Oral Infections and Systemic Health - More than Just Links to Cardiovascular Diseases.

PURPOSE: During the past 20 years, a plethora of research reports has been published showing a statistical association between poor oral health and cardiovascular diseases. The aim of this narrative review was to focus on associations between oral infections and non-atherosclerosis-related systemic diseases. MATERIALS AND METHODS: An open literature search and evaluation of articles were conducted on Medline and Cochrane databases with the key words 'oral infection', 'periodontitis', 'pneumonia', 'osteoarthritis', 'rheumatic diseases', 'inflammatory bowel disease', 'kidney disease', 'liver diseases', 'metabolic syndrome', 'diabetes', 'cancer', 'Alzheimer's disease'. Cardiovascular diseases were excluded from the analysis. RESULTS: The scarcity of controlled studies did not allow conducting a systematic review with meta-analysis on the topics, but dental infections have been shown be associated with several general diseases also beyond the atherosclerosis paradigm. However, there is no causal evidence of the role of dental infections in this regard. Poor oral health has nevertheless often been observed to be associated with worsening of the diseases and may also affect treatments. CONCLUSIONS: Maintaining good oral health is imperative regarding many diseases, and its importance in the daily life of any patient group cannot be over emphasised.

Difference in the expression of inflammatory mediators in gingival crevicular fluid in postmenopausal patients with chronic periodontitis with and without menopausal hormone therapy.

OBJECTIVE: Hormonal changes experience by women produce significant changes in the periodontium. The aim of this study is to assess whether menopausal hormone therapy, in patients diagnosed with moderate chronic periodontitis and menopause presents a beneficial effect, in terms of clinical and immunological outcomes. STUDY DESIGN: Thirty subjects with moderate chronic periodontitis and menopause were selected and assigned to two groups in accordance to the presence of menopausal hormone therapy. Periodontal clinical parameters, microbiological samples and immunological variables were assessed in both groups. Inter-group differences were evaluated using non-paired Student t-tests and chi square tests. Also, Pearson coefficient correlation was performed to determine the correlation between variables. RESULTS: There were statistically significant differences between groups for clinical attachment level, probing pocket depth, interleukin 1ß and interleukin 6. Smoking habit, deeper PPD and higher Il-6 levels in non-menopausal hormone therapy users group, tend to increase the interleukin 1ß GCF levels. These findings were supported by serum estrogen levels. The variables levels were higher in the menopausal hormone therapy users group. CONCLUSION: Within the limitations of the present study, the hypothesis that menopausal hormone therapy user's women will show better periodontal status and differences in immunological variables respect to those being non-menopausal hormone therapy users was supported.

Impact of abutment material on peri-implant soft tissue color. An in vitro study.

OBJECTIVES: The objectives of the present study is to determine the differences in peri-implant soft tissue color with the utilization of titanium, titanium gold-plated, white zirconia, Vita Classical (VC) A4-shaded zirconia, and fluorescent white zirconia abutments and to establish the influence of gingival thickness on the resulting color. METHODS: Four implants were contralaterally inserted in 19 fresh pig mandibles, and the color of the peri-implant mucosa with the different abutments was spectrophotometrically measured at 1-, 2-, and 3-mm height from the margin. RESULTS: At 1-mm height, titanium significantly differed from all zirconia abutments in lightness (L*), chroma along red axis (a*), and chroma along yellow-blue axis (b*) parameters. At 2 mm, all zirconia abutments differed from titanium in b* but only fluorescent zirconia in a*. At 3 mm, titanium differed from VC A4-shaded and fluorescent zirconia abutments in b*. At soft tissue thicknesses <1 and 1-2 mm, titanium differed from fluorescent zirconia in a* and b* and from VC A4-shaded zirconia in b*; at thickness >2 mm, no differences were found among abutments. All abutments differed from natural teeth in a* and b* at all heights and thicknesses except for fluorescent zirconia at thickness >2 mm. The Euclidean distance (ΔΕ) differed between titanium abutments and gold, VC A4, and fluorescent zirconia at <1- and 1-2-mm thicknesses. CONCLUSION: The natural gingival color was not reproduced with any abutment at gingival thicknesses <2 mm. The worst color match was with titanium abutments and the best with fluorescent zirconia, followed by VC A4-shaded zirconia. At gingival thicknesses >2 mm, no differences were detected among abutments. CLINICAL RELEVANCE: This study demonstrates that the type of abutment and the gingival thickness affect the resulting peri-implant gingival color.

