Halitosis: a conceptual, etiologic and therapeutic approach / Halitose: uma abordagem conceitual, etiológica e terapêutica

Objective: Halitosis is the offensive odor emanated by the oral and nasal cavities and perceived by the individual and/or by other people. Halitosis is a symptom that directly impacts on the social aspects of an individual's life and may be a sign for a systemic disorder in some cases. Material and Methods: A search was conducted on the literature in order to gather the main aspects about halitosis and make a review about the main features necessary to the clinical practice when a professional deals with a patient with halitosis. Results: The information was summarized and discussed with a focus on what clinicians should be aware of when dealing with a patient with halitosis. Conclusion: Halitosis is a prevalent symptom that affects approximately 25% of the individuals. Its classification takes into consideration the origin of the compounds producing the malodor. The diagnosis must take into consideration the various etiological possibilities before defining the treatment. The treatment must be focused on the cause and since there is a wide range of possible causes, halitosis needs a multidisciplinary approach (AU)

Objetivo: Halitose é um cheiro ofensivo expelido pela cavidade bucal e pela cavidade nasal e percebido pelo indivíduo e/ou pelas outras pessoas. A halitose é um sintoma que impacta diretamente aspectos sociais da vida de um indivíduo e pode ser um sinal de alguma desordem sistêmica em alguns casos. Material e Métodos: Uma busca foi feita na literatura para reunir os principais aspectos da halitose e conduzir uma revisão sobre as principais características necessárias à prática clínica quando um profissional lida com um paciente com a queixa de halitose. Resultados: A informação disponível foi sumarizada e discutida com foco naquilo que um clínico deve estar atento quando lida com um paciente com a queixa de halitose presente. Conclusão: A halitose é um sintoma prevalente que afeta aproximadamente 25% dos indivíduos. Sua classificação leva em consideração a origem dos compostos que produzem o mau hálito. O diagnóstico deve levar em conta as várias etiologias possíveis antes de definir um tratamento. O tratamento deve ser focado na causa e, como há uma ampla variedade de possíveis causas, a halitose é um sintoma que precisa de uma abordagem multidisciplina (AU)

Periodontal diseases: is it possible to prevent them? A populational and individual approach

Abstract Periodontal diseases are infectious inflammatory chronic diseases of a multifactorial nature. They are primarily caused by dysbiotic ecological changes in dental biofilm, which may be influenced by risk factors. The prevention of periodontal diseases may involve different strategies focused on reducing distal, intermediate, and proximal risk factors at both the population and individual levels. Effective prevention depends on interdisciplinary and common risk factor approaches. Also, patient-centered preventive models are more effective than professional-centered models in the management of periodontal diseases. Regular and periodic control of dental biofilm is an essential measure for the different levels of prevention of periodontal diseases. The effectiveness of periodontal disease prevention largely depends on positive modifications of behavior, knowledge, health literacy, patient empowerment, motivation, and compliance.

Associação entre doença periodontal e obesidade: uma revisão de literatura / Association between periodontal disease and obesity: a literature review

Objetivo: Este estudo teve o objetivo de avaliar a associação entre doença periodontal e obesidade. Métodos: Foi realizada uma busca nas bases PubMed, SciELO e Bireme, sendo incluídos estudos relevantes relacionados ao tema para síntese deste trabalho. Resultados: Foram selecionados treze artigos para serem incluídos nessa revisão, sendo um ensaio clínico, uma meta-análise, dois estudos de coorte, dois caso-controle, cinco estudos transversais e duas revisões sistemáticas. Conclusão: Existe uma plausibilidade biológica entre a obesidade e a doença periodontal, porém não há um consenso na literatura sobre essa associação. Desta forma, são necessários mais estudos prospectivos, laboratoriais, de coorte e meta-análises que avaliem tal associação entre as doenças.

Aim: This study aimed to assess the association between periodontal disease and obesity. Methods: A search was performed in the PubMed, SciELO, and Bireme databases, including relevant studies related to the theme for the synthesis of this work. Results: Thirteen articles were selected to be included in this review, one clinical trial, one meta-analysis, two cohort studies, two case-control studies, five cross-sectional studies and two systematic reviews. Conclusion: There is a biological plausibility between obesity and periodontitis, but there is no consensus in the literature about this association. Thus, further prospective, laboratory, cohort, and meta-analysis studies are needed to assess such an association between diseases.

Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT)

Abstract The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Periodontitis and periodontopathogens in individuals hospitalized in the intensive care unit: a case-control study

Abstract The aim of the present study was to compare periodontal conditions between intensive care unit (ICU) in-patients and non-ICU patients through clinical and microbiological periodontal parameters. This case-control study included 88 individuals hospitalized in ICU and 176 non-hospitalized controls. All individuals underwent a complete periodontal examination and microbiological sampling. The total bacterial load and counts of Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetemcomitans were evaluated using qPCR. Data were analyzed through the Chi-square, Fisher exact, and t-Student tests, and the Spearman correlation, as appropriate. The prevalence of periodontitis was 39.7% among controls and 59.0% among ICU in-patients (OR=2.18; p=0.002). ICU in-patients had a significantly higher occurrence of cardiovascular disease (p=0.002; OR=2.20) and history of periodontal disease (p=0.031; OR=1.92) than controls. Bacterial counts of A. actinomycetemcomitans, T. denticola and P. gingivalis were significantly higher in ICU in-patients with periodontitis than in controls. The correlation between periodontal parameters and microbiological findings among cases and controls showed a significant and positive correlation between: total bacteria load and % of sites with probing depth (PD) ≥ 4 mm (cases: r=0.22 and controls: r=0.13) and P. gingivalis and % sites with bleeding on probing (BOP) (cases: r=0.22 and controls: r=0.23). Thus, ICU in-patients presented a higher prevalence of periodontitis and worse periodontal condition (higher mean plaque index, BOP, clinical attachment level ≥3 mm, and sites with PD 4 to 6 mm).

Resumo O objetivo deste estudo foi comparar as condição periodontais entre pacientes internados em Unidade de terapia intensiva (UTI) e indivíduos não hospitalizados através de parâmetros periodontais clínicos e microbiológicos. Este estudo caso-controle incluiu 88 indivíduos hospitalizados em UTI e 176 controles não hospitalizados. Todos os indivíduos foram submetidos a um exame periodontal completo e amostragem microbiológica. A carga bacteriana total e as contagens de Porphyromonas gingivalis, Treponema denticola e Aggregatibacter actinomycetemcomitans foram avaliadas utilizando qPCR. Os dados foram analisados, conforme apropriado, por meio dos testes de Qui-quadrado, Fisher exato, t-Student, Mann-Whitney e correlação de Spearman. A prevalência de periodontite foi de 39,7% entre os controles e de 59,0% entre pacientes internados em UTI (OR=2,18, IC 95%: 1,29-3,68; p=0,002). Pacientes admitidos na UTI apresentram significativamente uma maior ocorrência de doença cardiovascular (p=0,002, OR=2,20) e história de doença periodontal (p=0,031; OR=1,92) do que os controles. As contagens bacterianas de A. actinomycetemcomitans, T. denticola e P. gingivalis foram significativamente maiores nos pacientes em UTI com periodontite do que nos controles. A correlação entre os parâmetros clínicos periodontais e os achados microbiológicos entre casos e controles mostrou correlação significativa e positiva entre: carga bacteriana total e % de sítios com profundidade de sondagem (PS) ≥4 mm (casos: r=0,22 e controles: r=0,13) e P. gingivalis e % de sítios com sangramento à sondagem (SS) (casos: r=0,22 e controles: r=0,23). Pacientes internados na UTI apresentaram maior prevalência de periodontite e pior condição periodontal (maior média de índice de placa, SS, de sítios com nível de inserção clínica ≥ 3mm e PS de 4 a 6 mm) do que os controles.

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TGF-ß and TNF-α: follow-up over 5 years

Abstract Objective The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. Material and Methods Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. Results A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. Conclusions The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

Periodontal condition and immunological aspects of individuals hospitalized in the intensive care unit

