Probióticos associados ao tratamento das doenças periodontais: revisão de literatura / Probiotics associated with the treatment of periodontal diseases: literature review

Objetivo: revisar a literatura sobre o tratamento dasdoenças periodontais associado a probióticos, identificandoas funcionalidades e os principais agentes microbianosempregados. Material e método: foi realizadabusca nas bases de dados eletrônicas PubMed e ScienceDirect, empregando os termos de busca probiotics eperiodontal diseases. Como critérios de inclusão, foramselecionadas pesquisas clínicas originais e ensaios clínicospublicados em português ou inglês. Resultados:após pesquisa e minuciosa revisão por título e resumode cada estudo, 40 ensaios clínicos randomizados foramselecionados para avaliação dos desfechos observados.Todos os estudos empregaram probióticos associadosa raspagem, alisamento e polimento coronorradicular.A cepa bacteriana mais utilizada é o Lactobacillus reuteri.Foi demonstrado que os probióticos conferem potencialauxilio ao tratamento das lesões periodontais.Embora os parâmetros avaliados nem sempre sejam beneficiadospelo tratamento, o uso dos microrganismosbenéficos reduziu a necessidade de intervenção cirúrgicaprincipalmente em pacientes com bolsas profundas.Considerações finais: A utilização dos probióticosse mostra segura e traz pequenos ganhos auxiliares notratamento das doenças que acometem o periodonto.Desenhos de estudos com rigor metodológico e amostrasrepresentativas são encorajados visando analisar etestar os benefícios desses agentes. (AU)

Objective: this study aimed to review the literature on the treatment of periodontal diseases associated with probiotics, identifying functionalities and the most used microbial agents. Material and method: a search was performed in the main electronic databases PubMed and Science Direct using the search terms "Probiotics" and "Periodontal diseases". The inclusion criteria were original clinical researches and clinical trials published in Portuguese and English. Results: after the research and meticulous revision for the title and abstract of each study, 40 randomized clinical trials were selected for evaluation of the outcomes observed. All studies used probiotics associated with scaling and crown-root planning and polishing. The most used bacterial strain was Lactobacillus reuteri. It was shown that probiotics provide potential assistance for the treatment of periodontal lesions. Although the parameters evaluated are not always favored by the treatment, the use of the beneficial microorganisms reduced the need for surgical intervention, especially in patients with deep pockets. Final considerations: the use of probiotics is safe and promotes small additional improvements in the treatment of periodontal diseases affecting the periodontium. Study designs with methodological rigor and representative samples are encouraged, aiming to analyze and test the benefits of such microbial agents. (AU)

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

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

Prevalence of periodontopathogens and Candida spp. in smokers after nonsurgical periodontal therapy - a pilot study

Abstract This pilot study aimed to evaluate the influence of smoking on clinical and microbiological parameters after nonsurgical periodontal therapy. Forty-eight subjects were grouped into smokers (SM, n = 24) and nonsmokers (NS, n = 24) and paired according to gender, age, ethnicity, and periodontal status. Both groups received oral hygiene education and scaling and root planing. Clinical evaluation was performed using plaque index (PI), bleeding on probing (BOP), pocket probing depth (PPD), gingival recession (GR), and clinical attachment level (CAL) before instrumentation (baseline) and at 3 and 6 months. The prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Candida albicans, Candida glabrata, Candida tropicalis, and Candida dubliniensis in subgingival biofilm was determined by polymerase chain reaction. The data were statistically analyzed considering p < 0.05. Clinical conditions improved between baseline and 3 months after periodontal treatment. However, NS had a better clinical response, presenting greater PPD reduction and CAL increase in comparison to SM. Periodontal treatment reduced the levels of P. gingivalis, A. actinomycetemcomitans, and T. forsythia individually after 3 months for the NS group and after 6 months for both groups. The prevalence of Candida species was markedly higher in SM than in NS at all time points evaluated. Periodontopathogens associated or not with C. albicans or C. dubliniensis were more prevalent in SM than in NS at baseline and after 3 months. It was concluded that smoking impairs clinical and microbiological responses to periodontal therapy. Periodontopathogens combined or not with some Candida species are resistant to short-term periodontal therapy in SM.

Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy

Abstract This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH) technique, in women in the second trimester of pregnancy (between 14 and 24 weeks), and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD), bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4-5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.

Effect of Resveratrol on periodontal pathogens during experimental periodontitis in rats

Abstract The objective of this study was to investigate the antibacterial effect of resveratrol against putative periodontal pathogens during the progression of experimental periodontitis in rats. Periodontitis was induced in rats in one of the first molars chosen to receive a ligature. Animals were assigned to one of two groups: daily administration of the placebo solution (control group, n = 12) or 10 mg/Kg of resveratrol (RESV group, n = 12). The therapies were administered systemically for 30 days, for 19 days before periodontitis induction and then for another 11 days. Then, the presence and concentrations of Porphyromonas gingivalis, Tannerella forsythia and Aggregatibacter actinomycetemcomitans in the cotton ligatures collected from the first molars were evaluated using real-time PCR. Inter-group comparisons of the microbiological outcomes revealed that no differences were detected for P. gingivalis, T. forsythia and A. actinomycetemcomitans levels (p > 0.05). Continuous use of resveratrol did not promote additional benefits in microbiological outcomes during experimental periodontitis in rats.

Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial

Abstract Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

Efectos del tabaquismo en la microbiota y tejido periodontal: revisión de la literatura / Effects of smoking on the microbiota and periodontal tissue: literature review

La Periodontitis es una enfermedad inflamatoria local crónica de los tejidos de soporte delos dientes que conduce a la pérdida progresiva del ligamento periodontal y del hueso alveolar. El tabaquismo es un factor de riesgo conocido para muchas enfermedades y la evidencia creciente sugiere que el tabaquismo afecta negativamente a la salud periodontal. El hábito del tabaquismo provoca el aumento de la flora bacteriana periodonto patógenas, aumentando su patogenicidad y alteraciones en el tejido periodontal, sin embargo el efecto del tabaquismo no es directamente a estas bacterias. La nicotina provoca una disminución del flujo sanguíneo y disminución de capilares lo que dificulta la respuesta inmune contra las bacterias patógenas. Además el sistema inmune se ve suprimido frente al tabaquismo, por lo que la acción de los leucocitos es escasamente eficaz para combatir la enfermedad periodontal. Como conclusión, el tabaquismo, principalmente la nicotina, afecta al flujo sanguíneo gingival, la producción de citocinas, la función de los neutrófilos, el recambio de tejido conectivo y como consecuencia de estos factores, aumenta el número de bacterias periodonto patógenas lo que afecta negativamente al tejido periodontal.

Periodontitis is a chronic local inflammatory disease of tissue supporting the teeth that leads to progressive loss of periodontal ligament and alveolar bone. Smoking is a known risk factor for many diseases and increasing evidence suggests that smoking negatively affects periodontal health. Cigarette smoking increased periodontal pathogenic bacterial flora, increasing their pathogenicity and alterations in the periodontal tissue, however the effect of smoking is not directly to these bacteria. Nicotine causes a decreased blood flow and decreased capillary hindering the immune response against pathogenic bacteria. In addition, the immune system is suppressed, so the action of leukocytes is poorly effective against periodontal disease. In conclusion, smoking, mainly nicotine, affects the gingival blood flow, cytokine production, the neutrophil function, replacement of connective tissue and because of these factors, increases the number of periodontal pathogenic bacteria which negatively affects the periodontal tissue.

Detection and sampling methods for isolation of Candidaspp. from oral cavities in diabetics and non-diabetics

The purpose of this study was to detect Candida spp. on the tongue and in the subgingival sites in healthy and type 2 diabetes (T2D) patients with chronic periodontitis (CP), and to compare the accuracy of sampling methods. This study included 131 patients divided into four groups: healthy control (group A), nondiabetics + CP (Group B), diabetics with good metabolic control + CP (group C) and diabetics with poor glycoregulation + CP (Group D). Cotton swab samples from tongue and subgingival samples were obtained from each patient with help of sterile paper points and a sterile curette. Swab cultures were made on Sabouraud dextrose agar. The number of CFUs was counted. The sampling methods for subgingival plaque were compared by Receiving Operator Curve (ROC). The presence of Candida spp. on the tongue was statistically significant among groups (group D vs. others three groups: χ2: p < 0.005 for each group). Positive findings of subgingival Candida spp. did not differ among the groups. There were no significant differences in the quantification ofCandida spp., neither on the tongue, nor in the subgingival samples. 17.2% of diabetic patients revealed the presence ofCandida spp. in the subgingival samples, with negative finding on tongue. There was a significant difference in the sampling methods for subgingival plaque (p = 0.000). Candidaspp. is more prevalent on the tongue of diabetics. The sampling of subgingival plaque by a sterile curette is more accurate than with paper points. Subgingival plaque may represent a reservoir of commensals. It is necessary to standardize the sampling of subgingival plaque.

Association between periodontal condition and subgingival microbiota in women during pregnancy: a longitudinal study

Objectivo In this study, the gingival conditions and the quantitative detection for Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia in pregnant women were determined. Material and Methods Quantitative determinations of periodontal bacteria by using a SyBr green system in women during pregnancy were performed. Women at the 2nd and 3rd trimesters of pregnancy and non-pregnant women were included in this study. A. actinomycetemcomitans was observed in high numbers in women at the 2nd and 3rd trimesters of pregnancy with a significant difference (p<0.05). F. nucleatum and P. intermedia were also observed in high levels. Results and Conclusion Our results show that pregnant women are more susceptible to gingivitis, and the presence of A. actinomycetemcomitans in subgingival biofilm might be taken into account for the treatment of periodontal disease. .

