Impacto do uso sistêmico de estatinas e de bisfosfonatos nos tecidos periodontais: revisão narrativa / Impact of the systemic use of statins and bisphosphonates in the periodontal tissues: narrative review

Introdução: A literatura tem apontado uma possível relação entre diversas condições sistêmicas e as doenças periodontais. Dentro das doenças sistêmicas que podem gerar o uso crônico de medicamentos, com potencial associação com as doenças periodontais, destacam-se a hipercolesterolemia e o uso de estatinas; e as doenças do metabolismo ósseo e o uso de bisfosfonatos. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura sobre o efeito das estatinas e dos bisfosfonatos nos parâmetros clínicos e radiográficos periodontais de indivíduos adultos. Resultados: Apenas estudos observacionais em humanos foram incluídos. Um estudo mostrou que, em pacientes que apresentam doença periodontal e usam estatina, houve 37% menos bolsas periodontais (profundidade de sondagem ≥4mm) quando comparadas aos que não utilizam a medicação, além de apresentarem menor índice de carga inflamatória e menor perda de inserção clínica. Em relação aos bisfosfonatos em indivíduos com doenças que envolvem o metabolismo ósseo, sugere-se que a utilização do fármaco tem obtido resultados positivos nos parâmetros periodontais, como menores sinais clínicos de inflamação gengival, menor profundidade de sondagem, menor perda de inserção clínica e maior nível de osso alveolar, quando comparados aos que nunca realizam essa terapia. Conclusão: Dessa forma, as estatinas e os bisfosfonatos apresentam efeitos promissores, em pacientes sob tratamento para suas respectivas condições sistêmicas, na melhoria dos parâmetros periodontais, porém é importante salientar que são necessários mais estudos sobre o assunto para melhor entender os reais efeitos a longo prazo do uso desses fármacos.(AU)

Introduction: The literature showed a possible relationship between several systemic conditions and periodontal diseases. Within the systemic diseases that can generate the chronic use of these drugs, potentially related with periodontal diseases, it may be cited the hypercholesterolemia and the use of statins; and bone metabolism diseases and the use of bisphosphonates. Objective: In this sense, the present study aimed to review the literature about the effect of statins and bisphosphonates in the periodontal parameters of adults individuals. Results: Only observational studies in humans were included. A study showed that, in patients with periodontal disease and users of statins, there 37% fewer periodontal pockets (probing depth ≥4mm) when compared to those who do not use the medication, as well as having a lower rate of inflammatory burden and less loss of clinical insertion. Regarding the bisphosphonates in individuals diagnosed with diseases involving bone metabolism, it was suggested that the use of the drug has obtained positive results in periodontal parameters, such as a greater absence of plaque, less clinical signs of gingival inflammation, less probing depth, lower level of clinical insertion and higher level of alveolar bone when compared to those who never undergo this therapy. Conclusion: Thus, statins and bisphosphonates have promising effects in patients under treatment for their respective systemic condition in improving periodontal parameters, but it is important to emphasize that further studies on the subject are needed to better understand the long-term effects of the use of these drugs.(AU)

Dispositivos de Administración Electrónica de Nicotina y sus Efectos en los Tejidos Periodontales y la Región Orofacial: Revisión de la Literatura / Electronic Nicotine Delivery Systems and their Effect in Periodontal Tissue and the Orofacial Region. A Review

RESUMEN: Los dispositivos de administración electrónica de nicotina aparecieron con el objetivo de reemplazar el uso del tabaco y contribuir al reciente crecimiento de las políticas antitabaco. Actualmente, los efectos que producen los químicos que contiene son desconocidos. El objetivo de este trabajo consistió en describir la información encontrada en la literatura sobre los posibles daños generados por los dispositivos de administración electrónica de nicotina, en la cavidad bucal y los tejidos periodontales. Se realizó una búsqueda electrónica y manual, sin límite de idioma ni año. Se excluyeron, opiniones de expertos y artículos que estudiaran otros dispositivos de administración de nicotina. Se seleccionaron 18 artículos, 7 estudios in-vitro, 2 estudios longitudinales, 2 ensayos clínicos y 7 reportes de caso. Se encontró que existen niveles de citotoxicidad elevados, observando cambios a nivel de morfología y metabolismo celular. Sin embargo, si lo comparamos con el tabaco, se observa que los niveles de toxicidad son menores en los dispositivos de administración electrónica de nicotina. En los estudios longitudinales y ensayos clínicos se observó un aumento del sangramiento al sondaje y de la circulación sanguínea, medida con láser Doppler, al cambiar de cigarro convencional a cigarro electrónico. Los reportes de caso informan de importantes traumatismos en el territorio maxilofacial, causados por la explosión de estos dispositivos, durante su uso. Los dispositivos de administración electrónica de nicotina son tóxicos a nivel de las células periodontales, generando necrosis y daños al ADN celular. Presentan riesgos de uso, reportándose traumatismos graves a nivel oral y maxilofacial, por sobrecalentamiento de las baterías. Los ensayos clínicos y estudios longitudinales no fueron concluyentes, por lo que se debe seguir investigando en la materia.

ABSTRACT: Electronic nicotine delivery systems were introduced to replace tobacco use and contribute to the anti-smoking policies. Today, the effect the chemicals it contains produce in the human body, are unknown. The aim of this work was to describe the information found in the literature about the possible damage produced in the periodontal tissue and the oral cavity, by the electronic nicotine delivery systems. An electronic and manual search was carried by a single reviewer, without year or language limit, excluding expert's opinions and articles that studied other nicotine delivery systems. Eighteen articles were selected; 7 in vitro studies, 2 longitudinal studies, 2 clinical trials and 7 case reports. Toxicity levels were found to be high, showing changes in cellular morphology and metabolism. Comparing with conventional cigarette, toxicity levels were lower in the electronic nicotine delivery systems. Longitudinal studies and clinical trials observed an increase in bleeding on probing and in blood circulation, by using laser doppler velocimetry, when changing from conventional cigarette to electronic cigarette. Also reports about explosions while using these electronic devises were encountered in the literature, with grave consequences in the maxillofacial territory. Electronic nicotine delivery systems show toxic levels, generating necrosis and DNA damage in periodontal ligament and gingival fibroblast cells. The risk of using these devices is high, due to possible explosion following overheating of the lithium battery, causing facial and oral trauma. Clinical trials and longitudinal studies were not conclusive, so investigations should continue in this matter.

Efectos del tabaquismo en la microbiota y tejido periodontal: revisión de la literatura / Effects of smoking on the microbiota and periodontal tissue: literature review

La Periodontitis es una enfermedad inflamatoria local crónica de los tejidos de soporte delos dientes que conduce a la pérdida progresiva del ligamento periodontal y del hueso alveolar. El tabaquismo es un factor de riesgo conocido para muchas enfermedades y la evidencia creciente sugiere que el tabaquismo afecta negativamente a la salud periodontal. El hábito del tabaquismo provoca el aumento de la flora bacteriana periodonto patógenas, aumentando su patogenicidad y alteraciones en el tejido periodontal, sin embargo el efecto del tabaquismo no es directamente a estas bacterias. La nicotina provoca una disminución del flujo sanguíneo y disminución de capilares lo que dificulta la respuesta inmune contra las bacterias patógenas. Además el sistema inmune se ve suprimido frente al tabaquismo, por lo que la acción de los leucocitos es escasamente eficaz para combatir la enfermedad periodontal. Como conclusión, el tabaquismo, principalmente la nicotina, afecta al flujo sanguíneo gingival, la producción de citocinas, la función de los neutrófilos, el recambio de tejido conectivo y como consecuencia de estos factores, aumenta el número de bacterias periodonto patógenas lo que afecta negativamente al tejido periodontal.

Periodontitis is a chronic local inflammatory disease of tissue supporting the teeth that leads to progressive loss of periodontal ligament and alveolar bone. Smoking is a known risk factor for many diseases and increasing evidence suggests that smoking negatively affects periodontal health. Cigarette smoking increased periodontal pathogenic bacterial flora, increasing their pathogenicity and alterations in the periodontal tissue, however the effect of smoking is not directly to these bacteria. Nicotine causes a decreased blood flow and decreased capillary hindering the immune response against pathogenic bacteria. In addition, the immune system is suppressed, so the action of leukocytes is poorly effective against periodontal disease. In conclusion, smoking, mainly nicotine, affects the gingival blood flow, cytokine production, the neutrophil function, replacement of connective tissue and because of these factors, increases the number of periodontal pathogenic bacteria which negatively affects the periodontal tissue.

