Oral cancer over six decades: a multivariable analysis of a clinicopathologic retrospective study

Abstract Studies have reported changes in the epidemiological profile of patients with oral cancer in recent decades, especially regarding gender and age. This study aimed to evaluate a historical series of oral malignant lesions prevalence over six decades and define characteristics associated with the occurrence, mainly, of oral squamous cell carcinoma (OSCC). A retrospective review of histopathological records from 1953 to 2019 was conducted in three oral pathology laboratories in South Brazil about age, sex, anatomical site, clinical aspect, and histopathological diagnosis. Descriptive and analytical analyses were performed comparing the histopathological diagnoses with other variables. Multivariable logistic regression was applied to determine the associated predictors of OSCC. Of the 53,065 records available in the institutions, 986 were oral malignant tumors (including all malignant neoplasms), representing 1.86% of all diagnoses. The occurrence of OSCC in the 1960's was 80.0%, decreasing over time reaching the lowest percentage of cases in the 1990's (75.8%) and significantly increasing to 88.7% in the 2010s. Females had a lower chance than males of having OSCC independently of the decade (odds ratio=0.30, p<0.001). This was the same for older individuals compared to those younger than 40 years. No interactions between sex, age, and decade were observed. The number of diagnoses of oral malignant lesions increased over time, and the occurrence of OSCC varied. Older individuals and males had higher chances of having OSCC independently of the decade. Therefore, in this study sample, no changes were observed in the epidemiological profile over the years concerning these predictors.

Resumo Alguns estudos relataram mudanças no perfil epidemiológico dos pacientes com câncer bucal nas últimas décadas, principalmente quanto ao gênero e a idade. Este estudo teve como objetivo avaliar, em uma série histórica, a prevalência de todas as lesões malignas bucais ao longo de seis décadas e definir características associadas na ocorrência, principalmente, de carcinoma espinocelular (CEC). Um levantamento retrospectivo dos registros histopatológicos de 1953 a 2019 foi realizado em três laboratórios de Patologia Bucal no Sul do Brasil em relação à idade, gênero, sítio anatômico, aspecto clínico e diagnóstico histopatológico. Análises descritivas e analíticas foram realizadas comparando-se os diagnósticos histopatológicos com as outras variáveis. A regressão logística multivariada foi aplicada para determinar os possíveis preditores associados ao CEC. Dos 53.065 prontuários disponíveis nas instituições, 986 eram tumores malignos bucais (incluindo todas as neoplasias malignas), representando 1,86% de todos os diagnósticos. A ocorrência de CEC na década de 1960 foi de 80,0%, diminuindo ao longo do tempo, atingindo o menor percentual de casos na década de 1990 (75,8%) e aumentando significativamente para 88,7% na década de 2010. As mulheres tiveram menor risco de desenvolver CEC do que os homens, independentemente da década (OR=0,30, p<0,001). Este foi o mesmo para indivíduos com idade mais avançada em comparação com aqueles com menos de 40 anos de idade. Não foram observadas interações entre gênero, idade e década. O número de diagnósticos de lesões malignas bucais aumentou ao longo das décadas e a ocorrência de CEC variou. Indivíduos com mais de 40 anos e do sexo masculino tiveram maiores chances de ter CEC, independentemente da década analisada. Portanto, nessa amostra estudada, não foram observadas mudanças no perfil epidemiológico ao longo dos anos com relação a esses preditores.

