), and it was found that the composition of the gut microbiota of the C-SP group was significantly different from that of the C-PH group, with Porphyromonadaceae and Fusobacterium being significantly enriched in the C-SP group. In the colon, the C-SP group showed significantly reduced crypt depth and zonula occludens-1 expression. The mRNA expression levels of pro-inflammatory cytokines, chemokines and tight junction proteins were significantly higher in the C-SP group. To further investigate whether salivary bacteria could persist in the intestine, the salivary microbiota was stained with carboxyfluorescein diacetate succinimidyl ester and transplanted into mice. We found that salivary microbes from both the PH group and the SP group could persist in the gut for at least 24 h. Thus, our data demonstrate that periodontitis may induce gut microbiota dysbiosis through the influx of salivary microbes.

Association between Volatile Sulfur Compounds Prevotella intermedia and Matrix Metalloproteinase-8 Expression

Abstract Objective: To determine the correlation between levels of methyl mercaptan (CH3SH) hydrogen sulfide (H2S), the proportion of Prevotella intermedia (Pi), and matrix metalloproteinase-8 (MMP-8) gene expression levels in periodontitis patients accompanied by halitosis. Material and Methods: Samples were obtained from gingival crevicular fluid (GCF) in the deepest pocket and by swabbing in the tongue coating area in patients with periodontitis presenting with halitosis (n = 23) and healthy subjects as controls (n = 7). The values of CH3SH and H2S were obtained using Oral Chroma. The proportion of Pi and MMP-8 expression levels were evaluated using PCR-RT. All the result was statistically analyzed using SPSS software. Results: The levels of CH3SH and H2S in participants with PD ≥ 6 mm showed a robust negative correlation with the proportion of P. intermedia in GCF and tongue coating. No statistically significant association was detected between CH3SH and H2S levels and MMP-8 expression levels (p>0.05). Conclusion: There is no association between CH3SH and H2S levels, the proportion of P. intermedia, and MMP-8 expression in patients with periodontitis accompanied by halitosis (AU).