Comparative study of the synovial levels of RANKL and OPG in rheumatoid arthritis, spondyloarthritis and osteoarthritis

Abstract Introduction In chronic arthropathies, there are several mechanisms of joint destruction. In recent years, studies have reported the implication of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) in the process of activation and differentiation of osteoclasts, a key cell in the development of bone erosion. The RANKL/OPG ratio is increased in the serum of patients with malignant diseases and lytic bone disease, as well as rheumatoid arthritis (RA). The objective of this study was to measure and compare the concentrations of OPG and RANKL in the synovial fluid (SF) of patients with rheumatoid arthritis, spondyloarthritis (SpA) and osteoarthritis (OA). Methods This was an observational and cross-sectional study with 83 patients, 33 with RA, 32 with SpA and 18 with OA, followed up regularly in the outpatient clinics of the Rheumatology Department of the Clinics Hospital of the Ribeirão Preto Medical School-USP. All patients were assessed for indications for arthrocentesis by the attending physicians at the time of SF collection and were evaluated for demographic variables and medication use. Disease activity was assessed in individuals with RA and SpA. The quantification of SF OPG and RANKL levels was performed by ELISA, and the correlations of the results with clinical, laboratory and radiological parameters were assessed. Results We found no statistically significant difference in the RANKL and OPG levels among the groups. Patients with RA showed a positive correlation between the SF cell count and RANKL level (r = 0.59; p < 0.05) and the RANKL/ OPG ratio (r = 0.55; p < 0.05). Patients with OA showed a strong correlation between C-reactive protein (CRP) and the RANKL/OPG ratio (r = 0.82; p < 0.05). There was no correlation between the OPG and RANKL levels and markers of inflammatory activity or the disease activity index in patients with RA or SpA. Conclusion Within this patient cohort, the RANKL/OPG ratio was correlated with the SF cell count in patients with RA and with serum CRP in patients with OA, which may suggest a relationship with active inflammation and more destructive joint disease.

Dysbiotic oral microbiota contributes to alveolar bone loss associated with obesity in mice

Abstract Periodontal diseases (PD) are inflammatory conditions that affect the teeth supporting tissues. Increased body fat tissues may contribute to activation of the systemic inflammatory response, leading to comorbidities. Some studies have shown that individuals with obesity present higher incidence of PD than eutrophics. Objective: To investigate the impact of obesity on periodontal tissues and oral microbiota in mice. Methodology: Two obesity mice models were performed, one using 12 weeks of the dietary protocol with a high-fat (HF) diet in C57BL/6 mice and the other using leptin receptor-deficient mice (db/db-/-), which became spontaneously obese. After euthanasia, a DNA-DNA hybridization technique was employed to evaluate the microbiota composition and topical application of chlorhexidine (CHX), an antiseptic, was used to investigate the impact of the oral microbiota on the alveolar bone regarding obesity. Results: Increased adipose tissue may induce alveolar bone loss, neutrophil recruitment, and changes in the oral biofilm, similar to that observed in an experimental model of PD. Topical application of CHX impaired bone changes. Conclusion: Obesity may induce changes in the oral microbiota and neutrophil recruitment, which are associated with alveolar bone loss.

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.

Comparative study of oral and salivary parameters in patients with and without loss of bone mass

Abstract Osteoporosis is an insidious and increasingly prevalent disease that can cause fractures and affect patients' quality of life. The current study comparatively evaluates patients with and without loss of bone mass in terms of salivary calcium, viscosity, and pH. A controlled cross-sectional study was conducted in two groups of 32 postmenopausal women subjected to a bone densitometry scan and later referred for dental management at the Federal University of Minas Gerais, Brazil. The patients were assigned to two groups: Group 1 - patients with low bone mineral density (BMD) and Group 2 - patients without bone mineral changes. The following salivary parameters were evaluated: calcium concentration, flow rate, viscosity, pH, and average total protein. An oral examination was performed for assessment of DMFT variables and tongue coating. Data were analyzed using descriptive and inferential statistics, adopting a p-value < 0.05. The patients' mean age was 60 years (± 7.35). Salivary flow, pH, and viscosity were similar among the groups. Average total protein was 14.8 mg/mL and 19.0 mg/mL in Groups 1 and 2, respectively. Tongue coating and salivary calcium levels were significantly higher in Group 1 (p < 0.001). Salivary calcium is an important screening tool and may eventually be used for the diagnosis of bone mineral changes.

Influência da deficiência de estrógeno na movimentação ortodôntica / The influence of estrogen deficiency in orthodontic tooth movement

O perfil dos pacientes que procuram tratamento ortodôntico mudou nas últimas décadas. O número de pacientes adultos e idosos do sexo feminino cresceu consideravelmente. Esta mudança na demanda trouxe desafios biológicos para o atendimento ortodôntico, por muitas vezes tratarem-se de pacientes com alterações sistêmicas ou sob uso de medicamentos controlados. Dentre estes, podese citar a deficiência de estrógeno e a osteoporose, comuns nessa faixa etária, e que podem interferir na movimentação dentária ortodôntica (MDO). Esta revisão de literatura se propõe a descrever os aspectos biológicos da movimentação ortodôntica e a identificar como a deficiência de estrógeno e a osteoporose podem interferir na remodelação óssea e, consequentemente, na MDO. Este artigo objetiva ainda alertar o ortodontista da importância de se avaliar cuidadosamente a condição sistêmica dos pacientes com possível deficiência de estrógeno/osteoporose, para um correto diagnóstico e elaboração do plano de tratamento.