Prevalence of Subgingival Staphylococcus at Periodontally Healthy and Diseased Sites

Staphylococci are considered members of the transient oral microbiota and are seldom isolated from the oral cavity. The aim of this study was to establish the prevalence of subgingival staphylococci in healthy and periodontal disease sites. Sterile endodontic paper points were used to isolate subgingival staphylococci in periodontally healthy and periodontally diseased sites in 30 adult subjects (n=540 sites). Staphylococcus spp were identified by an automated method and confirmed by conventional biochemical tests. All the samples were identified as coagulase-negative staphylococci. The results were analyzed using Mann-Whitney U, chi-square and Fisher's exact test at 5% significance level. A total of 86.7% of the subjects harbored these microorganisms in 11.7% of their periodontal sites. The most frequently isolated species was S. auricularis, which was isolated from 31.4% of the periodontal sites, followed by S. epidermidis, isolated from 21.4% of them. There was no statistically significant difference between the frequencies of these species isolated either from the healthy and the diseased sites (p>0.153). Although staphylococci are present in the subgingival environment and contribute to the pathogenic synergism involved in periodontal diseases, the results suggest that they do not participate directly in the pathogenesis of these diseases.

Os estafilococos são considerados membros da microbiota oral transiente e são pouco isolados da cavidade oral. O objetivo deste estudo foi estabelecer a prevalência de estafilococos subgengivais em sítios saudáveis e com doença periodontal. Pontas endodônticas de papel absorvente estéreis foram usadas para isolar estafilococos subgengivais de sítios periodontais doentes e saudáveis, em 30 indivíduos adultos (n=540 sítios). Os Staphylococcus spp foram identificados por método automatizado e confirmados por provas bioquímicas convencionais. Todas as amostras foram identificadas como estafilococos coagulase-negativa. Os resultados foram analisados através dos testes de Mann-Whitney U, Qui-quadrado ou Exato de Fisher para um nível de significância de 5%. Um total de 86,7% dos indivíduos albergavam estes microrganismos em 11,7% de seus sítios periodontais. A espécie mais frequentemente isolada foi S. auricularis, a qual foi isolada em 31.4% dos sítios periodontais, seguida pela espécie S. epidermidis, isolada de 21.4% dos sítios. Não houve associação significativa na freqüência de isolamento das espécies, seja nos sitios periodontais saudáveis ou doentes (p>0.153). Embora os estafilococos estejam presentes no ambiente subgengival e contribuam para o sinergismo patogênico envolvido em doenças periodontais, sugere-se que eles não participem diretamente na patogênese destas doenças.

Anaerobic enhancement of protease secretion by periodontal Candida albicans strains / Aumento anaeróbio da secreção de protease pelas cepas de Candida albicans periodontal

Among other non-bacterial organisms, yeasts have been isolated from subgingival sites with relative frequency. Candida albicans is the species most commonly isolated although its role in periodontal disease has not been established. Objective: This study evaluated the secretion patterns of aspartyl-protease (Sap) by periodontal and nonperiodontal Candida albicans strains in normoxic and anoxic conditions. Material and methods: Periodontal strains (n=10; periodontal pockets ≥3.00 mm) and nonperiodontal Candida albicans strains (n=10) were grown under normoxic and anoxic conditions in protease-inducible broth. Sap activities were quantified in supernatants using azocasein as substrate. Whole-protein contents in supernatants were determined by Bradford’s method. Specific protease activities (Sap activity.protein-1) were assessed and compared. Results: While nonperiodontal strains secrete similar amounts of Sap under both atmospheric conditions, periodontal strains secrete reduced amounts in the presence of molecular oxygen. Conclusion: Despite the limited number of assayed isolates, the possibilities of adaptation or selection of candidal strains to periodontal microenvironment may be considered...

Entre organismos não bacterianos, as leveduras têm sido isoladas de sítios subgengivais com relativa frequência. Candida albicans é a espécie mais comumente isolada, embora seu papel na doença periodontal não esteja estabelecido. Objetivo: Este estudo avaliou os padrões de secreção de aspartil-protease (Sap) por cepas periodontais e não periodontais de Candida albicans em situações de normóxia e anóxia. Material e métodos: Cepas periodontais (n=10; bolsas periodontais ≥3,00 milímetros) e cepas de não periodontais (n=10) Candida albicans foram cultivadas sob condições normóxicas e anóxicas em caldo de protease-induzida. A atividade Sap foi quantificada em sobrenadantes utilizando azocaseína como substrato. O conteúdo de proteínas totais nos sobrenadantes foi determinado pelo método de Bradford. Atividades de protease específica (atividade de proteína Sap-1) foram avaliadas e comparadas. Resultados: Apesar das cepas não periodontais secre¬tarem quantidades semelhantes de Sap em ambas as condições atmosféricas, as cepas periodontais secretam quantidades reduzidas na presença de oxigênio molecular. Conclusão: Apesar do número limitado de amostras analisadas, as possibilidades de adaptação ou seleção de cepas de Candida no microambiente periodontal pode ser considerada...