Co-relation of body mass index, dental caries and periodontal status with fluorosis in different high fluoridated areas of Haryana state, India.

Background and Aim: The aim of the present study is to compare the effect of corticotomy versus prostaglandin E1 injection in human subjects on rate of tooth movement, anchorage loss and their effect on crest bone height and root length. Settings and Design: Clinical interventional study. Split mouth design was used. Materials and Methods: Study was done on 32 regular orthodontic patients. A volume of 100 mcg of prostaglandin E1 was injected on the right side once in 2 weeks and on the left side corticotomy was performed, and canine retraction was started on both sides simultaneously. The rate of space closure and anchorage loss was assessed with casts. The root length and crestal bone height changes were assed with IOPAs. The comparison of rate of tooth movement, anchorage loss, crestal bone height and root length changes between the sides were statistically analyzed using paired t-test. Results: The average rate of space closure on right side was 0.36 mm/week with a standard deviation of 0.05 mm/week and on the left side average rate of space closure was 0.40 mm/week with a standard deviation of 0.04 mm/week. The difference between the rate of closure between the right side and left where found to be statistically significant (P = 0.003). The anchorage loss, the crestal bone height changes and root length changes were not statistically significant. Conclusion: The rate of tooth movement was significantly more with corticotomies when compared with given dose of prostaglandin injection.

Evaluation of a model for induction of periodontal disease in dogs / Avaliação de um modelo para indução de doença periodontal em cães

There are several methods for inducing periodontal disease in animal models, being the bone defect one of the most reported. This study aimed to evaluate this model, through clinical, radiographic, tomographic and histological analyzes, thus providing standardized data for future regenerative works. Twelve dogs were subjected to the induction protocol. In a first surgical procedure, a mucoperiosteal flap was made on the buccal aspect of the right third and fourth premolars and a defect was produced exposing the furcation and mesial and distal roots, with dimensions: 5mm coronoapical, 5mm mesiodistal, and 3mm buccolingual. Periodontal ligament and cementum were curetted and the defect was filled with molding polyester, which was removed after 21 days on new surgical procedure. Clinical and radiographic examinations were performed after the two surgeries and before the collection of parts for dental tomography and histological analysis. All animals showed grade II furcation exposure in both teeth. Clinical attachment level increased after induction. Defect size did not change for coronoapical and buccolingual measurements, while mesiodistal size was significantly higher than at the time of defect production. Radiographic analysis showed decreased radiopacity and discontinuity of lamina dura in every tooth in the furcation area. The horizontal progression of the disease was evident in micro-computed tomography and defect content in the histological analysis. Therefore, it is concluded that this method promotes the induction of periodontal disease in dogs in a standardized way, thus being a good model for future work.

Existem vários métodos para indução de doença periodontal em modelos animais, sendo o do defeito ósseo um dos mais descritos. Este estudo objetiva avaliar esse modelo em cães, por análises clínica, radiográfica, tomográfica e histológica, fornecendo assim dados padronizados para trabalhos futuros. Doze cães foram submetidos ao protocolo de indução. Em um primeiro procedimento cirúrgico, um retalho mucoperiosteal foi produzido na face vestibular do terceiro e do quarto dentes pré-molares direitos e foi criado um defeito, expondo a furca e parte das raízes mesial e distal, com as dimensões: 5 mm corono-apical, 5 mm mesio-distal e 3 mm vestíbulo-lingual. O ligamento periodontal e o cemento foram curetados e o defeito foi então preenchido com poliéster de moldagem, que foi removido após 21 dias em um novo procedimento cirúrgico. Exames clínicos e radiográficos foram realizados após as duas cirurgias e antes da coleta dos dentes e tecidos associados para análise tomográfica e histológica. Todos os animais apresentaram exposição de furca grau II em ambos os dentes. O nível clínico de inserção aumentou após a indução. O tamanho do defeito não apresentou alteração nas medidas corono-apical e vestíbulo-lingual, enquanto o tamanho mesio-distal foi significativamente maior que o produzido. Análise radiográfica mostrou diminuição da radiopacidade e descontinuidade da lamina dura na região da furca dos dois dentes. A progressão horizontal da doença foi evidente na microtomografia e pelo conteúdo do defeito nas análises histológicas. Assim, conclui-se que este modelo promove a indução de doença periodontal em cães de forma padronizada, sendo um bom modelo para trabalhos futuros.