Abstract There are few studies on the clinical and immunological periodontal status of intensive care unit (ICU) in-patients. The aim of the present study was to evaluate the periodontal condition among ICU in-patients through clinical and immunological periodontal parameters. From the sample of 373 hospitalized ICU patients, 182 were submitted' to a thorough clinical periodontal and immunological evaluation. Data on bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were collected and gingival sulcular fluid samples were quantified through ELISA on IL-1, IL-6, and MMP-2 for immunological evaluation. Data was statistically analyzed by Chi-square, Fisher's exact, Mann-Whitney tests, and Sperman's correlation and multivariate logistic regression analysis. A high dental plaque index and a high prevalence of periodontitis (48.3%), mostly in moderate and localized chronic form, were observed. Individuals with periodontitis presented higher levels of IL-1 and MMP-2, while individuals with cardiovascular disease (CVD) and individuals with two or more systemic diseases (MSD) presented higher levels of IL-1; diabetes mellitus (DM) and MSD individuals presented higher levels of IL-6. A positive association was found between the severity of periodontitis and CVD (OR 2.2; CI = 1.11-4.42). This study reported a 48.3% of the prevalence of periodontitis in ICU patients and a positive association between the severity of periodontitis and CVD. Additionally, higher levels of IL-1 and MMP-2 were found in individuals with periodontitis, higher levels of IL-6 were found in individuals with DM, and higher levels of IL-1 were found in individuals with CVD.

Resumo Existem poucos estudos sobre o estado clínico periodontal e imunológico de pacientes em unidade de terapia intensiva (UTI). O objetivo do presente estudo foi avaliar a condição periodontal entre os pacientes internados na UTI através de parâmetros clínicos periodontais e imunológicos. De uma amostra inicial de 373 pacientes internados em UTI, 183 foram submetidos a exame periodontal completo e análise imunológica. Os dados sobre o sangramento na sondagem (BOP), profundidade de sondagem (PD) e nível clínico de inserção (CAL) foram coletados e as amostras de fluido sulcular gengival foram quantificadas para avaliação imunológica através de ELISA para IL-1, IL-6 e MMP-2. Os dados foram analisados estatisticamente pelos testes de Qui-quadrado, exato de Fischer, Mann-Whitney, correlação de Sperman e análise de regressão logística multivariada. Foi observado um alto índice de placa dental e uma alta prevalência de periodontite (48,3%), principalmente na forma crônica moderada e localizada. Os indivíduos com periodontite apresentaram níveis mais altos de IL-1 e MMP-2, enquanto indivíduos com doença cardiovascular (CVD) e com mais de duas doenças sistêmicas (MSD) apresentaram níveis mais altos de IL-1 e os com diabetes mellitus (DM) e MSD apresentaram níveis mais elevados de IL-6. Foi encontrada associação positiva entre a gravidade da periodontite e CVD (OR 2.2; IC = 1,11-4,42). Este estudo reportou uma prevalência de periodontite em 48.3% dos pacientes em UTI e uma associação positiva entre ocorrência de periodontite e CVD. Além disso, níveis mais elevados de IL-1 e MMP-2 foram encontrados em indivíduos com periodontite, de IL-6 em indivíduos com DM e de IL-1 em indivíduos com CVD.

Cross-cultural adaptation of the Brazilian version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15)

Abstract The dentine hypersensitivity (DH) is able to impair the oral health related quality of life (OHRQoL). However, there isn't any specific validated questionnaire to be used in Brazil. The objective was to adapt and to validate the English version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) for use in Brazil. DHEQ-15 was cross-culturally adapted into the Brazilian-Portuguese language and then validated in a cross-sectional study with 100 participants recruited at a University clinic. Study sample comprised 2 groups: 100 individuals with DH, and 100 individuals without. The instrument was self-administered twice 7 to 10 days apart. The participants answered a global rating of oral health. The psychometric properties of the Brazilian version of DHEQ-15 were verified through internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient - ICC), convergent (Spearman correlation) and discriminant (Mann-Whitney test) validity. The significance threshold was set at p<0.05. Sample comprised 69 men and 131 women, of mean age 30.4y. The Brazilian DHEQ-15 demonstrated very good internal consistency (α = 0.945). Test-retest reliability revealed excellent reproducibility (ICC = 0.959, p < 0.001). There was statistically significant correlation between the scores obtained on all DHEQ-15 domains and the global rating of oral health (p<0.001). Participants with DH scored significantly higher than those without DH (p<0.001). This study provides evidence supporting the cross-cultural validity of the Brazilian version of DHEQ-15 for use in Brazil.