Influence of lingual bracket position on microbial and periodontal parameters in vivo

OBJECTIVE: Lingual orthodontics is becoming more popular in dental practice. The purpose of the present investigation was to compare plaque formation on teeth bonded with the same bracket onto buccal or lingual surface, with non-bonded control teeth, via an in vivo growth experiment over a 30-day period. MATERIAL AND METHODS: A randomized controlled trial with split-mouth design was set up enrolling 20 dental students. Within each subject sites with buccal and lingual brackets and control sites were followed. Clinical periodontal parameters (periodontal pocket depth: PPD; bleeding on probing: BOP) were recorded at baseline and on days 1, 7 and 30. Microbiological samples were taken from the brackets and the teeth on days 1, 7 and 30 to detect colony-forming units (CFU). Total CFU, streptococci CFU and anaerobe CFU were measured. RESULTS: No significant differences (P>0.05) were found between buccal and lingual brackets in terms of clinical periodontal parameters and microbiological values. Conclusion: Bracket position does not have significant impact on bacterial load and on periodontal parameters.

Impacto da cirurgia bariátrica na condição periodontal e quantificação de bactérias periodontopatogênicas por meio da q-PCR: estudo longitudinal / Impact of bariatric surgery on periodontal status and quantification of periodontopathogenic bacteria using q-PCR: longitudinal survey

Este estudo longitudinal teve como objetivo avaliar o impacto da cirurgia bariátrica na condição periodontal e quantificar bactérias periodontopatogênicas em pacientes submetidos a esta cirurgia. Trata-se de um estudo prospectivo, composto por 50 pacientes submetidos à cirurgia bariátrica por derivação gastrojejunal em Y de Roux, em 3 hospitais do estado de São Paulo. A coleta de dados foi realizada em três períodos: pré-operatório, pós-operatório de 6 e de 12 meses e consistiu de: avaliação do fluxo salivar; exame clínico bucal para avaliar desgaste dentário e doença periodontal; coleta de amostras do fluido gengival para quantificação das bactérias periodontopatogênicas Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola ePrevotella intermédia por meio de Reação em Cadeia da Polimerase em Tempo Real (q-PCR); aplicação de questionário relacionado aos fatores para ocorrência de desgaste dentário e autopercepção da saúde bucal; avaliação do peso e altura para obtenção do índice de massa corporal (IMC) e coleta de dados complementares relacionados à saúde do indivíduo, por meio do prontuário médico. No baseline, 51 pacientes com IMC normal foram analisados e comparados aos obesos. ANOVA, teste de Tukey, correlação de Pearson e teste t de Student foram utilizados na análise estatística (p<0,050). No baseline, foi observado maior índice de sangramento gengival (ISG), presença de cálculo e sítios com bolsa 4-5 mm em obesos comparados ao grupo controle (p<0,050), que mostrou uma melhor autopercepção da saúde bucal do que os obesos (p=0,008). A média do IMC nos pacientes submetidos à cirurgia bariátrica diminuiu de 49,69±8,76 kg/m2 para 36,16±8,12 kg/m2 e para 32,26 kg/m2 após 6 e 12 meses da cirurgia (p<0,000), respectivamente. Antes da cirurgia, 67% dos pacientes apresentavam altos níveis séricos de proteína C-reativa (PCR) e 38% glicemia alta. Houve redução significativa nos níveis séricos de PCR e glicose após a cirurgia. O fluxo salivar...

The aim of this longitudinal study was to evaluate the impact of bariatric surgery on periodontal condition and quantify periodontopathogenic bacteria in patients undergoing this surgery. This was a prospective study composed of 50 patients who underwent bariatric surgery for Roux-en-Y gastric bypass in three hospitals in the state of São Paulo. Data collection was performed in three periods: preoperative, postoperative of 6 and 12 months and consisted of: salivary flow evaluation; oral clinical examination to assess tooth wear and periodontal disease; gingival fluid sample collection for quantification of periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia using Real-time Polymerase Chain Reaction (q-PCR); questionnaire applied as regards factors related to occurrence of tooth wear and self-perceived oral health; weight and height evaluation to determine the body mass index (BMI), in addition to collection of individual's health-related data from medical files. At baseline, 51 patients with normal BMI were analyzed and compared with obese subjects. ANOVA, Tukey test, Pearson correlation and Students t-test were used for statistical analysis (p<0.050). At baseline, greater gingival bleeding index (GBI), presence of calculus and sites with 4-5 mm pocket depth were observed in obese compared with the control group (p<0.050), which showed better self-perceived oral health than the obese (p=0.008). Mean BMI decreased from 49.69±8.76 kg/m2 to 36.16±8.12 kg/m2 and to 32.26 kg/m2 after 6 and 12 months postoperatively (p <0.000), respectively. Before surgery 67% of patients had high C-reactive protein (CRP) serum levels and 38% high glucose level. There was significant reduction in serum CRP and glucose after surgery. Salivary flow was similar in all three periods, ranging from 0.86 to 0.96 mL / min. After bariatric surgery, the percentage of tooth surfaces with dentin wear increased...

Impacto da cirurgia bariátrica na condição periodontal e quantificação de bactérias periodontopatogênicas por meio da q-PCR: estudo longitudinal / Impact of bariatric surgery on periodontal status and quantification of periodontopathogenic bacteria using q-PCR: longitudinal survey

Este estudo longitudinal teve como objetivo avaliar o impacto da cirurgia bariátrica na condição periodontal e quantificar bactérias periodontopatogênicas em pacientes submetidos a esta cirurgia. Trata-se de um estudo prospectivo, composto por 50 pacientes submetidos à cirurgia bariátrica por derivação gastrojejunal em Y de Roux, em 3 hospitais do estado de São Paulo. A coleta de dados foi realizada em três períodos: pré-operatório, pós-operatório de 6 e de 12 meses e consistiu de: avaliação do fluxo salivar; exame clínico bucal para avaliar desgaste dentário e doença periodontal; coleta de amostras do fluido gengival para quantificação das bactérias periodontopatogênicas Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola ePrevotella intermédia por meio de Reação em Cadeia da Polimerase em Tempo Real (q-PCR); aplicação de questionário relacionado aos fatores para ocorrência de desgaste dentário e autopercepção da saúde bucal; avaliação do peso e altura para obtenção do índice de massa corporal (IMC) e coleta de dados complementares relacionados à saúde do indivíduo, por meio do prontuário médico. No baseline, 51 pacientes com IMC normal foram analisados e comparados aos obesos. ANOVA, teste de Tukey, correlação de Pearson e teste t de Student foram utilizados na análise estatística (p<0,050). No baseline, foi observado maior índice de sangramento gengival (ISG), presença de cálculo e sítios com bolsa 4-5 mm em obesos comparados ao grupo controle (p<0,050), que mostrou uma melhor autopercepção da saúde bucal do que os obesos (p=0,008). A média do IMC nos pacientes submetidos à cirurgia bariátrica diminuiu de 49,69±8,76 kg/m2 para 36,16±8,12 kg/m2 e para 32,26 kg/m2 após 6 e 12 meses da cirurgia (p<0,000), respectivamente. Antes da cirurgia, 67% dos pacientes apresentavam altos níveis séricos de proteína C-reativa (PCR) e 38% glicemia alta. Houve redução significativa nos níveis séricos de PCR e glicose após a cirurgia. O fluxo salivar...

The aim of this longitudinal study was to evaluate the impact of bariatric surgery on periodontal condition and quantify periodontopathogenic bacteria in patients undergoing this surgery. This was a prospective study composed of 50 patients who underwent bariatric surgery for Roux-en-Y gastric bypass in three hospitals in the state of São Paulo. Data collection was performed in three periods: preoperative, postoperative of 6 and 12 months and consisted of: salivary flow evaluation; oral clinical examination to assess tooth wear and periodontal disease; gingival fluid sample collection for quantification of periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia using Real-time Polymerase Chain Reaction (q-PCR); questionnaire applied as regards factors related to occurrence of tooth wear and self-perceived oral health; weight and height evaluation to determine the body mass index (BMI), in addition to collection of individual's health-related data from medical files. At baseline, 51 patients with normal BMI were analyzed and compared with obese subjects. ANOVA, Tukey test, Pearson correlation and Students t-test were used for statistical analysis (p<0.050). At baseline, greater gingival bleeding index (GBI), presence of calculus and sites with 4-5 mm pocket depth were observed in obese compared with the control group (p<0.050), which showed better self-perceived oral health than the obese (p=0.008). Mean BMI decreased from 49.69±8.76 kg/m2 to 36.16±8.12 kg/m2 and to 32.26 kg/m2 after 6 and 12 months postoperatively (p <0.000), respectively. Before surgery 67% of patients had high C-reactive protein (CRP) serum levels and 38% high glucose level. There was significant reduction in serum CRP and glucose after surgery. Salivary flow was similar in all three periods, ranging from 0.86 to 0.96 mL / min. After bariatric surgery, the percentage of tooth surfaces with dentin wear increased...

Antimicrobial activity of six plant extracts from the Brazilian savanna on periodontal pathogens / Actividad antimicrobiana de seis extractos de plantas de la sabana brasileña en patógenos periodontales

The extracts of plants from Brazilian savanna are currently used in popular medicine. This study evaluated the inhibitory activity of the alcoholic and aqueous extracts from savanna plants on periodontal bacteria. The minimal inhibitory concentrations were evaluated by the agar dilution method, using Wilkins-Chalgren agar. Antimicrobial activity of plants extracts on microbial biofilms was determined in microplates. Psidium cattleianum and Myracrodruon urundeuva extracts demonstrated significant inhibitory activity on all bacterial strains tested; alcoholic and aqueous extracts showed similar results. The extracts from these two species were able to inhibit both planktonic cells and microbial biofilm.

Los extractos de las plantas de la sabana brasileña actualmente se utilizan en la medicina popular. Este estudio evaluó la actividad inhibitoria de los extractos alcohólicos y acuosos de plantas de la sabana en bacterias periodontales. Las concentraciones inhibitorias mínimas fueron evaluados por el método de dilución en agar, utilizando agar Wilkins-Chalgren. La actividad antimicrobiana de los extractos de plantas en las biopelículas microbianas se determinó en microplacas. Los extractos de Psidium cattleianum y Myracrodruon urundeuva demostraron una importante actividad inhibitoria sobre todas las cepas bacterianas probadas, extractos alcohólicos y acuosos mostraron resultados similares. Los extractos de estas dos especies fueron capaces de inhibir las células planctónicas y biofilm microbiano.

Presencia de Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans en el biofilm subgingival de pacientes diabéticos tipo 2: estudio transversal / Presence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans in the subgingival biofilm of diabetic mellitus 2 patients: a cross sectional study

Antecedentes: La investigación de la microflora subgingival en pacientes diabéticos tipo 2 con periodontitis ha presentado resultados contradictorios. Objetivo: Determinar la presencia de Porphyromonas gingivalis, Tannerella forshytia, Treponema denticola y Aggregatibacter actinomycetemcomitans, en el biofilm subgingival de pacientes diabéticos tipo 2 y relacionarlo con el grado de control metabólico. Método: Estudio descriptivo transversal, en el cual se analizaron 23 pacientes diabéticos derivados consecutivamente del Policlínico de Especialidades de la Universidad de los Andes. Previo consentimiento informado, se realizó un examen clínico periodontal que incluyó mediciones de profundidad al sondaje, nivel de inserción clínica y sangrado gingival. Fueron clasificados según severidad de periodontitis y control metabólico de la diabetes determinado por un promedio de 3 exámenes de hemoglobina glicosilada. La detección microbiológica se realizó mediante la técnica de reacción en cadena de la polimerasa. Resultados: En el grupo de pacientes estudiados, Treponema denticola y Tannerella forsythia fueron las bacterias más prevalentes (65.2 por ciento), seguida por Porphyromonas gingivalis (17.3 por ciento) y Aggregatibacter actinomycetemcomitans (13 por ciento). Los pacientes con peor control glicémico tuvieron una mayor presencia de Treponema denticola, Tannerella forsythia, Porphyromonas gingivalis y Agreggatibacter actinomycetemcomitans y un aumento en el índice de sangrado al sondaje. Conclusiones: En el grupo de pacientes diabéticos estudiado, las bacterias más prevalentes fueron Treponema denticola y Tannerella forsythia. Los pacientes diabéticos tipo 2 con moderado y mal control glicémico presentaron mayor presencia de los microorganismos estudiados, comparado con los grupos con mejores niveles de control glicémico.

Background: The investigation of subgingival microflora in type 2 diabetic patients with periodontitis presented conflicting results. Aim: To determine the presence of Porphyromonas gingivalis, Tannerella forshytia, Treponema denticola and Aggregatibacter actinomycetemcomitans in subgingival biofilm of patients with diabetes type 2 and to relate it to the degree of metabolic control. Method: A descriptive study, which analyzed 23 diabetic patients consecutively referred from the Internal Medicine Unit of Medicine Faculty at Universidad de los Andes was conducted. After obtaining an informed consent from the patients a clinical examination that included measurements of periodontal pocket depth, clinical attachment level and gingival bleeding was performed. The patients were classified according to the severity of periodontitis and metabolic control of diabetes as determined by an average of 3 of glycosylated haemoglobin tests. Microbial technique was performed by chain reaction of polymerase. Results: In the group of patients examined the most prevalent bacteria were, Treponema denticola and Tannerella forsythia (65.2 percent), followed by Porphyromonas gingivalis (17.3 percent) and Aggregatibacter actinomycetemcomitans (13 percent). Patients with poor glycemic control had a greater presence of Treponema denticola, Tannerella forsythia, Porphyromonas gingivalis and Agreggatibacter actinomycetemcomitans and an increase in the rate of bleeding on probing. Conclusions: In the group of diabetic patients studied, the most prevalent bacteria were Treponema denticola and Tannerella forsythia. Type 2 diabetic patients with moderate and poor glycemic control had a higher presence of these microorganisms, compared to groups with higher levels of glycemic control.

Mycobacterium leprae in the periodontium, saliva and skin smears of leprosy patients / Mycobacterium leprae no periodonto, saliva e raspados intradérmicos de sujeitos com hanseníase

Purpose: To verify the presence of M. leprae in the periodontium, saliva and skin slit smears of leprosy patients. To correlate bacteriological and molecular findings with clinical data and compare laboratory techniques. Methods: A cross-sectional study was designed to use bacteriological (baciloscopy) and molecular (PCR) parameters to detect M. leprae in exudates of the gingival sulcus/periodontium pocket, saliva and skin slit smears from multiple clinical forms of leprosy patients without previous treatment. Results: The study included 48 leprosy patients with 15 multibacillary (MB) cases and 33 paucibacillary (PB) cases. The diagnosis of MB was confirmed through bacteriological examination and PCR results from skin slit smears. A total of 16 (48.5%) PB patients were PCR positive only. Four PB patients with negative PCR skin smears were PCR positive for the periodontium and saliva, with 2 cases and 1 case, respectively. No periodontium or saliva samples had positive bacteriological results. Conclusion: There was no correlation between periodontal disease and the presence of M. leprae. Bacteriological examination did not prove to be an efficient technique for the analysis of saliva and periodontium samples. PCR analysis of skin smears was more efficient at diagnosing PB patients than bacteriological examination. PCR positive results for the detection of M. leprae in PB patients can be increased by collecting slit skin smears, periodontium and saliva samples.

Objetivo: verificar através da baciloscopia e da reação em cadeia da polimerase (PCR) a presença do M. leprae no periodonto, saliva e raspados intradérmicos de pacientes com hanseníase. Metodologia: Realizou-se um estudo transversal do tipo detecção de casos numa instituição referência de hanseníase no Amazonas. Resultados: Foram avaliados 48 pacientes, sendo 15 multibacilares (MB) e 33 paucibacilares (PB). Os pacientes MB tiveram o diagnóstico confirmado pela baciloscopia e PCR dos raspados intradérmicos, enquanto que 16 (48,5%) dos PB foram positivos apenas na PCR. Quatro pacientes PB negativos na PCR de raspados intradérmicos foram positivos no periodonto e na saliva, 1 positivo na saliva e 2 no periodonto. Nenhuma amostra do periodonto e da saliva foi positiva na baciloscopia. Conclusão: Não houve relação entre a doença periodontal e a presença do M. leprae; a baciloscopia não mostrou ser uma técnica eficiente para análise da saliva e periodonto; a técnica de PCR de raspado dérmico mostrou ser um método mais eficaz no diagnóstico dos PB do que a baciloscopia; a positividade da PCR para detecção do M. leprae nos PB pode ser aumentada coletando raspado intradérmico, periodonto e saliva.

Efeito do tratamento periodontal não-cirúrgico em pacientes portadores de Diabetes mellitus tipo 2 com doença periodontal: Análises clínica, enzimática e microbiológica / Effect of the non-surgical periodontal treatment in type 2 diabetes patients with periodontal disease: Clinical, enzymatic and microbiological analysis

Objetivos: Avaliar o efeito do tratamento periodontal não-cirúrgico sobre parâmetros clínicos, microbiota subgengival e a atividade enzimática na saliva e no fluido sulcular gengival em pacientes portadores de diabetes e em indivíduos sistemicamente sadios, ambos com periodontite crônica. Material e método: a amostra populacional foi composta por 40 indivíduos divididos em dois grupos: 20 portadores de Diabetes mellitus tipo 2 com inadequado controle metabólico (grupo DM2) e 20 indivíduos sistemicamente sadios (grupo controle), ambos portadores de periodontite crônica. Clinicamente os indivíduos foram avaliados quanto: ao índice de placa visível (IPV), ao índice de sangramento marginal (ISM), à profundidade de sondagem (PS), ao nível clínico de inserção (NI), à presença de sangramento à sondagem (SS) e à presença de supuração (SUP). Foram realizadas coletas de saliva e de fluido sulcular gengival para determinação da atividade peroxidásica total salivar (PTS) e da mieloperoxidase (MPO), por meio de espectrofotometria. Amostras de placa bacteriana subgengival de 4 sítios rasos e 4 profundos com doença periodontal foram avaliadas pela técnica de Checkerboard DNA-DNA hybridization. Toda a amostra recebeu terapia periodontal não-cirúrgica com posterior fase de acompanhamento para realização de controle de placa profissional a cada quinze dias por um período de três meses. Todas as avaliações foram realizadas no baseline e aos três meses após o término da terapia periodontal. Resultados: No baseline, o grupo DM2 apresentou maior percentual de sítios com IPV e SS (p< 0.01) sem diferença estatisticamente significante entre grupos quanto aos demais parâmetros clínicos. O tratamento periodontal não-cirúrgico resultou em melhora significativa dos parâmetros clínicos avaliados nos 2 grupos. Aos três meses pós-tratamento foram observados maiores percentuais de sítios com IPV, ISM, SS e média de PS (p<0.05) para o grupo DM2. Quanto à análise microbiológica...

Efeito do tratamento periodontal não-cirúrgico em pacientes portadores de diabetes mellitus tipo 2 com doença periodontal: análises clínica, enzimática e microbiológica / Effect of the non-surgical periodontal treatment in type 2 diabetes patients with periodontal disease: clinical, enzymatic and microbiological analysis

Avaliar o efeito do tratamento periodontal não-cirúrgico sobre parâmetros clínicos, microbiota subgengival e a atividade enzimática na saliva e no fluido sulcular gengival em pacientes portadores de diabetes e em indivíduos sistemicamente sadios, ambos com periodontite crônica. Material e método: a amostra populacional foi composta por 40 indivíduos divididos em dois grupos: 20 portadores de Diabetes mellitus tipo 2 com inadequado controle metabólico (grupo DM2) e 20 indivíduos sistemicamente sadios (grupo controle), ambos portadores de periodontite crônica. Clinicamente os indivíduos foram avaliados quanto: ao índice de placa visível (IPV), ao índice de sangramento marginal (ISM), à profundidade de sondagem (PS), ao nível clínico de inserção (NI), à presença de sangramento à sondagem (SS) e à presença de supuração (SUP). Foram realizadas coletas de saliva e de fluido sulcular gengival para determinação da atividade peroxidásica total salivar (PTS) e da mieloperoxidase (MPO), por meio de espectrofotometria. Amostras de placa bacteriana subgengival de 4 sítios rasos e 4 profundos com doença periodontal foram avaliadas pela técnica de Checkerboard DNA-DNA hybridization. Toda a amostra recebeu terapia periodontal não-cirúrgica com posterior fase de acompanhamento para realização de controle de placa profissional a cada quinze dias por um período de três meses. Todas as avaliações foram realizadas no baseline e aos três meses após o término da terapia periodontal. Resultados: No baseline, o grupo DM2 apresentou maior percentual de sítios com IPV e SS (p< 0.01) sem diferença estatisticamente significante entre grupos quanto aos demais parâmetros clínicos. O tratamento periodontal não-cirúrgico resultou em melhora significativa dos parâmetros clínicos avaliados nos 2 grupos. Aos três meses pós-tratamento foram observados maiores...

To evaluate the effect of periodontal treatment on clinical parameters as well as on subgingival microbiota and enzimatic activity in the saliva and the gingival crevicular fluid of diabetes patients and systemically healthy individuals with chronic periodontitis. Material and Methods: The sample was constituted by 40 individuals divided in two groups: 20 type 2 diabetes mellitus patients with inadequate metabolic control (DM2 group) and 20 systemically healthy individuals (control group), both groups with chronic periodontitis. Clinical assessments included visible plaque index (VPI), bleeding on probing (BOP), gingival bleeding index (GBI), suppuration (SUP), probing depth (PD) and clinical attachment level (CAL). Saliva and gingival crevicular fluid samples were collected for determination of the total salivary peroxidase (TPS) activity and myeloperoxidase (MPO) activity respectively, by spectrophotometric assays. Subgingival plaque samples from 4 shallow and 4 deep sites with periodontal disease were evaluated by the Checkerboard DNA-DNA hybridization technique. All the patients received non-surgical periodontal therapy followed of the period for accomplishment of professional plaque control performed twice a month during three months. All the evaluations were assessed at baseline and 3 months after periodontal therapy. Results: At baseline, the DM2 group presented a significantly higher percentage of sites with VPI and BOP (p<0.01). No significant differences between groups were observed for the other clinical parameters. Nonsurgical periodontal treatment resulted in a significant improvement of clinical parameters. At 3 months post-treatment, the DM2 group presented significantly higher percentage of sites with VPI, GBI, BOP and mean PD (p<0.05). Regarding the microbiological analysis, at baseline, only C. rectus and S. anginosus were founded significantly higher...

Detection of Porphyromonas gingivalis and Streptococcus intermedius in chronic periodontitis patients by multiplex PCR

Se muestra la utilización del ensayo de polimerasa en cadena (PCR) múltiplex para la detección de Porphyromonas gingivalis y Streptococcus intermedius en pacientes con periodontitis crónica. Se analizaron un total de 180 muestrasde 65 adultos con periodontitis no tratada y 17 voluntarios sanos, las células se procesaron inicialmente colocándolas a baño María durante 10 min. El lisado celular fue usado comofuente de ADN para los ensayos del PCR múltiplex. Los primers fueron diseñados a partir de secuencias génicas defracciones 16 rRNA obtenidas de la base de datos GenBank-EMBL y que mostraron especificidad para los patógenos mencionados. El sistema PCR múltiplex fue diseñado para identificar 8.2 células de P. gingivalis y S. intermedius. De los pacientes con periodontitis, sólo el 78.5 por ciento fueron positivos para una o ambas bacterias. En el 37 por ciento se identificó únicamente P. gingivalis, en el 17 por ciento S. intermedius y en un 24.5 por ciento ambos. P. gingivalis fue detectada en el 23.5 por ciento de los voluntarios sanos, mientras que, S. intermedius no se detectó en esegrupo de pacientes. La distribución de la identificación de estas bacterias está relacionada con la profundidad de las bolsas periodontales. Mientras que el 95.23 por ciento de los pacientes con bolsas de 6 a 7 mm fueron positivas para ambas bacterias, mientras que sólo el 70.45 por ciento de ellos fue positivo cuando las bolsas tenían de 4 a 5 mm de profundidad