An increasing number of adult patients are seeking for orthodontic treatment in the last decades, especially postmenopausal women. This represents a biological challenge for the orthodontic treatment, since these patients more often present systemic disorders or are routinely using controlling medication. Among them, estrogen deficiency and osteoporosis are commonly reported in elderly women. This review article elucidates the biological aspects of orthodontic tooth movement, emphasizing how the estrogen deficiency may interfere with this process. This literature review suggests that estrogen deficiency and the use of drugs for osteoporosis treatment may alter the bone remodeling and, consequently, the orthodontic tooth movement. The orthodontist must be aware of the patient’s systemic condition to better elaborate the correct treatment plan.

Ativaçäo osteoblástica e mecanismos de migraçäo de neutrófilos induzidos pela dentina / Osteoblastic activation and mechanisms of neurophil migration induced by dentin

Após a mineralizaçäo, as moléculas de dentina permanecem imobilizadas pela fase mineral da matriz, sendo expostas ou liberadas como conseqüência de danos ao ligamento periodontal e à polpa. Uma vez liberadas, estas moléculas poderiam participar na migraçäo e ativaçäo de células ósseas e inflamatórias influenciando o curso dos processos associados à dissoluçäo da matriz dentinária. Com o objetivo de avaliar a capacidade da dentina em induzir eventos inflamatórios, verificamos o efeito de extratos brutos na liberaçäo in vitro de mediadores inflamatórios por macrófagos e osteoblastos. Avaliamos ainda, a capacidade de extratos brutos e das Sialoproteína (DSP) e Fosfoproteína (DPP) dentinárias em induzir quimiotaxia de neutrófilos in vivo e caracterizamos os mediadores envolvidos neste processo. Os extratos dentinários induziram osteoblastos a produzir IL-1 , TNF- , IL-6, CINC-1 e IL-10, sem interferir com a morfologia e a diferenciaçäo destas células. Os extratos dentinários, a DSP e a DPP induziram macrófagos a produzir IL-1 , TNF- e as quimiocinas MIP-1 , KC e MIP-2, bem como estimularam a migraçäo de leucócitos de maneira dose-dependente. A investigaçäo dos mecanismos envolvidos revelou a participaçäo de IL-1 , TNF- , KC e MIP-2 e excluiu a participaçäo de prostaglandinas, leucotrienos e MIP-1 na migraçäo leucocitária. Observamos ainda que macrófagos e mastócitos respectivamente estimulam e inibem o recrutamento de neutrófilos induzido por DSP e DPP e que macrófagos estimulados in vitro produzem fator(es) quimiotático(s) para neutrófilos. A partir destes resultados, podemos concluir que a dentina é capaz de estimular a produçäo de mediadores inflamatórios, com reconhecida atividade sobre osteoclastos, por células osteoblásticas e macrófagos in vitro. Os mecanismos pelos quais as proteínas dentinárias induzem migraçäo de neutrófilos in vivo säo indiretos e dependentes de IL-1 , TNF- e das quimiocinas KC e MIP-2, sendo modulados por macrófagos e mastócitos

Pilomatricoma of the auricular region: case report

Pilomatricomas são tumores relativamente raros de origem ectodérmica a partir das células da bainha externa do folículo piloso. Estes se apresentam geralmente como nódulos dérmicos ou subcutâneos, usualmente assintomáticos, solitários, firmes ou duros e extremamente móveis. O objetivo deste artigo é apresentar um caso que ilustra a dificuldade de diagnóstico encontrada pelos cirurgiões e patologistas bucais e apresentar uma revisão da literatura relativa aos pilomatricomas da região auricular.

Fatores do comportamento relacionado à higiene bucal em adolescentes / Factors associated with oral hygiene in adolescents

O presente estudo visou analisar informaçöes sobre fatores de comportamento de adolescentes acerca de sua higiene bucal. Os dados obtidos foram coletados através de entrevistas realizadas em duas escolas, uma publica e uma particular, pertencentes a um mesmo bairro da cidade de Belo Horizonte MG- Brasil. A amostra constou de 117 adolescentes de ambos os sexos, com idades variando entre 14 e 17 anos. Os resultados indicaram que, indiferente à classe social e ao sexo, a escovaçäo se apresenta como um comportamento complexo com uma série de fatores influenciando sua prática, e que apesar dos adelescentes se preocuparem com a ocorrência da cárie dentária e com a limpeza de seus dentes, a escovaçäo para este grupo está fortemente associada a motivos relacionados à saúde bucal