A influência da periodontite no controle glicêmico do diabetes mellitus tipo 2: mecanismos biológicos / The Influence of Periodontitis on Glycemic Control of Type 2 Diabetes Mellitus: Biological Mechanisms

O diabetes mellitus (DM) é uma doença crônica que vem afetando um número cada vez maior de pessoas em todo o mundo. Caracteriza-se pela incapacidade do organismo de regular o processamento de glicose, sendo dividida em dois tipos principais: tipo 1 e tipo 2 (DM2), sendo este último o mais comum. A periodontite é uma doença resultante da interação complexa entre o biofilme bacteriano e a resposta imunoinflamatória do hospedeiro que leva à destruição dos tecidos de suporte dental. Evidências sugerem uma relação bidirecional entre estas doenças: o DM interfere no curso clínico da periodontite e a periodontite parece exercer influência sobre o DM. Para avaliar a influência da periodontite sobre o DM foi feita uma revisão de literatura abordando os principais mecanismos biológicos envolvidos. Foi constatado que a influência da periodontite sobre o controle glicêmico do DM2 baseia-se principalmente em mecanismos imunoinflamatórios. Na infecção periodontal, certas cepas bacterianas e seus produtos são capazes de ocasionar uma inflamação sistêmica crônica, com envolvimento de citocinas pró-inflamatórias, substâncias do estresse oxidativo e proteína C-reativa, o que resulta em resistência à insulina e, consequentemente, a um pobre controle glicêmico. Entretanto, estes mecanismos que implicam na resistência à insulina no DM2 ainda são pouco claros e estudos futuros ainda são necessários (AU)

Diabetes mellitus (DM) is a chronic disease that is affecting more and more people around the world. It is characterized by the body's inability to regulate the glucose processing, being divided into two main types: type 1 and type 2 (DM2), the latter being the most common. Periodontitis is a disease resulting from the complex interaction between the bacterial biofilm and the host immune-inflammatory response that leads to the destruction of the dental supporting tissues. Evidence suggests a bidirectional relationship between these diseases: DM interferes with the clinical course of periodontitis and periodontitis seems to exert influence on DM. In order to evaluate the influence of periodontitis on DM, a literature review was conducted addressing the main biological mechanisms involved. It was found that the influence of periodontitis on the glycemic control of DM2 is mainly based on immunoinflammatory mechanisms. During periodontal infection, certain bacterial strains and their products are capable of causing chronic systemic inflammation, involving proinflammatory cytokines, oxidative stress substances and C-reactive protein, leading to insulin resistance and, consequently, poor glycemic control. However, these mechanisms that imply insulin resistance in DM2 are still unclear and future studies are still needed. (AU)

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis / Os efeitos do tabagismo sobre a perda dentária em indivíduos em terapia periodontal de suporte: uma revisão sistemática e meta-análise / Los efectos del consumo de tabaco en la pérdida de dientes entre personas con una terapia de mantenimiento periodontal: un revisión sistemática y metaanálisis

Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Resumo: A perda dentária tem sido relatada em estudos longitudinais sobre terapia periodontal de suporte (TPS), mas houve menos investigação sobre o efeito independente do tabagismo sobre a perda dentária, ajustado por importantes variáveis de confusão. Esta revisão sistemática teve como objetivo avaliar e analisar o efeito isolado do tabagismo sobre perda dentária em indivíduos em TPS. A estratégia incluiu fontes eletrônicas, busca manual, literatura cinzenta e artigos recentes (publicados a partir de abril de 2018), sem restrição quanto ao idioma; as datas de publicação foram incluídas. Foram selecionados estudos clínico-epidemiológicos com dados sobre perda dentária entre tabagistas em TPS, comparado com grupos-controle de não-tabagistas. A qualidade metodológica foi avaliada com a Escala de Newcastle-Ottawa. Foi realizada uma meta-análise, assim como, I2 testes de heterogeneidade e de sensibilidade. A qualidade das evidências foi avaliada com a escala GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Onze artigos foram incluídos na revisão sistemática, sendo quatro estudos de casos e controles e sete estudos de coorte. Dez dos 11 estudos concluíram que o tabagismo é importante fator de risco para a ocorrência de perda dentária. De acordo com a meta-análise de quatro dos estudos de coorte, os tabagistas em TPS apresentavam risco 3,24 vezes maior de ocorrência de perda dentária quando comparados aos não tabagistas (IC95%: 1,33-7,90). O risco global de viés nos estudos foi baixo. A revisão mostrou qualidade moderada das evidências científicas de que os tabagistas em TPS apresentam risco maior de perda dentária do que os não-tabagistas.

