Endocannabinoid system and periodontitis: mechanisms and therapeutic implications / Sistema endocanabinoide e periodontite: mecanismos e implicações terapêuticas

Introdução: A periodontite é um importante problema de saúde pública. Embora o princípio da terapia da periodontite esteja focado principalmente na remoção do biofilme dental e dos fatores associados, sua fisiopatologia registra diferentes eventos moleculares e inflamatórios relacionados ao sistema imunológico do hospedeiro, como a participação do sistema endocanabinoide. Objetivo: Esta revisão teve como objetivo explorar e elucidar os mecanismos e papéis do sistema endocanabinoide na fisiopatologia da periodontite e suas possibilidades para futuras terapias relacionadas. Material e método: Realizou-se uma busca eletrônica na plataforma PubMed por estudos envolvendo a ação do sistema endocanabinoide sobre a periodontite. Resultado: Dezenove estudos clínicos e pré-clínicos foram incluídos nesta revisão narrativa. Conclusão: Os receptores canabinoides tipo 1 e 2 são componentes integrais do sistema endocanabinoide e manifestam-se de várias formas nos tecidos periodontais. As ações e mecanismos através dos quais os receptores canabinoides são ativados em locais saudáveis ou inflamados continuam a ser o foco de investigações em curso. Além disso, os fitocanabinoides e canabinoides sintéticos apresentam potencial como tratamentos, com estudos pré-clínicos indicando benefícios na redução da inflamação e na facilitação da reparação dos tecidos.

Introduction: Periodontitis is a major public health problem. Although the principle of periodontitis therapy is mainly focused on removing dental biofilm and associated factors, its physiopathology enrolls different molecular and inflammatory events related to the host immune system, as the participation of the endocannabinoid system. Objective: This review aimed to explore and elucidate the mechanisms and roles of the endocannabinoid system on periodontitis physiopathology and its possibilities for future related therapies. Material and method: An electronic search was carried out on the PubMed platform for studies involving the action of the endocannabinoid system on periodontitis. Result: Nineteen clinical and preclinical studies were included in this narrative review. Conclusion: Cannabinoid receptors type 1 and 2 are integral components of the endocannabinoid system, manifesting in various forms in the periodontal tissues. The actions and mechanisms through which cannabinoid receptors are activated in healthy or inflamed sites remain the focus of ongoing investigations. Moreover, phytocannabinoids and synthetic cannabinoids show therapeutic potential, with pre-clinical studies indicating benefits in reducing inflammation and facilitating tissue repair

Efecto del tratamiento periodontal no quirúrgico sobre la función endotelial / Effect of the non-quirurgical periodontal treatment over the endotelial function

RESUMEN Introducción: La periodontitis se caracteriza por ser una inflamación mediada por el huésped y asociada a microbios que producen la pérdida de la adherencia periodontal. Una infección focal localizada como la enfermedad periodontal podría conducir a una inflamación sistémica. La disfunción endotelial vascular se ha asociado con una variedad de enfermedades y factores de riesgo para la aterosclerosis, que incluyen la edad, hipertensión arterial, dislipidemias, diabetes, tabaquismo, enfermedades cardiovasculares específicas como arteriopatía coronaria, cerebral y procesos infecciosos e inflamatorios como enfermedad periodontal. Objetivo: Evaluar los efectos del tratamiento periodontal no quirúrgico sobre la función endotelial de los pacientes con periodontitis crónica mediante una revisión de ensayos clínicos aleatorizados. Métodos: Se utilizó una estrategia de búsqueda primaria en combinación de vocabulario controlado y términos de texto libre para la elaboración de una estrategia de búsqueda en MEDLINE a través de PubMed, mediante el PubMed Advanced Search Builder el 5 de julio de 2019. Análisis e integración de la información: Fueron seleccionados 29 artículos de 2214. Para la elección se tuvo en cuenta que fueran estudios en humanos donde estuvieran relacionadas las variables de estudio. Del 100 por ciento de los artículos seleccionados se encontró que el 37,9 por ciento pertenecían a estudios de casos y controles, el 31 por ciento pertenecían a estudios transversales, el 10,34 por ciento a estudios de cohorte y solo 20,6 por ciento fueros estudios de ensayos clínicos, de los cuales solo 3 artículos (10 por ciento) fueron seleccionados para esta revisión. Conclusiones: La terapia periodontal no presenta un efecto sobre la función endotelial en un periodo de 3 meses, sin embargo, a los 6 meses se reporta una mejoría en la función endotelial(AU)

ABSTRACT Introduction: Periodontitis is characterized by being an inflammation mediated by the host and associated with microbes that produce, the loss of periodontal adhesion. A localized focal infection such as periodontal disease could lead to systemic inflammation. Vascular endothelial dysfunction has been associated with a variety of pathologies and risk factors for atherosclerosis, including age, hypertension, dyslipidemias, diabetes, smoking, specific cardiovascular pathologies such as coronary artery disease, cerebral, inflammatory, and infectious processes such as periodontal disease. Objective: Assess the effects of non-surgical periodontal treatment on the endothelial function of patients with chronic periodontitis through a review of randomized clinical trials. Methods: We used a primary search strategy using a combination of controlled vocabulary and free text terms based on the MEDLINE search strategy through PubMed using the PubMed Advanced Search Builder on July 05, 2019. Analysis and integration of the information: 29 articles of 2214 were selected because they are human studies where the study variables are related. 100 percent of the selected articles found that 37.9 percent belonged to case-control studies, 31 percent belonged to cross-sectional studies, 10.34 percent to cohort studies and only 20.6 percent were clinical trial studies, of which only 3 articles (10 percent) were selected for this review. Conclusions: Periodontal therapy does not have an effect on endothelial function in a period of 3 months, however at 6 months an improvement in endothelial function was reported(AU)

Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis

Abstract: Gingivitis and periodontitis are associated with a negative impact on Oral Health Related Quality of Life (OHRQoL), exerting a significant influence on aspects related to the patients' function and esthetics. Periodontitis has been associated with several systemic conditions, including adverse pregnancy outcomes, cardiovascular diseases, type 2 diabetes mellitus (DM), respiratory disorders, fatal pneumonia in hemodialysis patients, chronic renal disease and metabolic syndrome. The aim of this paper was to review the results of different periodontal treatments and their impacts on patients' OHRQoL and systemic health. Non-surgical and surgical periodontal treatments are predictable procedures in terms of controlling infection, reducing probing pocket depth and gaining clinical attachment. In addition, the treatment of periodontitis may significantly improve OHRQoL and promote a reduction in the levels of systemic markers of inflammation, including some cytokines associated with cardiovascular diseases. Studies have also suggested that periodontal treatment may improve glycemic control in patients with DM. Strategies and actions for preventing the onset and recurrence of periodontitis, and the challenges facing the field of periodontology in the XXI century are presented in this review.

Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth

Abstract Excessive weight is associated with periodontitis because of inflammatory mediators secreted by the adipose tissue. Periodontal impairments can occur during pregnancy due to association between high hormonal levels and inadequate oral hygiene. Moreover, periodontitis and excessive weight during pregnancy can negatively affect an infant's weight at birth. Objective This observational, cross-sectional study aimed to evaluate the association between pre-pregnancy overweight/obesity, periodontitis during the third trimester of pregnancy, and the infants' birth weight. Methodology The sample set was divided into 2 groups according to the preconception body mass index: obesity/overweight (G1=50) and normal weight (G2=50). Educational level, monthly household income, and systemic impairments during pregnancy were assessed. Pocket probing depth (PPD) and clinical attachment level (CAL) were obtained to analyze periodontitis. The children's birth weight was classified as low (<2.5 kg), insufficient (2.5-2.999 kg), normal (3-3.999 kg), or excessive (≥4 kg). Bivariate analysis (Mann-Whitney U test, t-test, chi-squared test) and logistic regression (stepwise backward likelihood ratio) were performed (p<0.05). Results G1 showed lower socioeconomic levels and higher prevalence of arterial hypertension and gestational diabetes mellitus during pregnancy than G2 (p=0.002). G1 showed higher means of PPD and CAL (p=0.041 and p=0.039, respectively) and therefore a higher prevalence of periodontitis than G2 (p=0.0003). G1 showed lower infants' birth weight than G2 (p=0.0004). Excessive maternal weight and educational levels were independent variables associated with periodontitis during the third trimester of pregnancy (X2[2]=23.21; p<0.0001). Maternal overweight/obesity was also associated with low/insufficient birth weight (X2[1]=7.01; p=0.008). Conclusion The present findings suggest an association between excessive pre-pregnancy weight, maternal periodontitis, and low/insufficient birth weight.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

Abstract Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ±1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.