Diabetes y periodontitis: una relación bidireccional / Diabetes and periodontitis: A bidirectional relationship

La diabetes mellitus es un grupo de enfermedades metabólicas caracterizadas por una hiperglucemia resultante de un defecto en la secreción de insulina, un defecto en la acción de esta, o bien una combinación de ambos. La periodontitis se considera actualmente una infección crónica localizada en la cavidad oral, que puede activar la respuesta inmunitaria inflamatoria del hospedador a nivel local y sistémico, y que además puede ser una fuente de bacteriemia. Hoy en día se sabe que la periodontitis tiene una influencia sobre la patogénesis de ciertas enfermedades sistémicas. La relación biológica entre la diabetes y la enfermedad periodontal está bien documentada. A mediados de la década de 1990 se encontró soporte científico suficiente para la asociación entre la diabetes y la periodontitis, que se comenzó a designar como la sexta complicación de la diabetes. Se han realizado estudios que muestran una mejora tanto en los parámetros clínicos e inmunológicos de la periodontitis como en el control glucémico a largo plazo de la diabetes tras el tratamiento de la enfermedad periodontal. Además, la evidencia científica confirma que un peor control glucémico contribuye a un peor estado periodontal. La interrelación entre ambas afecciones deja constancia de la importancia de la necesidad de una buena comunicación entre el médico internista y el odontólogo de los pacientes diabéticos, teniendo siempre en cuenta la posibilidad de que ambas enfermedades puedan estar ocurriendo simultáneamente, para garantizar el diagnóstico precoz de ambas (AU

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both (AU)

Factors involved in the spectrophotometric measurement of soft tissue: A clinical study of interrater and intrarater reliability.

STATEMENT OF PROBLEM: The reliability of spectrophotometric measurements of gingival color has not been tested. PURPOSE: The purpose of this study was to evaluate the repeatability and reproducibility of gingival color measurements with a digital spectrophotometer. Measurement error was estimated by determining the interrater agreement and by repeating measurements in different illumination environments with and without contact of the device with the gingiva. MATERIAL AND METHODS: Two trained examiners measured the gingival shade around 30 central incisors with a spectrophotometer with and without external illumination and with and without contact of the device with the gingiva. Color data obtained (CIELab color coordinates; L*, c*, h*, a*, b*) were analyzed with the intraclass correlation coefficient (ICC) and the Student t test for paired samples. RESULTS: Mean L*, c*, a*, and b* values differed significantly between measurements made with and without contact of the device with the tissue, but no difference was found in h* values. An ICC of >0.9 was obtained for interrater and intrarater agreements in all cases. Shade measurements did not differ between the presence and absence of stable ambient light. CONCLUSIONS: The repeatability and reproducibility of soft tissue shade measurements were almost perfect (ICC >0.9) under the examination conditions tested. The measurements were affected by pressure but not by ambient light.

Reacciones adversas a medicamentos en la cavidad oral / Side effects of drugs on the oral cavity

A pesar de que los fármacos son la herramienta terapéutica más potente de la que disponemos para mejorar la calidad de vida de la población, su uso no está exento de efectos adversos. Hoy en día son muchos los pacientes polimedicados, siendo complicado encontrar la causa de los efectos adversos generados por la medicación y aumentando estos de manera exponencial cuando se combinan más de 4 fármacos. Existe un amplio número de fármacos que pueden dar lugar a numerosos efectos adversos en la cavidad bucal. Los más frecuentes son la xerostomía, las alteraciones del gusto, el agrandamiento gingival y las mucositis producidas por el tratamiento oncológico. También se revisan otras alteraciones de las glándulas salivales, las alteraciones de la mucosa oral, las pigmentaciones, la halitosis, la osteonecrosis, las infecciones oportunistas y las diátesis hemorrágicas (AU)

Although drugs are the most powerful therapeutic tools we have for improving the quality of life of the population, their use is not free of adverse effects. Today there are many polymedicated patients, and it is difficult to find the cause of their adverse effects that increase exponentially when more than 4 drugs are combined. There are a large number of drugs that can result in numerous adverse effects in the oral cavity. The most common are xerostomia, altered taste, gingival enlargement and mucositis caused by cancer treatment. We also review other disorders of the salivary glands, oral mucosal changes, pigmentations, halitosis, osteonecrosis, opportunistic infections and bleeding diathesis (AU)

[Diabetes and periodontitis: A bidirectional relationship]. / Diabetes y periodontitis: una relación bidireccional.