Resumen: La mortalidad dental ha sido estudiada en estudios longitudinales acerca de la terapia de mantenimiento periodontal (TMP), pero el efecto independiente de fumar en la pérdida de dientes (PD), ajustado a variables de confusión importantes, se ha evaluado muy poco. Esta revisión sistemática tuvo como objetivo evaluar y analizar el efecto aislado de fumar en la PD con personas bajo TMP. Se investigó en medios electrónicos, manuales, literatura gris, y artículos recientes (desde abril 2018), sin restricciones respecto a la lengua; incluyendo sus respectivas fechas de publicación. Además, se seleccionaron estudios clínicos epidemiológicos que trabajaban sobre datos de PD entre fumadores que estaban bajo TMP, en comparación con grupos de control de no fumadores. La calidad metodológica se evaluó usando la Escala de Newcastle-Ottawa. Se realizó un metaanálisis, así como tests de heterogeneidad I2 y sensibilidad. La evidencia de calidad fue evaluada usando GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Se incluyeron once trabajos en la revisión sistemática (cuatro de caso-control y siete estudios de cohortes). Diez de los once estudios concluyeron que fumar era un factor de riesgo importante para la ocurrencia de PD. Los metaanálisis de cuatro de los estudios de cohorte descubrieron que los fumadores tenían 3,24 veces más la oportunidad de sufrir PD, en comparación con los no fumadores TMP (IC95%: 1,33-7,90). En general, el riesgo de sesgo en los estudios fue bajo. La calidad de la evidencia científica respaldó moderadamente que los fumadores bajo TMP contaban con más oportunidad de PD que los no fumadores.

Factors associated with the non-wear of mandibular dentures in the Brazilian public primary health care

Abstract This study investigated factors that affect the use of complete conventional mandibular dentures (CCMD) by patients of the Brazilian Public Health Service. For this, two hundred and thirty one subjects who received CCMD in the Primary Health Care of the Public Health Service in Belo Horizonte - Brazil were evaluated and divided in Group 1 - irregular/non-wear; Group 2 - regular wear. Multivariate logistic regression analysis was used to create predictive models for CCMD non-wear and included socio-demographic and biological variables, technical quality of CCMD, and user satisfaction. The prevalence of CCMD non-wear was 41.10%. The mean score of CCMD quality was 54.97 (0-100). Not wearing the CCMD was significantly associated with user satisfaction and technical quality (p < 0.05). The lack of retention of the CCMD was the most important factor in the evaluation of satisfaction and quality. The final predictive model (specificity = 92.65%; AROC = 0.8759) for not wearing the CCMD retained the variables CCMD stability (OR = 0.888; 95%CI = 0.827-0.954), freeway space (OR = 0.916; 95%CI = 0.860-0.976), satisfaction with speech (OR = 0.694; 95%CI = 0.612-0.786), and irregular CCMD edges (OR = 3.185; 95%CI = 1.478-6.864). Socio-demographic and biological variables were not associated with patients not wearing the CCMD, whereas technical quality and user satisfaction were strongly associated.

Periodontitis and type 2 diabetes among women with previous gestational diabetes: epidemiological and immunological aspects in a follow-up of three years

Abstract Periodontitis can contribute to the development of insulin resistance. Gestational diabetes is a risk factor for type 2 diabetes. Therefore, periodontitis, when associated with gestational diabetes, could increase the risk for the development of type 2 diabetes after pregnancy. Objective The aim of this study was to verify the incidence on the development of type 2 diabetes in women with previous gestational diabetes with and without periodontitis after a three-year time interval. Material and Methods Initial sample of this follow-up study consisted of 90 women diagnosed with gestational diabetes who underwent periodontal examination. After three years, 49 women were subjected to new periodontal examination and biological, behavioral, and social data of interest were collected. Additionally, the quantification of the C-reactive protein in blood samples was performed. Fasting glucose and glycated hemoglobin levels were requested. Saliva samples were collected for quantification of interleukin 6 and 10, tumor necrosis factor α, matrix metalloproteinase 2 and 9. Results The incidence of type 2 diabetes mellitus was 18.4% and of periodontitis was 10.2%. There was no significant difference in the incidence of type 2 diabetes mellitus among women with and without periodontitis. It was observed impact of C-reactive protein in the development of type 2 diabetes mellitus. However, it was not observed impact of periodontitis on the development of type 2 diabetes mellitus among women with previous gestational diabetes. Conclusions It was not observed impact of periodontitis on the development of type 2 diabetes among women with previous gestational diabetes. The impact of C-reactive protein in the development of type 2 diabetes mellitus highlights the importance of an inflammatory process in the diabetes pathogenesis.