The role of potassium channels in the endothelial dysfunction induced by periodontitis

Abstract Objective: Periodontitis is associated with endothelial dysfunction, which is clinically characterized by a reduction in endothelium-dependent relaxation. However, we have previously shown that impairment in endothelium-dependent relaxation is transient. Therefore, we evaluated which mediators are involved in endothelium-dependent relaxation recovery. Material and methods: Rats were subjected to ligature-induced experimental periodontitis. Twenty-one days after the procedure, the animals were prepared for blood pressure recording, and the responses to acetylcholine or sodium nitroprusside were obtained before and 30 minutes after injection of a nitric oxide synthase inhibitor (L-NAME), cyclooxygenase inhibitor (Indomethacin, SC-550 and NS- 398), or calcium-dependent potassium channel blockers (apamin plus TRAM- 34). The maxilla and mandible were removed for bone loss analysis. Blood and gingivae were obtained for C-reactive protein (CRP) and myeloperoxidase (MPO) measurement, respectively. Results: Experimental periodontitis induces bone loss and an increase in the gingival MPO and plasmatic CRP. Periodontitis also reduced endothelium-dependent vasodilation, a hallmark of endothelial dysfunction, 14 days after the procedure. However, the response was restored at day 21. We found that endothelium-dependent vasodilation at day 21 in ligature animals was mediated, at least in part, by the activation of endothelial calcium-activated potassium channels. Conclusions: Periodontitis induces impairment in endothelial-dependent relaxation; this impairment recovers, even in the presence of periodontitis. The recovery is mediated by the activation of endothelial calcium-activated potassium channels in ligature animals. Although important for maintenance of vascular homeostasis, this effect could mask the lack of NO, which has other beneficial properties.

Methodological aspects in the study of periodontal breakdown in rats: influence of the presence and time of ligature / Aspectos metodológicos no estudo da destruiçãoperiodontal em ratos: influência da presençae tempo de ligadura

The aim of the present work was to evaluate the effect of different times on alveolar bone loss (ABL) and whether the presence of ligature on one side affects ABL on the contralateral site.This is a secondary analysis of databases from studies conductedat the Federal University of Rio Grande do Sul. Included studiesused ligature­induced periodontal disease in rats. In order to beincluded, the studies were required to have a control group withoutany ligatures and an intra­group control. Three studies were included, which used different time periods: 2 weeks with ligatureand 8 weeks without ligature; 5 weeks with ligature and 17 weekswithout ligature; 22 weeks with and without ligature. Animals wereraised similarly and sacrificed by decapitation. Maxillae weredefleshed with 9% sodium hypochlorite. Pictures were taken andfive measurements were obtained from each image.The presence of ligature generated significantly greater ABL compared to sides without ligature. Comparing sides with ligature, ABL was lower at 2 weeks than at 5 and 22 weeks. Sides without ligature showed no significant difference between 8 and 17 weeks for spontaneous periodontitis. However, after22 weeks, animals exhibited significantly greater ABL whencompared to other periods. The presence of ligature on oneside did not influence ABL on the contralateral side. Two weeks of ligature­induced periodontal disease seems to besufficient to demonstrate significant ABL. Teeth withoutligature contralateral to teeth with ligature may be considered sound controls, thereby reducing the amount of animals neededin periodontal research.

Avaliar o efeito de diferentes períodos experimentais e se a presença de ligadura em um dos lados afeta a perda óssea alveolar (POA) no lado contra lateral. O presente estudo trata se de uma análise secundária dos bancos de dados de estudos realizados na Universidade Federal do Rio Grande do Sul. Os estudos incluídos utilizaram o modelo de indução de doença periodontal por ligadura em ratos. Os estudos necessitavam possuir grupo controle sem ligadura, assim como controle intra­ grupo. Foram incluídos 3 estudos, com diferentes períodos de análise: 2 semanas com ligadura e 8 semanas sem ligadura;5 semanas com ligadura e 17 semanas sem ligadura; 22semanas com e sem ligadura. Os ratos foram criados nas mesmas condições, sacrificados por decapitação, as maxilas retiradas e os tecidos moles removidos com hipoclorito de sódio 9%. Tomadas fotográficas foram realizadas e cinco mensurações foram obtidas de cada imagem. A presença de ligadura gerou uma perda óssea alveolar significativamente maior quando comparado ao lado sem ligadura. Nos lados com ligadura um período de 2 semanas mostra menor perda óssea alveolar que 5 e 22 semanas. Lados sem ligadura foram avaliados e não observou­ se diferença significativa entre 8 e 17 semanas para periodontite espontânea. No entanto a partir de 22 semanas os animais exibiram significativamente maior perda óssea alveolar quando comparado aos demais tempos experimentais. A presença de ligadura em um dos lados não influenciou a perda óssea do lado contra lateral. Duas semanas de doença periodontal induzida por ligadura parece ser suficiente para demonstrar perda óssea significativa e a utilização de lados contra laterais de dentes com ligadura é possível de ser considerada como controles saudáveis, reduzindo o número de animais em pesquisa.

Disfunção endotelial e periodontite ­ predição de risco para eventos cardiovasculares / Periodontitis and endothelial dysfunction ­ risk prediction for cardiovascular events

O objetivo deste estudo foi realizar uma revisão da literatura sobre a associação entre a disfunção endotelial, diagnosticada no exame de dilatação mediada por fluxo (DMF) da artéria braquial, e a periodontite crônica. Algumas evidências demonstraram uma associação entre as infecções periodontais e a disfunção endotelial. Alterações na função endotelial estão intimamente relacionadas com a aterosclerose, bem como seus fatores de risco, e constituem uma etapa intermediária na progressão de eventos adversos ao longo da história natural da doença cardiovascular, sendo esta uma das maiores causas de morte no mundo. A busca por artigos foi realizada no site Pubmed com as palavras-chave: periodontite, periodontite crônica, endotélio vascular, enfartos, derrames e doenças cardiovasculares. Após a busca, nove artigos foram selecionados para entrar nesta revisão. Os resultados dos estudos mostraram que indivíduos com periodontite apresentam a função endotelial prejudicada, quando comparados a indivíduos sem periodontite, e o tratamento da doença periodontal melhora a disfunção endotelial. Concluiu-se que a periodontite (DP) parece influenciar na função endotelial, e o seu tratamento pode melhorar a disfunção endotelial, um preditor de eventos cardiovasculares.

The aim of this study is to conduct a literature review on the association between endothelial dysfunction diagnosed on examination of flow-mediated dilatation (DMF) and chronic periodontitis. Some evidence shows an association between periodontal infections and endothelial dysfunction. Changes in endothelial function are closely related to atherosclerosis and its risk factors and is an intermediary step in the progression of adverse events throughout the natural history of cardiovascular disease, which is one of the largest causes of death worldwide. The electronic search was performed on Pubmed with the following key words: periodontitis, chronic periodontitis, vascular endothelium, heart attacks, strokes, cardiovascular diseases; overall, 9 articles were selected. The results of the studies showed that individuals with periodontitis have impaired endothelial function when compared to patients without periodontitis and the treatment of periodontal disease improves endothelial dysfunction. It was concluded that periodontal disease (PD) appears to influence on endothelial function and the treatment of periodontitis could improve endothelial dysfunction is a predictor of cardiovascular events.

Ansiedade, fluxo salivar, condição periodontal e cárie dentária em obesos antes e depois da cirurgia bariátrica / Anxiety, salivary flow, periodontal status and dental caries in obese before and after bariatric surgery

A presente pesquisa, dividida em três estudos (EI, EII e EIII), objetivou investigar a influência da obesidade e da cirurgia bariátrica (CB) na ansiedade e na saúde bucal de candidatos à CB. Candidatos à CB constituíram os grupos experimentais (GE) dos três estudos e o grupo controle (GC) do EIII. GC dos EI e EII foram compostos por obesos que não buscavam tratamento para a obesidade e não obesos, respectivamente. Cada estudo foi composto por 100 indivíduos divididos em GE e GC. Em EI e EIII, tipos longitudinais prospectivos, GE e GC foram avaliados em duas etapas: GE - antes CB (T0) e um ano após CB (T1); GC - inicial (T0) e um ano após inicial (T1). Foram avaliadas as variáveis: fluxo salivar (em EI); profundidade de sondagem, recessão gengival, nível de inserção clínica, periodontite, cálculo e sangramento gengival (em EII); lesões iniciais de cárie dentária - LIC e sangramento gengival (em EIII). Características sociodemográficas, comportamentais e antropométricas, ansiedade (medida pelo Inventário de Ansiedade Traço-Estado - IDATE), e presença de diabetes/hipertensão foram utilizadas nos três estudos. Para a análise dos dados foram utilizados os testes Exato de Fisher, Qui-quadrado, Mann-Whitney, Kruskal-Wallis (Dunn), e two-way Anova (Sidak), além de análises de regressão, linear e logística, e cálculos de risco relativo (RR) e taxa de incidência (IR). O nível de significância foi de 5%. Em ambos os EI e EIII, estado e traço de ansiedade não diferiram entre GC e GE, nem entre T1 e T0. No entanto, GC, em EII, apresentou maior ansiedade-traço do que GE (p = 0,0004). Em El, fluxo salivar não foi influenciado nem pelos grupos (p = 0,29) nem pelo tempo (p = 0,81). Em EII, GE teve mais casos de profundidade de sondagem entre 4 a 5 mm (p = 0,0006) do que GC, mas a presença de sangramento gengival foi mais frequente no GC (p = 0,0139). Em EIII, o número de dentes com LIC (p = 0,0013) e sangramento gengival (p = 0,0096) aumentou após um ano de CB. No entanto, CB não foi considerada fator de risco para LIC (RR = 0,86, p = 0,3439) e sangramento gengival (RR = 1,14, p = 0,4008). Concluiu-se que ambos os indivíduos, obesos e bariátricos, mostraram vulnerabilidade aos desfechos estudados, sendo necessária a participação do profissional de odontologia na equipe de atendimento a esses pacientes.(AU)

The present study was designed to observe the influence of obesity and bariatric surgery (BS) in anxiety and oral health of BS candidates. It was divided into 3 experimental designs (EI, EII and EIII). BS candidates constituted the experimental groups (EG). Control group (CG) of EI and EII were obese subjects not seeking treatment for obesity and non-obese subjects, respectively. Each study was composed of 100 subjects divided into EG and CG. In EI and EIII, both prospective longitudinal studies, EG and CG were evaluated in two stages: EG - before BS (T0) and one year after BS (T1); CG - baseline (T0) and one year after baseline (T1). The following outcomes were evaluated: salivary flow (only in EI); probing depth, gingival recession, clinical attachment level, periodontitis, calculus and gingival bleeding (for EII); initial lesions of dental caries ILDC, and gingival bleeding (for EIII). Sociodemographic, behavioral, anthropometric characteristics and the presence of diabetes/hypertension were determined in all experiments. Anxiety was measured by State-Trait Anxiety Inventory. Data analysis was performed by Exact Fisher, Chi-square, Mann-Whitney, Kruskal-Wallis (Dunn), and two-way Anova (Sidak) tests. In addition, linear and logistic regression analysis and calculations of relative risk (RR) and incidence rate (IR) were also used. Significance level was set at 5%. In both EI and EIII, state and trait anxiety did not differ between CG and EG, nor among T1 and T0. However, CG showed higher trait anxiety than EG (p=0.0004) in EII. In EI, salivary flow was not influenced by groups (p = 0.29) or time (p = 0.81). In EII, EG had more cases of probing depth between 4 to 5 mm (p = 0.0006) than CG, but the presence of gingival bleeding was more frequent in CG (p = 0.0139). In EIII, the number of teeth with ILDC (p = 0.0013) and gingival bleeding (p = 0.0096) increased after one year of BS. However, BS was not considered a risk factor for ILDC (RR = 0.86, p = 0.3439), and gingival bleeding (RR = 1.14, p = 0.4008). It was possible to conclude that both obese and BS subjects showed vulnerability to the studied outcomes, requiring dental professionals on care-staff to treat these patients.(AU)

Mecanismos moleculares implicados en la destrucción ósea en la periodontitis: revisión de la literatura / Molecular mechanisms involved in bone destruction in periodontitis: literature review

La periodontitis es una enfermedad inflamatoria crónica multifactorial, la cual se inicia a partir de la biopelícula que se forma alrededor de los dientes y se acumula en margen gingival, colonizando el surco gingival. La complejidad de la biopelícula madura genera estímulos para las células epiteliales e inflamatorias y sobre las demás células del tejido conectivo activando los mecanismos de la respuesta inmune innata y adaptativa. Se reconoce que la acumulación de placa dental genera de forma indefectible gingivitis, pero se desconocen las señales específicas que disparan la periodontitis. Se reconoce también que microorganismos periodontopáticos como Aggregatibacter actynomicetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Prevotella nigrescens, entre otros, poseen mediadores osteolíticos que actúan directa o indirectamente en las células del hueso y que son responsables del proceso de remodelación ósea, lo cual desequilibra el eje RANKL-RANK/OPG. Los productos microbianos y la respuesta inflamatoria inducen la secreción de citoquinas específicas como IL-1B, TNFalfa y otros mediadores pro-inflamatorios como PGE2, metalloproteinases, MMP-8, MMP-3, RANKL, además los linfocitos T y B activados inducen la pérdida de hueso alveolar al sintetizar y secretar directamente RANKL. Debido a que la pérdida de hueso alveolar es uno de los signos patognomónicos de la enfermedad periodontal, se hace importante revisar los mecanismos moleculares que explican la destrucción ósea, así como algunos avances en el tratamiento óseo.

Periodontitis is a multifactorial chronic inflammatory disease started by biofilm accumulation around the teeth and the gingival margin including the gingival sulcus. Mature biofilm is complex in microbial nature and it triggers signals to the boundary connective tissue and epithelial cells activating mechanisms of innate and acquired immune response. It is known that the dental plaque accumulation indefectibly results in gingivitis. However the specific signals that lead to periodontitis are unknown. The main periodontopathic organisms are Aggregatibacter actynomicetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Prevotella nigrescens among others. Those microorganisms produce osteolytic mediators that act directly and indirectly on bone cells affecting the bone turnover rate, regulated by the axis RANKL-RANK/OPG. Microbial products and periodontal inflammation induce the release of specific cytokines IL-1B, TNFalpha, PGE2, metalloproteinases, MMP-8, MMP-3, RANKL, T and B lymphocytes elicit bone resorption. Indeed, alveolar bone loss is one of the most pathognomonic features of periodontal disease. Therefore it is essential to review the molecular mechanisms explaining periodontal destruction, as well as the advances in bone therapy.

Effect of chronic stress in newborn rats on the progression of ligature-induced-periodontitis in adulthood

PURPOSE: To investigate the effect chronic stress in newborn rats on the progression of ligature-induced-periodontitis in adulthood. METHODS: Ten couples of adult Wistar rats were selected for mating. After birth, the female and their respective offsprings were allocated into two groups. Ligature Group (LG): offsprings were only watched during breast-feeding; Stress-ligature Group (SLG): after 24h of live birth, the offsprings were moved away from their mothers every day for four hours during breast-feeding for 20 days; in both approaches, after reaching ± 250g, ten rats were included in the groups. Periodontal disease was induced by a silk suture placed around the maxillary right second molar. The left side was used as control. After 15 days, the animals were subjected to euthanasia, maxillary bones were removed and stored in 10% formaldehyde. After 48h, radiographs were taken and revealed and were used for bone destruction analysis. Examiner was blind and calibrated for measurements. RESULTS: Stress-ligature group presented higher bone loss values in relation to ligature group (p<0.05). CONCLUSION: Exposure to chronic stress imposed on offsprings produced a greater progression of bone loss induced during adulthood.

Diabetes y su impacto en el territorio periodontal / Diabetes and its impact in periodontal tissues

Diabetes y enfermedad periodontal corresponden probablemente al mejor ejemplo de cómo una enfermedad sistémica puede tener un efecto en el territorio periodontal. Si bien esta asociación ha sido extensamente estudiada, muchas de las asociaciones propuestas presentan contradicciones. En la presente revisión de la literatura se analizan los siguientes tópicos relevantes para la práctica clínica en periodoncia e implantología: i) Identificación de enfermedad periodontal severa y su capacidad para diagnosticar casos de diabetes; ii) Efectos de la diabetes sobre la enfermedad periodontal; iii) Efectos de la diabetes sobre la reparación periodontal y periimplantaria; iv) Efecto del tratamiento periodontal sobre el control metabólico de la diabetes.

Diabetes and periodontal disease correspond to conditions that probably exemplify how a systemic disease may have a strong impact in the periodontium. Although this association has been studied for several years, many of these studies still show contradictory results. The present review analyses the following questions relevant for the clinician in the fields of periodontology: i) Value of the diagnosis of severe periodontitis and its capacity to identify previously un-diagnosed cases of diabetes; ii) Effects of diabetes on periodontal disease; iii) Effects of diabetes on periodontal and peri-implant tissue repair and regeneration and; iv) Effect of periodontal therapy on the metabolic control of diabetes.

Alteration of hemostasis in patientes treated with subgingival NSAIDS during periodontal therapy / Alteración de la hemostasia en pacientes tratados con antiinflamatorios no esteroideos por vía subgingival durante la terapia periodontal

El uso de AINEs en forma tópica como complemento de la terapia periodontal podría coadyuvar a resolver con más rapidez el proceso inflamatorio y los signos clínicos de la enfermedad.Se realizó un estudio clìnico randomizado en el que participaron59 pacientes, 33 con periodontitis crónica y 26 controles sanos. A todos los pacientes enfermos se les realizó raspaje y alisado radicular en un cuadrante por semana, aplicándosesubgingivalmente el gel a las 48 hs de cada sesión. Los pacientes sanos recibieron los geles en los mismos intervalos. Se utilizaron 4 tipos de geles conteniendo: placebo, ácido acetilsalicílico (AAS) 1por ciento, Ketoprofeno (KTP) 1 por ciento y Ketoprofeno 2 por ciento. Se estudiaron las variables clínicas: profundidad de sondaje, nivel de inserción, movilidad dentaria, índice de placa, índice gingival y sangrado al sondaje; y bioquímicas: tiempo de sangría (Ivy), recuento plaquetario en sangre entera y plasma rico en plaquetas, y agregación plaquetaria frente a distintos agonistas. En cuanto a los resultados clínicos, el AAS fue el más efectivo en la reducción de la profundidad de sondaje, el Índice gingival y el Sangrado al sondaje (p<0,05). Tanto KTP al 1 por ciento y al 2 por ciento se comportaron en forma similar y menos efectiva que AAS pero con diferencias significativas con respecto al placebo (p<0,05). Conrespecto a las pruebas bioquímicas, el AAS mostró un efecto inhibitorio de la agregación plaquetaria altamente significativo con todos los agonistas utilizados. Respuestas similares pero conmenor intensidad se hallaron con KTP 2 por ciento. El KTP 1 por ciento sólo mostró alterada la primer fase de agregación a la máxima concentraciónde ADP y ninguno a la mínima siendo el valor de p<0.05

Rheumatoid arthritis and periodontitis: biological links and the emergence of dual purpose therapies.

Rheumatoid arthritis and periodontitis are widely prevalent diseases and are characterized by tissue destruction due to chronic inflammation. Recently, there is growing evidence that the two diseases share many pathological features. This article reviews their clinical and biological links. However, there are only a limited number of studies in this area, which prevent us from offering clear evidence.

Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.

Prevalence of and risk indicators for chronic periodontitis in males from Campeche, Mexico

Objective: Determining the prevalence, severity and extension of chronic periodontitis and identifying risk indicators amongst policemen in Campeche, Mexico, using an electron probe. Materials and Methods: A cross-sectional study of a convenience sample of 161 men was conducted. A case of periodontitis was defined as a participant having clinical attachment loss in at least one ³ 4 mm site. Every periodontal site in the mouth was measured by a standardized periodontist using a Florida Probe System.™ STATA 8.2™ was used for bivariate and multivariate statistical analysis, using logistic binary regression. Results: Mean age was 38.36±10.99 years. 23,622 periodontal sites were available for examination. Mean (SD) teeth and sites examined per person were 24.45±4.63 and 146.72±27.80, respectively. Periodontitis prevalence was 62.7 percent. Periodontitis severity was 2.9 mm and extent was 53.7 percent. Adjusted for alcohol intake, factors associated with periodontitis prevalence were being older (³35 years; OR=2.08; CI95 percent=1.05-4.10), smoking (current/former; OR=2.22; CI95 percent=1.06-4.77) and gingivitis (presence; OR=3.35; CI95 percent=1.34-8.42). Conclusions: Many study participants had poor periodontal conditions, with substantial overall prevalence of periodontitis. Older age, tobacco use and the presence of gingivitis were factors associated with periodontitis prevalence.

Objetivo: Determinar la prevalencia, severidad y extensión de periodontitis crónica, e identificar indicadores de riesgo entre policías de Campeche, México, utilizando una sonda electrónica. Material y Métodos: Se realizó un estudio transversal en una muestra de conveniencia de 161 hombres. Un caso de periodontitis fue definido como pérdida de inserción en al menos un sitio ³ 4 mm. Todos los sitios periodontales fueron medidos utilizando la sonda Florida Probe System™ por un periodoncista estandarizado. Los análisis bivariado y multivariado fueron realizados en STATA 8.2 utilizando regresión logística binaria. Resultados: La media de edad fue 38,36±10,99 años. Un total de 23 622 sitios periodontales estuvieron disponibles para examen. El promedio de dientes y sitios examinados por persona fue 24,45±4,63 y 146,72±27,80, respectivamente. La prevalencia de periodontitis fue 62,7 por ciento. La severidad fue de 2,9 mm y la extensión fue 53,7 por ciento. Ajustando por consumo del alcohol, los factores asociados a la prevalencia fueron mayor edad (³35 años; RM=2,08; IC95 por ciento=1,05-4,10), tabaquismo (actual y pasado; RM=2,22; IC95 por ciento=1,06-4,77), y gingivitis (presencia; RM=3,35; CI95 por ciento=1,34-8,42). Conclusiones: La mayoría de los participantes tuvieron una condición periodontal desfavorable. La mayor edad, el uso de tabaco y la presencia de gingivitis fueron variables asociadas con la prevalencia de periodontitis.

Niveles extracelulares de glutamato y aspartato en el fluido gingival en la periodontitis / Extracellular glutamate and aspartate levels in the gingival crevicular fluid of periodontitis patients

El objetivo de este trabajo fue comparar los niveles extracelulares de glutamato y aspartato en el fluido del surco gingival (GCF) de personas adultas, en la periodontitis crónica localizada inducida por placa (PCIP) y la gingivitis inducida por placa (GIP). La enfermedad periodontal produce cambios inflamatorios en los tejidos de sostén de las piezas dentales afectadas. El análisis químico del GCF, con diferentes métodos de colección y análisis, ha sido usado para determinar la presencia de algunos elementos inflamatorios que aparecen en la enfermedad periodontal, tales como diversas enzimas, aminoácidos, etc.Las muestras del GCF se tomaron con la técnica de microdiálisis en las zonas dentales con PCIP con una profundidad del surco > 3 mm; pérdida de soporte > 2mm y en las zonas dentales con GIP en el mismo paciente (n=10) Total de muestras: 100. Para medir el glutamato y aspartato en el GCF se usó la técnica de electroforesis capilar acoplada a laser con detección inducida por fluorescencia (CZE-LIFD). Los resultados mostraron que en los dientes con PCIP el glutamato disminuyó (p<0.05) y el aspartato aumentó (p< 0.02) en comparación con los dientes con GIP.

The objective of this work was to compare glutamate and aspartate levels in periodontal chronic localized disease (PCIP) and dental zones with gingivitis (GIP) in the gingival crevicular fluid (GCF). Periodontal inflammation produces histological changes, increase of blood irrigation and also increase of subgingival fluid. GCF was recognized as an inflammatory exudes derived from the periodontal tissue. Different methods to collect and analyze GCF samples had been used to identify some substances in the GCF, such as the proteinglycans metabolite, to be a possible marker of active periodontal disease. A combination of microdialysis in situ in dental zones with PCIP (probing depth > 3 mm; attachment level > 2 mm) and dental zones with GIP (n=10), total samples: 100, and capillary zone electrophoresis coupled to a laser induced fluorescence detection (CZE-LIFD) was used to measure extracellular concentrations of amino acids: glutamate and aspartate in the GCF in adult patients The results showed that glutamate decrease (p<0.05) and aspartate increase (p<0.02) in PCIP disease zones compared with dental zones with GIP. We observed chemical in vivo evidence that differentiate the GIP zones and PCIP zones.

Aggressive periodontitis and rheumatoid arthritis

Periodontitis has remarkably similar pathobiology to Rheumatoid Arthritis [RA]. In both these diseases, progression consists of continuing presence of high levels of proinflammatory cytokines. Further more, low levels of Tissue Inhibitors of Metalloproteinases [TIMP] and high levels of Matrix Metalloproteinases [MMP], and PGE-2 secreted by macrophages, fibroblast and other resident and migrating inflammatory cells characterize the active stage of both diseases. This submitted work depicts an evidence based report of a female patient with rheumatoid arthritis and aggressive periodontitis