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both.

Immune-mediated diseases: what can be found in the oral cavity?

Immune-mediated diseases frequently affect oral mucosa, which may often be the first site of clinical manifestation. In this review, we describe the most important oral lesions related to inflammatory disorders and present their management and novel therapies. The review is based on an open PubMed literature search from 1980 to 2012 with relevant keywords. Pemphigus vulgaris, oral lichen planus, cicatricial pemphigoid, erythema multiforme, Stevens-Johnson syndrome, systemic lupus erythematosus, Sjögren's syndrome, and linear IgA dermatosis are the immune-mediated diseases with oral manifestations discussed. Etiology is unknown in most of these diseases, but recently some of them have been found to share common genes. Modern treatment of these diseases is based on drugs that interfere along the pathogenic mechanisms instead of the still commonly used palliative measures. However, the immunomodulatory drugs may also cause oral side effects, complicating the clinical picture. Therefore, consulting dental or oral medicine specialists can be necessary in some cases with various immune-mediated diseases.

[Side effects of drugs on the oral cavity]. / Reacciones adversas a medicamentos en la cavidad oral.

Although drugs are the most powerful therapeutic tools we have for improving the quality of life of the population, their use is not free of adverse effects. Today there are many polymedicated patients, and it is difficult to find the cause of their adverse effects that increase exponentially when more than 4 drugs are combined. There are a large number of drugs that can result in numerous adverse effects in the oral cavity. The most common are xerostomia, altered taste, gingival enlargement and mucositis caused by cancer treatment. We also review other disorders of the salivary glands, oral mucosal changes, pigmentations, halitosis, osteonecrosis, opportunistic infections and bleeding diathesis.

Aplicación de un gel de ácido tranexámico en pacientes tratados con anticoagulantes orales / Tranexamic acid gel in patients treated with oral anticoagulants

Fundamento y objetivo: Los pacientes en tratamiento con anticoagulantes orales tienen mayor susceptibilidad a la hemorragia y, por tanto, cualquier procedimiento médico quirúrgico, en especial la cirugía bucal, requiere un enfoque terapéutico que minimice los efectos hemorrágicos en estos pacientes y, por lo tanto, sus complicaciones. Material y método: La hipótesis de trabajo se basó en los estudios sobre aplicación local del ácido tranexámico después de las intervenciones maxilofaciales como alternativa terapéutica eficaz para la prevención y control de la hemorragia. El objetivo fue evaluar la eficacia de la aplicación de una solución en gel de ácido tranexámico después de una extracción dental, en pacientes bajo tratamiento anticoagulante, en términos de tiempo de cicatrización y grado de cicatrización. Resultados: Los resultados indican que la aplicación del gel de ácido tranexámico resulta muy efectiva por su consistencia y permanencia en su lugar de acción y, además, demuestra su eficacia como material procoagulante. Conclusiones: La aplicación del ácido tranexámico en gel (Kin Exogel) en pacientes en tratamiento con anticoagulantes orales favorece el grado de cicatrización y la coagulación en las primeras 48-72 h (AU)

Background and objective: Patients treated with oral anticoagulants have increased susceptibility to bleeding, and therefore any surgical medical procedure and especially oral surgery requires a therapeutic approach that minimizes bleeding effects in these patients. Material and method: The working hypothesis was based on studies of local application of tranexamic acid after maxillofacial interventions as effective therapeutic alternative for the prevention and control of bleeding. The aim was to assess the effectiveness of the application of a gel solution tranexamic acid after tooth extraction in anticoagulated patients in terms of healing time and degree of healing. Results: The results indicate that application of tranexamic acid gel is very effective for consistency and maintenance in the place of action and shows its efficacy as a procoagulant material. Conclusions: The application of a gel solution of tranexamic acid in oral anticoagulants patients ameliorates healing time and the bleeding time within the first 48-72 h (AU)

Diabetes and periodontal disease. Review of the literature.