Associations between physical activity domains and oral health: an analysis of a Brazilian population-based study

Abstract Physical activity comprises four domains (leisure, transportation, domestic, and work activities) that may be differently associated with oral health. The aim of this study was to assess the association between each physical activity domain and oral health conditions in Brazilian adults. A total of 38,539 participants in the 2019 Brazilian Health Survey aged 30 years or older were analyzed. The outcomes were self-perceived oral health (dichotomous) and self-reported number of missing teeth (counts). The presence, frequency, and time of activity in each domain and their combination were analyzed as main exposures. Odds ratios (OR) and mean ratios (MR) were estimated by fitting multivariable models. Higher leisure time physical activity was the only domain associated with better self-perception of oral health (OR = 1.32; 95%CI 1.26-1.38) and lower tooth loss (MR=0.88; 95%CI 0.86-0.90). Higher levels of work, transportation, and household activities were significantly associated with worse self-perception of oral health, while higher levels of work- and transportation-related physical activities were also associated with greater tooth loss. When the total recommended weekly physical activity time was analyzed, no significant associations were found. Sensitivity analysis suggested that this pattern persists in potential periodontitis-related cases, such as when selecting older age or excluding individuals with no tooth loss. In conclusion, leisure physical activity was the only domain with the potential of reflecting the benefits of physical activity on oral health. The inclusion of other domains can confound this association.

Assessment of the contextual effects on the prevalence of periodontitis: a systematic review

Abstract This study reviews the influence of contextual factors on periodontitis based on a systematic search of studies recorded in the PubMed, Scopus, Web of Science, and EMBASE databases. Periodontitis was assessed by clinical attachment loss and probing depth for studies with data on the socioeconomic status (SES) of a specific area (area-level SES) or dental care service (service-level) in a catchment area among individuals aged 18 and over. Two independent reviewers performed study selection, data extraction, and assessment of methodological quality. Of the 646 articles identified, 13 were included in the systematic review, representing 101,362 individuals from five countries (USA, UK, Brazil, China, and Uruguay). A higher prevalence of periodontitis was described in lower SES neighborhoods, more deprived postcodes, and poorer provinces. Gini Index results were mixed and inconclusive. Three studies showed that higher coverage of primary dental care at the municipal level was associated with a lower prevalence of periodontitis. Contextual factors at the area-level SES and dental care service might influence periodontitis, but the existing evidence is unclear. The contextual effect is important for periodontal health and may contribute to the prevalence of periodontitis, independent of well-known risk factors and individual levels.

Non-invasive and micro-invasive treatments to arrest active occlusal carious lesions in erupting permanent molars: A randomized clinical trial

Abstract: This study aimed to evaluate the efficacy of non-invasive and micro-invasive treatments on the arrest of occlusal enamel carious lesions in erupting permanent molars. This two-arm randomized clinical trial included 27 subjects, aged 5-11 years, with 64 erupting permanent molars presenting active occlusal enamel carious lesions (as assessed by the International Caries Detection and Assessment System [ICDAS]; scores 1-3). The sample was randomly assigned into two treatment groups: 1) resin-modified glass ionomer cement sealant (Clinpro XT Varnish; 3M ESPE) and 2) 4-week topical fluoride varnish application (Duraphat; Colgate). All children and parents received oral hygiene and dietary instructions. Teeth were evaluated at baseline and 3, 6, 9, and 12 months regarding the eruption stage, biofilm accumulation, as well as severity and activity of the carious lesions. The Kaplan-Meier method was used to evaluate the survival estimates for inactivation of the carious lesions for both treatment groups. Multivariate Cox regression models with shared frailty were performed to identify factors associated with the outcome (p < 0.05). After 12 months, 22% and 3% of the lesions treated with topical fluoride varnish and sealant, respectively remained active. The adjusted model demonstrated that younger children had a higher probability of active enamel carious lesions arresting (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.22-0.78; p=0.01). However, the probability of active enamel carious lesions arresting after sealant application was 8.85 times higher compared with fluoride varnish applications (p=0.01). Sealing is a more effective approach than fluoride varnish for arresting occlusal enamel carious lesions in erupting permanent molars.

New tendencies in non-surgical periodontal therapy

Abstract The aim of this review was to update the evidence of new approaches to non-surgical therapy (NSPT) in the treatment of periodontitis. Preclinical and clinical studies addressing the benefits of adjunctive antimicrobial photodynamic therapy, probiotics, prebiotics/synbiotics, statins, pro-resolving mediators, omega-6 and -3, ozone, and epigenetic therapy were scrutinized and discussed. Currently, the outcomes of these nine new approaches, when compared with subgingival debridement alone, did not demonstrate a significant added clinical benefit. However, some of these new alternative interventions may have the potential to improve the outcomes of NSPT alone. Future evidence based on randomized controlled clinical trials would help clinicians and patients in the selection of different adjunctive therapies.

Dietary patterns of patients with chronic coronary heart disease: a cross-sectional study / Modelos dietéticos de pacientes con enfermedad crónica de las arterias coronarias: un estudio transversal

The objective of this study was to identify dietary patterns in an outpatient cohort of coronary heart disease (CHD) patients, to compare these patterns with dietary recommendations of the international cardiology guidelines, and verify associations with cardiovascular risk factors. Dietary intake was assessed through a food frequency questionnaire. Dietary patterns were identified by cluster analysis. The total energy intake, fiber, cholesterol, macro and micronutrients were calculated. Two dietary patterns were identified in 123 patients. Pattern I was characterized by a greater consumption of whole carbohydrates, beans, meats, vegetables, and fruits. Pattern II was rich in refined carbohydrates, fried foods, and sweets. Participants in pattern I had lower values of diastolic blood pressure (DBP) with 77.1 ± 9.9 mmHg (p= 0.002) and glycated hemoglobin (HbA1c) of 7.83 ± 1.76 % (p= 0.029) compared to pattern II with 84.1 ± 14.3 mmHg and 9.02 ± 2.29 %, respectively. Therefore, pattern I had a healthier nutritional composition, however, nutritional adequacy was still lacking. Despite this, participants in pattern I had significantly lower values of DBP and HbA1c, in addition to being associated with a better control of DBP.

El objetivo de este estudio fue identificar los modelos dietéticos de una cohorte de pacientes ambulatorios con enfermedad de las arterias coronarias (EAC) y compararlos con las recomendaciones dietéticas de las directrices internacionales de cardiología y verificar su asociación con el control de los factores de riesgo cardiovascular. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de consumo. El modelo dietético fue identificado por análisis de conglomerados. Se calculó la ingesta energética total, fibras, colesterol, macro y micronutrientes. Se identificaron dos modelos dietéticos en 123 pacientes. El modelo I se caracterizó por un mayor consumo de carbohidratos enteros, frijoles, carnes, verduras y frutas. El modelo II era rico en carbohidratos refinados, alimentos fritos y dulces. Los participantes en el modelo I tuvieron valores más bajos de presión arterial diastólica (PAD) con 77.1 ± 9.9 mmHg (p= 0.002) y hemoglobina glucosilada (HbA1c) de 7.83 ± 1.76 % (p= 0.029) en comparación con el modelo II con 84.1 ± 14.3 mmHg y 9.02 ± 2.29%, respectivamente. Por lo tanto, el modelo I tenía una composición nutricional más saludable, sin embargo, todavía carece de adecuación nutricional. A pesar de esto, los participantes del modelo I tuvieron valores más bajos de PAD y HbA1c.

Self-reported dentin hypersensitivity in south brazilian adolescents: occurrence and risk indicators / Hipersensibilidade dentinária autorreportada em adolescentes do sul do Brasil: ocorrência e indicadores de risco

ABSTRACT The aim of this study was to assess the occurrence of selfreported dentin hypersensitivity (DH) and its risk indicators in adolescents from a southern Brazilian city. 736 students (1519 years old) were randomly selected from 20 public and private schools in the city of Passo Fundo, Brazil. DH was assessed through the answers on a Likert scale to the question: "Do you have tooth sensitivity?".Participants underwent a clinical examination in which present teeth were counted, and answered an interview based on a structured questionnaire on sociode mographic information, history of dental bleaching, orthodontic treatment and oral health habits. The dependent variable (DH) was dichotomized at the point where hypersen sitivity occurs fairly often or always. Data were analyzed by multivariable logistic regression, including demographic, health history, socioeconomic and behavioral variables. Results: 556 (75.5%) subjects reported having sensitive teeth never, rarely or sometimes, while 180 (24.5%) reported having sensitive teeth fairly often or always. In the final model, number of present teeth, age, skin color, flossing, smoking, bleaching and orthodontic history were not associated with selfreported DH. Females showed significantly greater chance of having DH than males [odds ratio (OR)=1.91; 95% confidence interval (95%CI) 1.342.72]. The likelihood of DH in students at public schools was 63% higher than in those at private schools (OR=1.63 95%, CI 1.012.75). DH is a common perception among adolescents and is associated with female gender and studying at public schools.

RESUMO O objetivo deste estudo foi determinar a ocorrência de hipersensibilidade dentinária (HD) autorreportada e seus indicadores de risco de uma cidade do sul do Brasil. 736 estudantes (1519 anos) foram selecionados aleatoriamente em 20 escolas públicas e privadas da cidade de Passo Fundo, Brasil. HD foi aferida pela resposta em escala Likert à pergunta: "Você tem sensibilidade nos dentes?". O exame clínico incluía a contagem de dentes presentes e um questionário estruturado foi aplicado incluindo dados sociodemográficos, história de clareamento dental, tratamento ortodôntico e hábitos de saúde bucal.A variável de pendentes (HD) foi dicotomizada no ponto que a hipersensibilidade ocorria repetidamente ou sempre. Os dados foram analisados por meio de regressão logística multivariada, incluindo variáveis demográficas, histórico de saúde, dados socioeconômicos e comportamentais. Nos resultados 556 (75.5%) indivíduos reportaram experiência de sensibilidade dentinária, nunca raramente ou às vezes, enquanto 180 (24.5%) reportaram ter sensibilidade repetidamente ou sempre. No modelo final, número de dentes presentes, idade, raça, uso do fio dental, tabagismo, histórico de clareamento dental e tratamento ortodôntico não foram associados com HD autorreportada. Mulheres mostraram uma chance significativamente maior de ter HD comparado aos homens [odds ratio (OR)=1,90; 95% intervalo de confiança (95%CI) 1.332.71]. Frequentar escolas públicas aumentou a chance de HD em 63% comparado com escolas particulares (OR=1,63 95%IC 1.012.75). HD é uma percepção comum entre adolescentes e está associada com gênero feminino e estudar em escolas públicas.

The impact of maintenance on peri-implant health

Abstract Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.

Occurrence and predictors of gingivitis and supragingival calculus in a population of Brazilian adults

Abstract: The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by ∼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.

Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

Abstract The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation.

Equipes de saúde bucal na estratégia da saúde da família em polo urbano do sul do Brasil / Oral health teams in the family health strategy in urban pole of southern Brazil

Introdução: a Estratégia da Saúde da Família (ESF) é uma política brasileira recente de gestão e execução dos serviços de saúde. Um dos alvos desta política é promover a saúde bucal. Para tanto, as equipes devem ser constituídas segundo normas do Ministério da Saúde, compostas por cirurgião-dentista e pelo menos um auxiliar. Objetivo: avaliar a composição das equipes de saúde bucal da ESF do município de Passo Fundo/RS/Brasil e comparar com as normas do Ministério da Saúde. Métodos: neste estudo transversal, a composição de 22 ESFs foi avaliada através de consulta ao Sistema de Informação de Atenção Básica (SIAB), referente ao biênio 2013-2014, e por aplicação de questionário para avaliar a estrutura das Equipes da Saúde da Família. Resultados: nenhuma das 22 ESFs apresentou equipe de saúde bucal completa. O único profissional identificado foi o cirurgião-dentista, presente em 17 das 22 ESFs (77%), integralmente pago com verba municipal, sem contrapartida federal. Não há uma padronização na carga horária do profissional odontólogo, diferente dos demais profissionais que compõem a atenção básica. Das ESFs regularizadas no SIAB, 20% não apresentam cirurgião-dentista em sua composição, ficando esta população desassistida em saúde bucal. Conclusões: as equipes de saúde bucal das ESFs do município de Passo Fundo/RS são incompletas e não seguem as normas Brasileiras.

Introduction: the Family Health Strategy (ESF) is a recent Brazilian policy of management and execution from health services. One of its targets is to promote the Oral Health. In order to achieve this the staffs shall be established accordingly to the Health Ministry rules, formed by a dental surgeon and at least one assistant. Objective: to evaluate the oral health teams structure of the ESF in the city of Passo Fundo/ RS/Brazil and contrast it with the Health Ministry rules. Methods: in this cross-sectional study, were valued the structure of 22 ESFs by looking at the Basic Health Care Information System (SIAB), referring to the biennium 2013-2014 and by applying a questionnaire to evaluate the ESF´s teams structure. Results: none of the 22 ESFs reported an Oral Health perfect team. The only professional identified was the dental surgeon, existing in 17 out of 22 ESFs (77%), paid in full by municipal funds with no federal financial reward. There is not a standard at dentists workload oppositely to other professional in SIAB. From the ESFs settled at SIAB 20% have no dental surgeon in its staff leaving people unattended in oral health. Conclusions: the oral health ESFs teams from the city of Passo Fundo/RS are incomplete and don´t obey the Brazilian regulation.

Preservação e aumento de rebordo alveolar após perda de implante osseointegrado / Ridge preservation and augmentation after dental implant failure ­ a case report

Este relato de caso objetivou descrever as técnicas de preservação e aumento de rebordo alveolar após perda de um implante osseointegrado. Paciente com 54 anos de idade, do sexo feminino, procurou o serviço odontológico da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul, pois um implante instalado há cincos anos na região do dente 25 encontrava-se com mobilidade. Ao exame clínico e radiográfico, constatou-se perda da osseointegração e extensa perda óssea da região vestibular. Realizou-se a remoção do implante, preservação e aumento de rebordo alveolar com enxerto de osso bovino desproteinizado e membrana de colágeno. Além do aumento da densidade óssea da região, observou-se aumento em espessura gengival, o que favoreceu a estética da área. Nove meses após esses procedimentos, um implante do tipo hexágono externo foi instalado. Posteriormente, uma nova prótese foi confeccionada. Concluiu-se que a preservação de rebordo alveolar é uma técnica de fundamental importância para a adequada instalação de implantes osseointegrados, pois favorece aspectos funcionais e estéticos, podendo ser aplicada em casos de perda de implantes e de dentes.

This case report aimed to describe a case of ridge preservation after loss of an osseointegrated implant. A 54 years-old female sought the dental service of the Federal University of Rio Grande do Sul because her implant, installed five years prior the initial exam, in the region of the element 25, presented mobility. Clinical and tomographic exams showed loss of osseointegration and extensive bone loss in the buccal surface. The implant was removed and the ridge preservation and augmentation was performed with deproteinized bovine bone graft and collagen membrane. In addition to the increased bone density in the region, the gingival thickness were increased in the region, favoring the aesthetics. After nine months, an external hexagon implant was installed. Aftwerwards, a new prosthesis was placed. It was concluded that the ridge preservation is extremely important for proper installation of osseointegrated dental implants, providing better functional and aesthetics aspects and can be applicable to cases where dental implants or tooth were lost.

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

Influence of factors in the oral mucosa maturation pattern: a cross-sectional study applying multivariate analyses

Aim: To evaluate the association between oral health status, socio-demographic and behavioralfactors with the pattern of maturity of normal epithelial oral mucosa. Methods: Exfoliative cytologyspecimens were collected from 117 men from the border of the tongue and floor of the mouth onopposite sides. Cells were stained with the Papanicolaou method and classified into: anucleated,superficial cells with nuclei, intermediate and parabasal cells. Quantification was made by selectingthe first 100 cells in each glass slide. Sociodemographic and behavioral variables were collected froma structured questionnaire. Oral health was analyzed by clinical examination, recording decayed,missing and filled teeth index (DMFT) and use of prostheses. Multivariable linear regression modelswere applied. Results: No significant differences for all studied variables influenced the patternof maturation of the oral mucosa except for alcohol consumption. There was an increase of cellsurface layers of the epithelium with the chronic use of alcohol. Conclusions: It is appropriate to usePapanicolaou cytopathological technique to analyze the maturation pattern of exposed subjects,with a strong recommendation for those who use alcohol - a risk factor for oral cancer, in which achange in the proportion of cell types is easily detected.

Doença periodontal como fator de prognóstico para doença cardiovascular / Periodontal disease as a prognostic factor in cardiovascular disease ­ a literature review

O objetivo dessa revisão da literatura foi apresentar evidências que sustentam a doença periodontal como um fator de prognóstico para a doença cardiovascular (DCV). Fator de risco refere-se a um fator que está relacionado diretamente com o estabelecimento da doença. Por outro lado, fator de prognóstico está relacionado com o curso de uma doença já existente. A evidência científica é bastante vasta sobre o papel da doença periodontal no desenvolvimento da doença cardiovascular, contudo, existe um número de estudos relativamente pequeno quando a doença periodontal é avaliada como fator de prognóstico. Esses estudos se diferem fundamentalmente pelo fato de que a amostra é composta exclusivamente por pacientes já com diagnóstico de doença cardiovascular. Nesta revisão, foram encontrados estudos observacionais e intervencionais, com desfechos principalmente de natureza sanguínea avaliando citocinas e marcadores inflamatórios cardiovasculares. De maneira geral, estudos observacionais encontraram associação entre presença de doença periodontal e maiores níveis séricos de proteína C-reativa (PCR), lipídeos e algumas citocinas (IL-6 e TNF alpha). Estudos de intervenção demonstraram que, após o tratamento periodontal, os níveis de PCR, fibrinogênio e IL-6 reduzem nos pacientes cardiopatas. Por outro lado, uma série de citocinas envolvidas no processo aterogênico ainda não foi avaliada em pacientes cardiopatas com doença periodontal. Pôde-se concluir que a doença periodontal pode vir a ser um importante fator de prognóstico para a doença cardiovascular, e isso tem implicações importantes no manejo clínico de pacientes cardiopatas por médicos e dentistas.

The purpose of this literature review is to present evidence to support periodontal disease as a prognostic factor for CVD. Risk factor is directly related to disease onset only. On the other hand, prognostic factors deal with prediction of the course of an existing disease. There is great amount of scientifi c evidence on the role of periodontal disease in the development of cardiovascular disease, however there are a relatively small number of studies where periodontal disease is evaluated as a prognostic factor. These studies are fundamentally different because the sample is composed exclusively of patients with diagnosis of the cardiovascular disease. In this review, we found observational and interventional studies with secondary outcomes, evaluating cytokines and cardiovascular infl ammatory markers. In general, observational studies associated the periodontal disease with higher serum levels of C-reactive protein (CRP), lipids and some cytokines (IL-6 and TNF alpha). Intervention studies demonstrated a reduction in CRP levels, fi brinogen, and IL-6 in cardiac patients after periodontal treatment. Moreover, a number of cytokines involved in the atherosclerotic process haven't been evaluated in cardiac patients with periodontal disease. It can be concluded that periodontal disease may be an important prognostic factor for cardiovascular disease and this has important implications for the clinical management of cardiac patients by health professionals.

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

Abstract The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.

Self-reported halitosis and associated demographic and behavioral factors

Abstract Halitosis is still poorly studied in young adults. The aim of this study was to evaluate the occurrence of self-reported halitosis and associate it with demographic and behavioral factors in young adult dental students. This cross-sectional study was designed as a census of students enrolled in three initial and three final semesters of a dental course in a Brazilian public university. Of 284 eligible students, 257 (90.5%) completed a self-administered questionnaire. Self-reported halitosis was the primary study outcome, and was assessed with the question "do you feel you have bad breath?". Data on age, gender, frequency of tooth brushing and interproximal cleaning, tongue cleaning, mouth rinse use and dry mouth were collected using the questionnaire, and were considered independent variables. Of the students surveyed, 26.5% reported as never, 51.7% as rarely, 21.4% as sometimes, and 0.4% as always feeling they had halitosis. Morning halitosis was reported by 90.6% of those who reported halitosis. In the final multiple model, last semester students had a 55% lower chance of reporting halitosis, compared with students from the first semesters [odds ratio (OR) 0.46; 95%CI 0.24-0.89]. Women had a 2.57fold higher chance of reporting halitosis (OR = 2.57; 95%CI 1.12-5.93). Dry mouth increased the chance of self-reported halitosis 3.95-fold, compared with absence of dry mouth (OR = 3.95; 95%CI 2.03-7.68). It can be concluded that self-reports of halitosis were low among dental students, but may represent an important complaint. Gender, dry mouth and level of college education of the dentist were factors significantly associated with self-reported halitosis.

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.

A population-based cohort study of oral health in South Brazil: The Porto Alegre Study / Um estudo de coorte de base populacional de saúde bucal no sul do Brasil: Estudo de Porto Alegre

Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies.

Poucos estudos de coorte de base populacional têm sido estabelecidos em Odontologia e isso é especialmente verdade para a América Latina. Nós conduzimos um estudo prospectivo de base populacional focando em saúde bucal em Porto Alegre, sul do Brasil, e aqui descrevemos a metodologia do estudo e discutimos direções futuras da pesquisa. A coorte foi estabelecida em 2001 utilizando uma amostra probabilística múltiplo-estágio de 1.465 dentados e 121 desdentados. Um acompanhamento de 5 anos foi realizado em 2006 e incluiu 755 indivíduos. Os objetivos principais do estudo foram determinar o padrão e os fatores de risco para progressão de doença periodontal e incidência de perda dentária. Um protocolo de exame de boca completa foi utilizado, incluindo registros periodontais em 6 sítios por dente. Os desfechos primários foram perda de inserção periodontal e perda dentária. Lesões de mucosa bucal, placa visível, gengivite, cálculo supragengival, profundidade de sondagem, recessão gengival e cárie dentária também foram acessados. Este é o primeiro estudo de coorte de base populacional a focar em doença periodontal na América Latina. Os achados deste estudo contribuirão para o entendimento da epidemiologia da doença periodontal e fornecerão dados valiosos para planejamento e implementação de estratégias preventivas e terapêuticas.

Influence of supragingival biofilm control and smoking habit on Interleukin-1β concentration

This investigation compared gingival crevicular fluid (GCF) interleukin-1β (IL-1β) concentrations in periodontitis patients subjected to a strict supragingival biofilm control (Supra) for 6 months. Never-smokers (23) and smokers (n = 20; 19.6 ± 11.8 cigarettes/day) moderate-to-severe chronic periodontitis patients underwent a 6 months period of supragingival control with weekly recall visits. Periodontal probing depth (PPD), bleeding on probing (BOP) and GCF samples (from different PPD category sites: 3-5 mm and 6–10 mm) were obtained at the baseline, 30, and 180 days. IL-1β was assessed by enzyme-linked immunosorbent assay. Generalized estimating equations were used to fit prediction models of IL-1β changes, considering the dependence between the examinations, and using only data from experimental sites. Overall IL-1β concentrations decreased from 3.2 pg/µL to 1.9 pg/µL. Higher baseline IL-1β concentrations were associated with higher baseline PPD values in both groups. There were no differences in IL-1β concentrations between never-smokers and smokers over time for any PPD category. Higher baseline PPD values and the presence of BOP on day 180 were significantly associated with higher IL-1β concentrations. A strict Supra regimen reduced IL-1β concentrations over time in periodontitis patients. The benefits observed for smokers underline the importance of oral hygiene measures, even considering the presence of this important risk factor.