Efecto de los antagonistas de los receptores AT1 de la angiotensina II sobre la enfermedad periodontal inducida por inyecciones de lipopolisacáridos en ratas / Effect of ang II AT1 receptor antagonists, on periodontal disease induced by injections of lipopolysaccharide in rats

La Enfermedad Periodontal (EP) es una condición inflamatoria progresiva que afecta los tejidos que soportan y rodean a los dientes. Las endotoxinas bacterianas como los lipopolisacáridos (LPS), inducen una cascada inflamatoria causando resorción ósea mediante la producción y modulación de la red de citoquinas del tejido periodontal, del sistema RANK-RANKL-OPG y de la producción de especies reactivas del oxígeno (ERO). Siendo la vía final la activación del factor de transcripción NFκB para el control de la infección. Se sabe que el Sistema Renina Angiotensina (SRA) esta involucrado en la inflamación. Estas acciones pro-inflamatorias de la Ang II son producidas por la activación de NFkB mediante los receptores AT1, y por la generación de ERO. Nuestro objetivo fue determinar si la inhibición del receptor AT1 con el uso del valsartán reduciría la respuesta inmunitaria innata inflamatoria en un modelo de EP inducida por las inyecciones de LPS en la encía de las ratas. Nuestros resultados demuestran que el Valsartán disminuyó la leucocitosis sistémica, la movilidad dentaria, atenuó la pérdida de peso corporal de las ratas, disminuyó la formación de enzimas antioxidantes y NOS, redujo la producción y liberación de citocinas pro inflamatorias y aumentó las citocinas antinflamatorias, disminuyó la activación de p-p38, p-NFkB y la expresión de los receptores TLR4. El Valsartán también revirtió los efectos del LPS sobre la resorción ósea ya que disminuyó el número de osteoclastos, la expresión de los receptores RANK/RANKL/OPG y la relación RANKL/OPG y aumentó los depósitos de calcio y colágeno. Los mecanismos por los cuales el Valsartán reduce los efectos inflamatorios producidos por el LPS no están claras, pero la interferencia del ensamblaje de la NAD(P)H oxidasa con apocinina y el Tempol, indica que el Valsartán puede interferir con los pasos para el reconocimiento de LPS y su asociación con TLR4. Concluyéndose que las ERO participan en la señalización intracelular de la ANG II, vía el AT1R. Este estudio ayuda a dilucidar el papel del SRA en procesos inflamatorios. Además contribuye con sus resultados a ofrecer una alternativa terapéutica en el tratamiento de la EP.

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. Objective: The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. Material and methods: Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson’s correlation test and Spearman’s correlation test. Results: The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. Conclusions: These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

Periodontal disease induced by porphyromonas gingivalis and fusobacterium nucleatum in Wistarrats / Periodontite induzida pela porphyromonas gingivalis e fusobacterium nucleatum em ratos Wistar

Prior studies have shown that it is necessary to place ligatures around molars to study periodontal destruction in rats. The present research aims to examine a periodontal disease model in which specific pathogen-free Wistar rats are orally exposed to Porphyromonas gingivalis associated with Fusobacterium nucleatum. Periodontitis was induced by specific infection with P. gingivalis and F. nucleatum. Twenty adult male Wistar rats were divided into two groups. The control animals were not infected. The experimental animals were repeatedly infected with Porphyromonas gingivalis and Fusobacterium nucleatum for one week. For the next three weeks, the animals were repeatedly infected with P. gingivalis alone. The distance from the cemento-enamel junction (CEJ) to the alveolar bone crest of the second molar was measured at different sites: buccal-distal (d), buccal-furcation region (f), buccal-mesial (h), and area region. The Mann-Whitney test was applied (p<0.001). The results showed that all values obtained were significantly greater in the infected group. Infected group values for the measures d, f, h, and area were 0.41 mm, 0.46 mm, 0.67mm, and 1.04 mm2, respectively, while in the control group, values for the measures d, f, h, and area were0.19 mm, 0.26 mm, 0.26 mm, 0.88 mm2, respectively. Our study showed that four weeks following infection with Porphyromonas gingivalis and Fusobacterium nucleatum bone loss in Wistar rats could be identified.