Etiologia, epidemiologia e tratamento da hipersensibilidade dentinária: uma revisão de literatura / Etiology, epidemiology and treatment of dentin hypersensitivity: a literature review

Introdução: A hipersensibilidade dentinária (HD) é definida como dor aguda originada em dentina exposta ao meio bucal. O tratamento da HD depende do conhecimento do profissional, e existem diversos aspectos propedêuticos e terapêuticos relacionados com esta condição clínica. Objetivo: Revisar a literatura quanto à etiologia, teorias do mecanismo de ação, epidemiologia e tratamento de casos de hipersensibilidade dentinária. Materiais e Métodos: Foi realizada busca eletrônica nas bases de dados Pubmed/Medline e Web of Science. Utilizou-se as palavras-chave: "dentin(e) sensitivity", "dentin(e) hipersensitivity", "etiology", "epidemiology" e "treatment". Os artigos relevantes foram lidos na íntegra, sem restrição de data ou idioma. Revisão de literatura: A exposição dos túbulos dentinários ao meio bucal geralmente ocorre na região cervical do dente e envolve fatores como retração gengival, perda de esmalte e periodontite. Algumas teorias foram propostas para explicar a HD e a mais aceita mundialmente é a teoria hidrodinâmica. A prevalência de HD varia de 4 a 74%, sendo mais comum em mulheres e dentes pré-molares. Muitos tratamentos têm sido empregados nos casos de HD, entretanto, nenhum tratamento totalmente eficaz e confiável foi identificado. Os tratamentos podem ser caseiros ou de consultório, e estão baseados na obliteração dos túbulos dentinários ou ação neural. Conclusões: Os principais fatores etiológicos para HD são erosão e retração gengival. Esta condição clínica apresenta alta prevalência na população brasileira. A teoria hidrodinâmica é a mais aceita para explicar HD. Não há nenhum tratamento considerado padrão-ouro, e uma combinação de tratamentos caseiro e profissional pode ser necessário para tratar o problema. (AU)

Introduction: The dentin hypersensitivity (DH) is defined as acute pain originated from dentin exposed into oral environment. The DH treatment depends on professional knowledge, and there are several aspects regarding this clinical condition. Aim: This study aimed to review the literature about the etiology, mechanism of action theories, epidemiology and treatment of dentin hypersensitivity. Materials and Methods: Electronic search was performed in Pubmed/Medline and Web of Science databases. It was used the keywords: dentin sensitivity, dentin hipersensitivity, etiology, epidemiology and treatment. The relevant articles were fully read, without date or language restriction. Literature review: the exposure of the dentinal tubules to the oral cavity usually occurs in the cervical region of the tooth, and it involves factors such as gingival recession, loss of enamel and periodontal disease. Some theories have been proposed to explain the DH, the most accepted worldwide is the hydrodynamic theory. The prevalence of DHranges from 4 to 74%, being more common in women and premolars teeth. Many treatments have been used in cases of DH, however, no totally effective and reliable treatment was identified. The treatments can be in-home or in-office, and they are based on obliterating dentinal tubules or neural action. Conclusions: The main etiological factors for DH are erosion and gingival recession. This clinical condition presents high prevalence in Brazilian. The hydrodynamic theory is the most widely accepted to explain DH. There is no gold standard treatment for DH, and a combination of in-office and in-home treatments may be necessary to treat the problem. (AU)

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.

Frequency of periodontal pathogens and Helicobacter pylori in the mouths and stomachs of obese individuals submitted to bariatric surgery: a cross-sectional study

ABSTRACT Objectives This cross-sectional study compared the frequency of oral periodontopathogens and H. pylori in the mouths and stomachs of obese individuals with or without periodontitis submitted to bariatric surgery. Material and Methods One hundred and fifty-four men and women aged 18-65 were conveniently distributed into four groups. Two groups were composed of individuals who underwent bariatric surgery with (BP) (n=40) and without (BNP) (n=39) periodontitis and two obese control groups with (CP) (n=35) and without (CNP) (n=40) periodontitis. The oral pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Parvimonas micra, Treponema denticola, Tannerella forsythia, Campylobacter rectus, and Helicobacter pylori were detected by a polymerase chain reaction technique using saliva, tongue and stomach biopsy samples. Results Statistical analysis demonstrated that periodontopathogens were highly frequent in the mouth (up to 91.4%). In the bariatric surgically treated group, orally, P. gingivalis, T. denticola and T. forsythia were more frequent in periodontitis, while C. rectus was more frequent in non-periodontitis subjects. Stomach biopsies also revealed the high frequency of five oral species in both candidates for bariatric surgery (91.6%) and the bariatric (83.3%) groups. H. pylori was frequently detected in the mouth (50.0%) and stomach (83.3%). In the stomach, oral species and H. pylori appeared in lower frequency in the bariatric group. Conclusions Obese individuals showed high frequencies of periodontopathogens and H. pylori in their mouths and stomachs. Bariatric surgery showed an inverse microbial effect on oral and stomach environments by revealing higher oral and lower stomach bacterial frequencies.