Diabetes mellitus (DM) is a metabolic disease characterized by an increased blood glucose level, while periodontal disease is mainly characterized by the destruction of tooth support tissues. Detailed investigation is warranted to consider these highly prevalent chronic diseases together and analyze their mutual influence. Over the years, various biologically plausible mechanisms have been established for a common inflammatory etiopathogenesis of these diseases. Numerous epidemiological studies have found a high degree of association between DM and periodontal disease, and periodontal disease has even been proposed as a sixth complication of DM. It has also been demonstrated that this relationship is bidirectional, with periodontitis exerting an effect on DM. These findings have diagnostic and therapeutic implications. Thus, the high prevalence of periodontal disease in DM indicates the need to evaluate glucose levels in periodontal patients. Conversely, intervention studies have demonstrated that the treatment of periodontal disease improves the glycemic control of DM patients.

Halitosis: un problema médico y social / Halitosis: A medical and social problem

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Immunomodulatory drugs: Oral and systemic adverse effects

OBJECTIVES: The main objectives are to present the different adverses effects of the immunomodulatory drugs that can impair the quality of life of the immunosupressed patients and study the impact of immunomodualtion on oral diseases. Immunomodulatory drugs have changed the treatment protocols of many diseases where immune functions play a central role, such as rheumatic diseases. Their effect on oral health has not been systematically investigated, however. Study DESIGN: We review current data on the new immunomodulatory drugs from the oral health perspective based on open literature search of the topic. RESULTS: These target specific drugs appear to have less drug interactions than earlier immunomodulating medicines but have nevertheless potential side effects such as activating latent infections. There are some data showing that the new immunomodulatory drugs may also have a role in the treatment of certain oral diseases such as lichen planus or ameliorating symptoms in Sjögren's syndrome, but the results have not been overly promising. CONCLUSIONS: In general, data are sparse of the effect of these new drugs vs. oral diseases and there are no properly powered randomized controlled trials published on this topic

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Immunomodulatory drugs: oral and systemic adverse effects.

OBJECTIVE: The main objectives are to present the different adverse effects of the immunomodulatory drugs that can impair the quality of life of the immunosuppressed patients and study the impact of immunomodulation on oral diseases. Immunomodulatory drugs have changed the treatment protocols of many diseases where immune functions play a central role, such as rheumatic diseases. Their effect on oral health has not been systematically investigated, however. STUDY DESIGN: We review current data on the new immunomodulatory drugs from the oral health perspective based on open literature search of the topic. RESULTS: These target specific drugs appear to have less drug interactions than earlier immunomodulating medicines but have nevertheless potential side effects such as activating latent infections. There are some data showing that the new immunomodulatory drugs may also have a role in the treatment of certain oral diseases such as lichen planus or ameliorating symptoms in Sjögren's syndrome, but the results have not been overly promising. CONCLUSION: In general, data are sparse of the effect of these new drugs vs. oral diseases and there are no properly powered randomized controlled trials published on this topic.

[Tranexamic acid gel in patients treated with oral anticoagulants]. / Aplicación de un gel de ácido tranexámico en pacientes tratados con anticoagulantes orales.

BACKGROUND AND OBJECTIVE: Patients treated with oral anticoagulants have increased susceptibility to bleeding, and therefore any surgical medical procedure and especially oral surgery requires a therapeutic approach that minimizes bleeding effects in these patients. MATERIAL AND METHOD: The working hypothesis was based on studies of local application of tranexamic acid after maxillofacial interventions as effective therapeutic alternative for the prevention and control of bleeding. The aim was to assess the effectiveness of the application of a gel solution tranexamic acid after tooth extraction in anticoagulated patients in terms of healing time and degree of healing. RESULTS: The results indicate that application of tranexamic acid gel is very effective for consistency and maintenance in the place of action and shows its efficacy as a procoagulant material. CONCLUSIONS: The application of a gel solution of tranexamic acid in oral anticoagulants patients ameliorates healing time and the bleeding time within the first 48-72 h.

Evaluation of p53, Caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain)

Objectives: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. Study Design: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 Results: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. Conclusions: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity (AU)

Efectos secundarios bucales de la radioterapia y quimioterapia en el cáncer en la región cervicofacial / Oral secondary effects of radiotherapy and chemotherapy in cancer of the cervicofacial region

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Evaluation of p53, caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain).

OBJECTIVE: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. STUDY DESIGN: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 RESULTS: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. CONCLUSIONS: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity.