Factores de riesgo modificables e inmodificables de la periodontitis: revisión narrativa / Modifiable and Non-Modifiable Risk Factors of Chronic Periodontitis: A Narrative Review

Antecedentes: La periodontitis crónica asociada a la placa bacteriana tiene factores de riesgo modificables e inmodificables que deben tenerse en cuenta en su prevención y control. Objetivo: Analizar la evidencia disponible sobre los factores de riesgo modificables e inmodificables de la periodontitis crónica con el fin de escribir guías de manejo clínico. Métodos: Se realizó una búsqueda sistemática de la literatura en tres bases de datos (PubMed, LiLACS y Embase) usando la siguiente combinación de términos del Medical Subejct Headings de Medline: "risk indicator OR risk factor AND chronic periodontitis". También se buscaron artículos y literatura gris en Google Académico. Se incluyeron estudios de corte transversal, casos y controles, longitudinales, ensayos clínicos controlados y revisiones generales y sistemáticas de la literatura. Se efectuó una revisión narrativa sobre el tema con las referencias más relevantes encontradas. Resultados: Se analizaron 39 artículos que cumplieron con los criterios de la búsqueda. Entre los factores de riesgo modificables se encontraron: diabetes no controlada, obesidad, estrés, tabaquismo y placa bacteriana. Los factores de riesgo inmodificables hallados fueron: cambios hormonales, infección por VIH, neutropenia, edad, sexo, raza y genética. Los dos factores de riesgo más frecuentemente asociados, además de la placa bacteriana, fueron diabetes y tabaquismo. Conclusiones: El control de la periodontitis crónica debe basarse no solo en el control de la placa bacteriana sino también en la prevención mediante la identificación temprana y el control de factores de riesgo para evitar la aparición o el avance de esta enfermedad.

Background: Dental-plaque associated chronic periodontitis is influenced by modifiable and non-modifiable risk factors that must be addressed through preventive and corrective treatment. Purpose: To analyze available evidence on modifiable and non-modifiable risk factors of chronic periodontitis in order to write clinical management guidelines. Methods: A systematic search of literature was conducted in three databases (PubMed, LiLACS, and Embase) using the following combination of terms from the Medical Subject Headings: "risk indicator OR risk factor AND chronic periodontitis." Other articles and gray literature were search in Google Scholar. The search included cross-sectional, cohort, and case control studies, controlled clinical trials, and general and systematic literature reviews. A narrative review was conducted with the most relevant articles found. Results: 39 articles met the search criteria. Modifiable risk factors found were: non-controlled diabetes, obesity, stress, smoking, and dental plaque. Non-modifiable factors were: hormonal changes, HIV infection, neutropenia, age, sex, race, and genetics. Besides dental plaque, the two most frequently associated factors were diabetes and smoking. Conclusion: The treatment of chronic periodontitis must focus, in addition to controlling dental plaque, on early detection prevention and risk-factor control to avoid the occurrence and advance of this type of disease.

Efeito da severidade da doença periodontal sobre a expressão do Receptor Ativado por Protease do Tipo 2 (PAR-2) / Effect of the severity of periodontal disease on the expression of Protease Activated Receptor Type 2 (PAR-2)

Pesquisas recentes investigando o receptor ativado por protease do tipo 2 (PAR-2) sugerem uma associação entre este receptor e a inflamação periodontal. Além disso, é sabido que a gingipaína, protease bacteriana secretada por um importante periodontopatógeno, Porphyromonas gingivalis (Pg), tem a capacidade de ativar o PAR-2. Ademais, um estudo anterior do grupo, verificou que quanto mais profunda a bolsa periodontal, maior era a expressão do receptor PAR-2. No entanto, não é sabido se a expressão de PAR-2 é proporcional a severidade de doença periodontal e a quantidade de gingipaína expressa na bolsa periodontal. Desta forma, o presente estudo, verificou no fluido gengival a correlação entre a expressão gênica de PAR-2 (Real Time-PCR) com os parâmetros clínicos periodontais, e a expressão gênica da protease gingipaína em pacientes com periodontite crônica severa e moderada, antes e após o tratamento periodontal não-cirúrgico. A expressão de PAR-2 e da protease gingipaína foi estatisticamente maior nos pacientes do grupo periodontite crônica severa (PS) em comparação com os pacientes do grupo periodontite crônica modera (PM) e controle (C). Além disso, o tratamento periodontal levou à redução significativa (p<0.05) da expressão de PAR-2 nos pacientes com periodontite crônica moderada. Em conclusão, dentro dos limites do presente estudo, nós demonstramos que a severidade da doença periodontal e a expressão de gingipaína influenciaram a expressão de PAR-2 no fluido gengival de pacientes com periodontite crônica.

Recent studies investigating the protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. In addition, it is known that gingipain, a bacterial protease secreted by an important periodontopathogen, Porphyromonas gingivalis (Pg), has the ability to activate PAR- 2. Furthermore, a previous study from our group found that the deeper the periodontal pocket, the higher the expression of the PAR-2 receptor. However, it is not known whether the expression of PAR-2 is associated to the severity of periodontal disease and the amount of gingipain expressed in the periodontal pocket. Thus, the present study verified, in the gingival fluid, the correlation between the PAR-2 gene expression (Real Time-PCR) with the clinical periodontal parameters, and the gene expression of the gingipain protease in patients with moderate and severe chronic periodontitis before and after non-surgical periodontal treatment. PAR-2 expression and gingipain protease were statistically more expressed in patients of the severe chronic periodontitis group (PS) compared with those in the moderate chronic periodontitis group (PM) and control group (C). Furthermore, periodontal treatment led to a significant reduction (p <0.05) in the expression of PAR-2 in patients with moderate chronic periodontitis. In conclusion, within the limits of the present study, we demonstrated that the severity of periodontal disease and the expression of gingipain influenced the PAR-2 expression in the gingival fluid of patients with chronic periodontitis.

Using a portable sulfide monitor as a motivational tool: A clinical study.

Aims and Objectives: Bad breath has a significant impact on daily life of those who suffer from it. Oral malodor may rank only behind dental caries and periodontal disease as the cause of patient's visit to dentist. An aim of this study was to use a portable sulfide monitor as a motivational tool for encouraging the patients towards the better oral hygiene by correlating the plaque scores with sulfide monitor scores, and comparing the sulfide monitor scores before and after complete prophylaxis and 3 months after patient motivation. Materials and Methods : 30 patients with chronic periodontitis, having chief complaint of oral malodor participated in this study. At first visit, the plaque scores (P1) and sulfide monitor scores before (BCR1) and after complete oral prophylaxis (BCR2) were taken. Then the patients were motivated towards the better oral hygiene. After 3 months, plaque scores (P2) and sulfide monitor scores (BCR3) were recorded again. Statistical Analysis: It was done using SPSS (student package software for statistical analysis). Paired sample test was performed. Results: Statistically significant reduction in sulfide monitor scores was reported after the complete oral prophylaxis and 3 months after patient motivation. Plaque scores were significantly reduced after a period of 3 months. Plaque scores and breathchecker scores were positively correlated. Conclusion : An intensity of the oral malodor was positively correlated with the plaque scores. The portable sulfide monitor was efficacious in motivating the patients towards the better oral hygiene.

Análise imuno-histoquímica de proteínas relacionadas às respostas Th1, Th2 e Th17 na doença periodontal / Immunohistochemical analysis of proteins related to the Th1, Th2 and Th17 cells in periodontal disease

A doença periodontal é uma condição inflamatória de caráter infeccioso, caracterizada pela destruição dos tecidos de proteção e sustentação dentários, face à resposta produzida pelo hospedeiro frente às agressões sofridas pelos microrganismos. Vários fatores estão envolvidos nesse processo, sendo as citocinas as principais moléculas reguladoras dessa resposta imune, desempenhando um papel protetor e/ou destrutivo na progressão da lesão. Diante disso, este experimento investigou a expressão iimmo-histoquímica de IFN-y, GATA-3, IL-17, IL-23, IL-6 e TGF-p em tecidos gengivais de humanos, na tentativa de se obter um maior entendimento da participação das respostas imunes Thl, Th2 e Thl7 no desenvolvimento destes processos patológicos. Para tanto, oitenta e duas amostras de tecidos gengivais foram subdivididas em três grupos: Grupo 1=15 (amostras de tecido gengival saudável-controle), Grupo 2=36 (amostras com gengivite crónica) e Grupo 3=31 (amostras com periodontite crónica). Todos os casos foram submetidos à análise morfológica a partir de cortes corados em hematoxilina e eosina e, posteriormente, submetidas à técnica de coloração pela imuno-histoquímica através do método da Estreptoavidina-Biotina. Os resultados mostraram positividade de marcação para todas as proteínas, sendo observada uma maior tendência de marcação para as citocinas das respostas Thl e Thl7 no grupo 3. Diferença estatisticamente significativa foi verificada entre a expressão de TGF-p e a condição clínica das amostras (p=0,02). Assim, podemos concluir que as respostas Thl e Thl7 podem atuar sinergicamente no processo destrutivo dos tecidos periodontais, sobrepondo-se à resposta Th2 que também se encontrou presente nestes tecidos.

Compliance improvement in periodontal maintenance

OBJECTIVES: The aim of this study was to assess the infuence of efforts applied to modify the patients' behavior towards periodontal maintenance. MATERIAL AND METHODS: Patients were classifed into three groups: Complete Compliance (participation in all visits), Irregular Compliance (irregular participation, one or more missing appointments), and Noncompliance (abandoned or never returned to the program). Complete compliers received usual procedures of the maintenance visit. The irregular compliers and non-compliers received usual procedures and strategies such as reminding next visit, informing patients on both periodontal disease and importance of maintenance, motivating the patient who showed an improvement in compliance. Thus, 137 patients were observed for 12 months. RESULTS: The degree of compliance has increased signifcantly during this period (p=0.001). No association was detected between age or gender and compliance degree. CONCLUSIONS: The results have shown that the intervention applied had a favorable infuence on the patients' compliance.