Imunomodulação do hospedeiro com dose subantimicrobiana de doxiciclina no tratamento coadjuvante da periodontite crônica – revisão da literatura / Host Immunomodulation with Subantimicrobial Dose Doxycycline as Adjunctive Treatment of Chronic Periodontitis – Literature Review

A Terapia de Modulação do Hospedeiro (TMH) com dose subantimicrobiana de Doxiciclina (DSD) tem o objetivo de complementar o tratamento periodontal convencional atuando na diminuição dos processos destrutivos da resposta imunoinflamatória e no aumento dos processos protetivos e regenerativos. O objetivo desta revisão da literatura é descrever os principais aspectos da TMH e avaliar, sob o ponto de vista clínico, a eficácia da DSD como tratamento coadjuvante à terapia periodontal convencional em pacientes portadores de periodontite crônica. Para tanto, foram realizadas buscas na base de dados PubMed e foram incluídos artigos indexados a partir do ano 2000 que abordavam o tema proposto. Para avaliação da eficácia clínica foram selecionados 6 estudos clínicos duplo-cegos, randomizados, placebo-controlados, com grupos paralelos, em pacientes com periodontite crônica e sem condições sistêmicas que pudessem influenciar o curso da doença periodontal. Os estudos clínicos selecionados mostraram uma capacidade superior da TMH com DSD na melhoria dos parâmetros clínicos e dos marcadores biológicos da periodontite quando comparados com o tratamento convencional sozinho

The Host Modulation Therapy (HMT) with subantimicrobial dose Doxycycline (SDD) is intended to complement the conventional periodontal treatment acting on reducing destructive processes of the immunoinflammatory response and increasing protective and regenerative processes. The purpose of this review is to describe the main aspects of HMT and evaluate, from a clinical point of view, the efficacy of SDDas an adjunct to conventional periodontal therapy in patients with chronic periodontitis. For this purpose, searches were conducted in PubMed database and articles indexed from 2000 that addressed the proposed theme were included. To evaluate the clinical efficacy, 6 double-blind, randomized, placebo-controlled, parallel-group clinical trial sin patients with chronic periodontitis and without systemic conditions that could influence the course of the periodontal disease, were selected. The selected clinical studies showed a superior ability of HMT with SDD in improving clinical parameters and biological markers of periodontitis when compared to conventional treatment alone.

Impact of different settings in periodontitis prevalence / Impacto das diferentes definições na prevalência de periodontite

Methods: The sample consisted of 200 pregnant women from a database. A Medline search was conducted to identify studies that evaluated the association between periodontitis and gestational diabetes. Periodontitis case definitions used in the retrieved studies were applied in the sample. The frequency of periodontitis among the different diagnostic criteria was compared through the Chi-square test. Results: After conducting a search, analysis, and selection from the literature, nine studies were included in the present study. Three studies showed the same criteria. As a result, seven different periodontitis definitions were identified. The frequency of periodontitis in the sample ranged from 24.5% to 72.5%. Conclusion: The prevalence of periodontitis greatly varies when different diagnostic criteria are used. The standardization of periodontitis case definitions in epidemiological studies is crucial for a better comparison among the studies and improvement of the results.(AU)

Objetivo: O objetivo deste estudo foi avaliar o impacto de diferentes critérios de diagnóstico na prevalência de periodontite em mulheres grávidas. Métodos: A amostra foi composta por 200 mulheres grávidas de um banco de dados. Uma pesquisa na base de dados Medline foi realizada para identificar estudos que avaliaram a associação entre periodontite e diabetes gestacional. Os diferentes critérios de diagnóstico para periodontite utilizados nesses estudos foram aplicados em nossa amostra. A comparação da frequência de periodontite entre os diferentes critérios de diagnóstico foi realizada utilizando o teste quiquadrado. Resultados: Após pesquisa bibliográfica, análise e seleção 9 estudos foram incluídos no presente estudo. Três estudos apresentavam o mesmo critério e, portanto, 7 diferentes critérios para diagnóstico da periodontite foram identificados. A prevalência de periodontite na amostra variou de 24,5% a 72,5% dependendo do critério diagnóstico utilizado. Conclusão: Na mesma amostra a prevalência de periodontite pode variar quando diferentes critérios foram utilizados para o diagnóstico. A padronização da definição de periodontite em estudos epidemiológicos é crucial para melhor comparação entre os estudos e melhoria dos resultados.(AU)

Avaliação do risco periodontal em terapia periodontal de manutenção / Periodontal risk assessment in maintenance therapy

Este estudo teve como objetivo fazer uma avaliação do risco em indivíduos cooperadores inseridos em um programa de terapia de manutenção periodontal (TMP), através do modelo ARP (avaliação do risco periodontal) proposto por um estudo prévio1. Metodologia: foram elegíveis para determinação do risco individual pelo modelo ARP, 150 indivíduos considerados cooperadores regulares, que finalizaram terapia periodontal ativa na Faculdade de Odontologia da Universidade Federal de Minas Gerais, Brasil. Resultados: a amostra total foi composta de dois indivíduos (1,3%) de baixo risco (BR), 83 (55,3%) de moderado risco (MR) e 65 (43,4%) de alto risco (AR) à periodontite. Na última rechamada, os 150 indivíduos tinham médias de sangramento a sondagem (SS) de 29,06%, sendo em BR=16,07; MR=24,21 e AR=35,65, e média de bolsas residuais (profundidade de sondagem ≥ 5 mm) =1,15 mm (BR sem bolsas; MR=0,58 e AR=1,91). A amostra tinha um total de 854 dentes perdidos, com média de perda dentária de 5,69 (BR=1,50; MR=4,54 e AR=7,29 dentes perdidos). O fator relação perda óssea por idade teve uma média de 1,00 (BR=0,54; MR=0,87 e AR=1,19). Conclusão: a adoção do modelo ARP contribui para a determinação do risco dos indivíduos, permitindo que estes escores sejam comparados ao longo do tempo. Assim, este instrumento pode ser válido para monitorar variáveis mutáveis de risco e auxiliar na estratégia de tratamento e cooperação nos programas de TMP.

Associação entre doença periodontal e doenças respirtória: o estado da ciência / Association between periodontal and respiratory diseases: the state of science

A doença periodontal crônica tem sido apontada como um provável fator de risco para várias doenças sistêmicas. Pesquisas sugerem uma associação entre pobre saúde bucal e doenças respiratórias crônicas, como a pneumonia e a doença pulmonar obstrutiva crônica. Essas infecções respiratórias envolvem a aspiração de patógenos oriundos da orofaringe para o trato respiratório inferior. O biofilme dentário pode servir como reservatório para os patógenos respiratórios; sendo assim, a combinação de higiene bucal e saúde periodontal deficientes pode aumentar o risco às doenças respiratórias, pela colonização de patógenos na orofaringe. Esse estudo objetivou analisar a evidência atual sobre a associação entre a doença periodontal e doenças respiratórias.

Efeito da periodontite sobre o diabetes mellitus: análise crítica de estudos observacionais / Effect of Periodontitis on the Diabetes Mellitus: critical analysis of observational studies

O Diabetes mellitus (DM) é considerado um fator de risco para o desenvolvimento da Periodontite (PE), contribuindo para maior prevalência e gravidade da alteração periodontal. Por outro lado, estudos epidemiológicos sugerem que a infecção periodontal pode favorecer um quadro de desequilíbrio insulínico e de manifestações de complicações associadas ao DM. O objetivo desta revisão de literatura é analisar de forma crítica os estudos que investigam a possível relação entre PE e DM. Concluiu-se que a maioria dos estudos analisados sugere que a PE pode afetar o controle glicêmico bem como as complicações associadas ao DM

Diabetes Mellitus (DM) is considered a risk factor for the development of periodontitis (PE), contributing to higher prevalence and severity of periodontal changes. Moreover epidemiological studies suggest that periodontal infection may foster an imbalance of insulin and signs of complications associated with DM. The aim of this review is to analyze critically the studies investigating the possible relationship between PE and DM. It was concluded that the most of the studies reviewed suggests that PE may affect glycemic control and complications associated with DM