Sleep disruption and Alzheimer's disease risk: Inferences from men with benign prostatic hyperplasia.

BACKGROUND: Sleep disturbances may increase risks of Alzheimer's disease (AD) and other dementias. Benign prostatic hyperplasia (BPH) is usually associated with lower urinary tract symptoms, including nocturia, and thereby disturbed sleep. We examined if men with BPH are at increased risk of AD and all-cause dementia. METHODS: In a Danish nationwide cohort (1996-2016), we identified 297,026 men with BPH, defined by inpatient or outpatient hospital diagnosis or by BPH-related surgical or medical treatment, and 1,107,176 men from the general population matched by birth year. We computed rates, cumulative incidences, and adjusted hazard ratios (HRs) of AD and all-cause dementia. Follow-up started 1 year after BPH diagnosis date/index date. FINDINGS: Median follow-up was 6·9 years (Interquartile range (IQR), 3·6 - 11·6 years] in the BPH cohort and 6·4 years (IQR: 3·4 - 10·8 years) in the comparison cohort. The cumulative 1-10 year risk of AD was 1·15% [95% confidence interval (CI), 1·11-1·20], in the BPH cohort and 1·00% (95% CI, 0·98 - 1·02) in the comparison cohort. The adjusted 1-10-year hazard ratios were 1·16 (95% CI: 1·10-1·21) for AD and 1·21 (95% CI: 1·17-1·25) for all-cause dementia. From >10 years up to 21 years of follow-up, BPH remained associated with 10%- 20% increased risk of AD and all-cause dementia. INTERPRETATION: During up to 21 years of follow-up, men with BPH had persistently higher risk of AD and all-cause dementia compared with men in the general population. Our results identify BPH as a common, potentially remediable disorder associated with dementia risk. FUNDING: Lundbeckfonden, Aarhus University Research Foundation, and the National Institutes of Health.

Comorbidity and risk of venous thromboembolism after hospitalization for first-time myocardial infarction: A population-based cohort study.

BACKGROUND: Myocardial infarction (MI) is a risk factor for venous thromboembolism (VTE). Although comorbidities affect MI prognosis, it is unclear whether they affect VTE risk after MI. OBJECTIVES: We examined the impact of comorbidity on VTE risk after MI. METHODS: We used nationwide population-based registries to identify first-time hospitalizations for MI and subsequent occurrence of VTE in Denmark (1995-2013). We included a comparison cohort from the general population matched 5:1 with MI patients by sex, age, and comorbidities. We computed 30-day and 1- to 12-month cumulative risks, rates, and hazard ratios of VTE. We also assessed the interaction between MI and comorbidity, defined as excess VTE risk in patients with both MI and comorbidity, by computing interaction contrasts and attributable fractions relating to the interaction. RESULTS: Thirty-day and 1- to 12-month VTE risks were 0.6% and 0.5% in the MI cohort (n = 160 338) and 0.03% and 0.3% in the comparison cohort (n = 792 384). The 30-day hazard ratio for VTE in the MI cohort was 23 (95% confidence interval, 20-27), which decreased during 1-year follow-up. Thirty days after MI, interactions between MI and comorbidity accounted for 16% and 39% of VTE rates in MI patients with low-to-moderate and high comorbidity, respectively. The interactions were driven primarily by hemiplegia and cancer. CONCLUSIONS: Thirty-day VTE risk was substantially increased after MI compared with the general population. Although the absolute VTE risk was low, comorbidity substantially increased this risk, especially hemiplegia and cancer. VTE prophylaxis might be indicated in such high-risk patients but warrants further investigation.

Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population-based cohort study.

BACKGROUND: Therapeutic advances have improved survival after hematological cancers. In turn, patients may be at increased risk of thromboembolic and bleeding events. OBJECTIVES: To examine the risks of myocardial infarction (MI), ischemic stroke, venous thromboembolism (VTE), and bleeding requiring hospital contact in patients with hematological cancers. METHODS: We conducted a Danish population-based cohort study (2000-2013). We identified all adult hematological cancer patients and sampled a general population comparison cohort in a 1:5 ratio matched by age, sex, previous thromboembolic events, bleeding, and solid cancer. Ten-year absolute risks of thromboembolism and bleeding were calculated and hazard ratios (HRs) were computed, controlling for matching factors. RESULTS: Among 32 141 hematological cancer patients, the 10-year absolute risk of any thromboembolic or bleeding complication following hematological cancer was 19%: 3.3% for MI, 3.5% for ischemic stroke, 5.2% for VTE, and 8.5% for bleeding. Except among patients with myeloid leukemia, acute lymphoid leukemia, or myelodysplastic syndrome, the risk of thromboembolic events surpassed that of bleeding. The hematological cancer cohort overall was at increased risk for MI [HR = 1.36, 95% confidence interval (CI): 1.25-1.49], ischemic stroke (HR = 1.22, 95% CI: 1.12-1.33), VTE (HR = 3.37, 95% CI: 3.13-3.64), and bleeding (HR = 2.39, 95% CI: 2.26-2.53) compared with the general population. CONCLUSIONS: Approximately 2 of 10 hematological cancer patients experienced MI, ischemic stroke, VTE, or bleeding requiring hospital contact within 10 years. The hematological cancer cohort had higher hazards of MI, ischemic stroke, VTE, and bleeding requiring hospital contact than a general population comparison cohort.

Osteonecrosis of the jaw and survival of patients with cancer: a nationwide cohort study in Denmark.

Osteonecrosis of the jaw (ONJ) is an adverse effect of bone-targeted therapies, which are used to prevent symptomatic skeletal events following bone malignancy. We examined the association between ONJ and survival among cancer patients treated with bone-targeted agents. Using nationwide registries and databases in Denmark, we identified 184 cancer patients with incident ONJ between 2010 and 2015, and a comparison cohort of 1067 cancer patients without ONJ and with a history of hospital-administered treatment with bisphosphonates or denosumab initiating from cancer diagnosis. At the date of confirmed ONJ diagnosis, the comparison cohort was matched to the ONJ patients on age, cancer site, year of cancer diagnosis, and stage at diagnosis. The patients were followed up for survival until emigration or 15 June 2016. We computed overall survival and estimated mortality rate ratios adjusted for sex, and for the presence of distant metastases and other comorbidity at start of follow-up. A match was found for 149 of the 184 ONJ patients. The 1- and 3-year survival among all 184 cancer patients with ONJ was 70% (95% confidence interval [CI]: 63%-76%) and 42% (95% CI: 34%-51%), respectively. Among the matched patients, ONJ was associated with an adjusted mortality rate ratio of 1.31 (95% CI: 1.01-1.71). ONJ was associated with reduced survival among cancer patients treated with bone-targeted agents. ONJ may be a marker of advanced disease or of survival-related lifestyle characteristics.

Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators.

We revisited the three interrelated epidemiological concepts of effect modification, interaction and mediation for clinical investigators and examined their applicability when using research databases. The standard methods that are available to assess interaction, effect modification and mediation are explained and exemplified. For each concept, we first give a simple "best-case" example from a randomized controlled trial, followed by a structurally similar example from an observational study using research databases. Our explanation of the examples is based on recent theoretical developments and insights in the context of large health care databases. Terminology is sometimes ambiguous for what constitutes effect modification and interaction. The strong assumptions underlying the assessment of interaction, and particularly mediation, require clinicians and epidemiologists to take extra care when conducting observational studies in the context of health care databases. These strong assumptions may limit the applicability of interaction and mediation assessments, at least until the biases and limitations of these assessments when using large research databases are clarified.

Long-Term Risk of Dementia Among Survivors of Ischemic or Hemorrhagic Stroke.

BACKGROUND AND PURPOSE: Stroke is a risk factor for dementia, but the risk of dementia after different stroke types is poorly understood. We examined the long-term risk of dementia among survivors of any first-time stroke and of first-time ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. METHODS: We conducted a 30-year nationwide population-based cohort study using data from Danish medical databases (1982-2013) covering all Danish hospitals. We identified 84 220 ischemic stroke survivors, 16 723 intracerebral hemorrhage survivors, 9872 subarachnoid hemorrhage survivors, and 104 303 survivors of unspecified stroke types. Patients were aged ≥18 years and survived for at least 3 months after diagnosis. We formed a comparison cohort from the general population (1 075 588 patients without stroke, matched to stroke patients by age and sex). We computed absolute risks and hazard ratios of dementia up to 30 years after stroke. RESULTS: The 30-year absolute risk of dementia among stroke survivors was 11.5% (95% confidence interval, 11.2%-11.7%). Compared with the general population, the hazard ratio (95% confidence interval) for dementia among stroke survivors was 1.80 (1.77-1.84) after any stroke, 1.72 (1.66-1.77) after ischemic stroke, 2.70 (2.53-2.89) after intracerebral hemorrhage, and 2.74 (2.45-3.06) after subarachnoid hemorrhage. Younger patients regardless of stroke type faced higher risks of poststroke dementia than older patients. The pattern of hazard ratios by stroke type did not change during follow-up and was not altered appreciably by age, sex, or preexisting diagnoses of vascular conditions. CONCLUSIONS: Stroke increases dementia risk. Survivors of intracerebral hemorrhage and subarachnoid hemorrhage are at particularly high long-term risk of poststroke dementia.

Cancer, other comorbidity, and risk of venous thromboembolism after stroke: a population-based cohort study.

INTRODUCTION: The impact of cancer and other comorbidity on the risk of venous thromboembolism (VTE) after stroke is poorly understood. METHODS: We used Danish population-based national databases to conduct a cohort study encompassing 201,025 patients diagnosed with a first-time ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage or unspecified stroke between 1995 and 2012. As a comparison cohort, 983,222 members of the general population were matched to the stroke patients by date of diagnosis, year of birth, sex, and specific comorbidities, using conditions in the Charlson Comorbidity Index and other VTE risk factors. We computed VTE cumulative risks, rates, and rate ratios. We examined the interaction with comorbidity, defined as the excess VTE rates not explained by stroke and comorbidity alone, for up to five years following stroke. RESULTS: Five-year VTE risks were 2.1% and 1.9% in the stroke and comparison cohorts, respectively. Three-month VTE rates peaked at a 5-fold increase (95% confidence interval [CI]: 4.4; 5.2) in stroke patients and remained 13% to 43% increased relative to the general population during subsequent follow-up. During the first three months after stroke, 15% to 33% of the VTE rates were attributable to the interaction between stroke and moderate (2-3) to high (≥4) comorbidity based on Charlson Comorbidity Index scores. Non-metastatic solid tumors and metastatic disease accounted for most observed interaction with stroke, representing 41% and 56% of attributable three-month VTE rates, respectively. No such interaction between comorbidity and stroke was observed during subsequent follow-up. CONCLUSIONS: Comorbidity, particularly cancer, increased the risk of VTE within three months following stroke.

Predictors of smoking cessation in smokers with chronic periodontitis: a 24-month study.

The purpose of this 24-month study was to identify predictors of smoking cessation in a cohort of smokers with chronic periodontitis, attending a multidisciplinary smoking cessation program. Of the 286 subjects screened, 116 were included and received non-surgical periodontal treatment and smoking cessation therapy, which consisted of lectures, cognitive behavioral therapy, and pharmacotherapy, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists, during periodontal maintenance sessions at 3, 6, 12 and 24 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and was validated by exhaled carbon monoxide (CO) measurements. The Fagerström Test for Cigarette Dependence was used to assess smoking dependence. Of the 61 individuals that remained up to the 24-month examination, 31, 21 and 18 declared that they were not smoking at 3, 12 and 24 months, respectively. Smoking cessation after 24 months was associated with the male gender (OR = 3.77, 95%CI = 1.16-12.30), baseline CO levels less than 10ppm (OR = 5.81, 95%CI 1.76-19.23), not living or working with another smoker (OR = 7.38, 95%CI 1.76-30.98) and a lower mean Fagerström test score (OR = 5.63, 95%CI 1.55-20.43). We concluded that smoking cessation was associated with demographic, smoking history and cigarette dependence variables.

Predictors of smoking cessation in smokers with chronic periodontitis: a 24-month study

Abstract The purpose of this 24-month study was to identify predictors of smoking cessation in a cohort of smokers with chronic periodontitis, attending a multidisciplinary smoking cessation program. Of the 286 subjects screened, 116 were included and received non-surgical periodontal treatment and smoking cessation therapy, which consisted of lectures, cognitive behavioral therapy, and pharmacotherapy, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists, during periodontal maintenance sessions at 3, 6, 12 and 24 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and was validated by exhaled carbon monoxide (CO) measurements. The Fagerström Test for Cigarette Dependence was used to assess smoking dependence. Of the 61 individuals that remained up to the 24-month examination, 31, 21 and 18 declared that they were not smoking at 3, 12 and 24 months, respectively. Smoking cessation after 24 months was associated with the male gender (OR = 3.77, 95%CI = 1.16-12.30), baseline CO levels less than 10ppm (OR = 5.81, 95%CI 1.76-19.23), not living or working with another smoker (OR = 7.38, 95%CI 1.76-30.98) and a lower mean Fagerström test score (OR = 5.63, 95%CI 1.55-20.43). We concluded that smoking cessation was associated with demographic, smoking history and cigarette dependence variables.

Implications of less-than-perfect reliability of clinical parameters for the misclassification of periodontitis.

OBJECTIVE: This study aimed to evaluate and compare the misclassification of periodontitis using two operational protocols currently employed in research, as a result of intra-examiner less-than-perfect reliability of their formative clinical parameters. METHODS: Full-mouth duplicate recordings (six sites per tooth) of probing depth (PD) and clinical attachment level (CAL) were obtained by a single examiner, 1 week apart, from 148 adults with self-perceived need for periodontal treatment. They were used to classify periodontitis subjects according to the protocols proposed by the 5th European Workshop in Periodontology (EWP5) and the collaboration between the US Centre for Diseases Control and Prevention and the American Academy of Periodontology (CDC-AAP). RESULTS: Hundred percent and 91.2% of the subjects were classified as periodontitis cases according to the EWP5 and CDC-AAP protocols, respectively. Test-retest agreement was observed in 95% and 85% of the classified subjects according to the EWP5 and CDC-AAP protocols, respectively. The difference was statistically significant (P < 0.01). Alignment of protocols, in terms of number of classification categories, resulted in a similar test-retest agreement of 95% using the EWP5 protocol for extensive periodontitis and 90% using the CDC-AAP protocol for severe periodontitis (P = 0.09). Misclassification was nondifferential when subjects were classified according either to the EWP5 or the aligned CDC-AAP protocols, while the reliability using the original CDC-AAP protocol depended on the extent of bleeding on probing, CAL ≥3 mm and PD ≥4 mm. CONCLUSION: This study suggests the EWP5 protocol is less error-prone than the CDC-AAP protocol in adult subjects with perceived need for periodontal treatment, as a result of intra-examiner less-than-perfect reliability of periodontal clinical parameters. Extensive or severe cases presented similar misclassification. Further studies using survey-like conditions are recommended to confirm these findings.

Reliability of recordings of subgingival calculus detected using an ultrasonic device.

OBJECTIVES: To assess the intra-examiner reliability of recordings of subgingival calculus detected using an ultrasonic device, and to investigate the influence of subject-, tooth- and site-level factors on the reliability of these subgingival calculus recordings. MATERIALS AND METHODS: On two occasions, within a 1-week interval, 147 adult periodontitis patients received a full-mouth clinical periodontal examination by a single trained examiner. Duplicate subgingival calculus recordings, in six sites per tooth, were obtained using an ultrasonic device for calculus detection and removal. RESULTS: Agreement was observed in 65 % of the 22,584 duplicate subgingival calculus recordings, ranging 45 % to 83 % according to subject. Using hierarchical modeling, disagreements in the subgingival calculus duplicate recordings were more likely in all other sites than the mid-buccal, and in sites harboring supragingival calculus. Disagreements were less likely in sites with PD ≥ 4 mm and with furcation involvement ≥ degree 2. Bleeding on probing or suppuration did not influence the reliability of subgingival calculus. At the subject-level, disagreements were less likely in patients presenting with the highest and lowest extent categories of the covariate subgingival calculus. CONCLUSIONS AND CLINICAL RELEVANCE: The reliability of subgingival calculus recordings using the ultrasound technology is reasonable. The results of the present study suggest that the reliability of subgingival calculus recordings is not influenced by the presence of inflammation. Moreover, subgingival calculus can be more reliably detected using the ultrasound device at sites with higher need for periodontal therapy, i.e., sites presenting with deep pockets and premolars and molars with furcation involvement.

Effect of smoking cessation on non-surgical periodontal therapy: results after 24 months.

AIM: The aim of this 24-month prospective study was to assess the effect of smoking cessation on non-surgical periodontal therapy (NSPT) in adult subjects with chronic periodontitis. MATERIALS AND METHODS: Relative to a previous 12-month follow-up study, recruitment and follow-up period were extended, resulting in 116 eligible among the 286 screened subjects. They received NSPT and concurrent smoking cessation interventions. Periodontal maintenance was performed every 3 months. A calibrated examiner, blinded to smoking status, performed full-mouth periodontal examination in six sites per tooth at baseline, 3, 12 and 24 months of follow-up. Expired air carbon monoxide concentration measurements and interviews were performed to gather demographic and behavioural information. RESULTS: From the 116 enrolled subjects, 61 remained up to 24 months of follow-up. Of these, 18 quit smoking (Q), 32 continued smoking (NQ) and 11 oscillated (O) at 24 months of follow-up. Thereby, Q showed significantly higher mean CAL gain in diseased sites and higher reduction in the proportion of sites with CAL ≥ 3 mm, when compared to NQ. In addition, Q presented significantly higher mean probing depth reduction relative to NQ(p ≤ 0.05). CONCLUSION: Smoking cessation promoted additional benefits on NSPT in chronic periodontitis subjects.

Reliability of direct and indirect clinical attachment level measurements.

AIMS: To investigate the influence of subject-, tooth- and site-level characteristics on intra-examiner reproducibility of direct and indirect clinical attachment level (CALDIR and CALIND ) recordings, and to quantify the impact of less-than-perfect reliability on our ability to assess periodontitis progression. MATERIALS AND METHODS: Within a 1-week interval, a single examiner performed duplicate probing depth (PD), CALDIR and gingival recession (GR) recordings in six sites of all teeth present in 148 periodontitis patients. CALIND was calculated on the basis of the PD and GR. RESULTS: Agreement was observed in 65%, 62%, 69% and 84% of the duplicate CALDIR , CALIND , PD and GR recordings, respectively, and >95% of the differences were within ±1 mm. This study identified multiple predictors for CAL measurement errors ≥1 mm, including tooth and site location, presence of supra- and subgingival calculus, bleeding on probing and suppuration. Measurement errors were more likely in patients diagnosed with "extensive" rather than "less extensive" periodontitis. In over half of the patients, measurement error frequencies were too high to allow for detection of possible CAL changes ≥2 mm with a false-positive rate ≤5%. Detection of CAL changes with low false-positives was more likely using recordings obtained by the direct method. CONCLUSIONS: From a measurement error point of view, CALDIR recordings are preferable over CALIND .

Subgingival microbial profiles as diagnostic markers of destructive periodontal diseases: a clinical epidemiology study.

AIMS: To describe the subgingival microbial profiles of the major putative periodontal pathogens and investigate their role as diagnostic markers for destructive periodontal diseases in an untreated and isolated population. MATERIALS AND METHODS: The source population consisted of all subjects aged ≥ 12 years in an isolated Brazilian population. An interview and a full-mouth clinical examination were conducted and subgingival plaque samples were obtained from four sites per subject. PCR analyses were used to identify the following micro-organisms: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia and Campylobacter rectus. RESULTS: Among the 214 clinically examined subjects (81% response), 170 of the 195 dentate subjects provided plaque samples. Two subgingival microbial profiles were identified: absence of all micro-organisms but Campylobacter rectus or co-occurrence of Tannerella forsythia and Porphyromonas gingivalis. Using a combination of microbiological and interview information, the smallest overall misclassification in the diagnosis of extensive clinical attachment loss ≥ 5 mm was 8.8% (4.7% of non-cases and 22% of cases), but this was not different from the 7.6% (2.3% non-cases and 24.4% cases) obtained using clinical and interview information (p = 0.292). CONCLUSION: Specific microbial profiles could be identified in this isolated population. They did not result in significant superior diagnostic accuracy when compared to traditional clinical markers.

Cessação de tabagismo em fumantes com periodontite crônica / Tabacco use cessation in chronic periodontitis smokers

O tabagismo é o mais importante fator de risco de diversas doenças crônicas, incluindo a periodontite. Embora cirurgiões-dentistas apresentem potencial para ajudar seus pacientes fumantes a abandonar o vicio, o papel do dentista na cessação do tabagismo ainda não está totalmente esclarecido. O objetivo deste estudo prospectivo de 12 meses foi verificar o efeito de um programa antitabágico multidisciplinar na cessação de tabagismo em fumantes com periodontite. Duzentos e um (201) sujeitos foram triados e 93 foram incluídos e receberam tratamento periodontal não-cirúrgico e terapia antitabágica. Durante o tratamento periodontal, os dentistas motivaram ativamente os participantes a pararem de fumar, usando técnicas de entrevista motivacional. Aconselhamento e suporte adicionais foram fornecidos durante as visitas de manutenção após 3, 6 e 12 meses do término do tratamento periodontal. A condição de tabagista foi avaliada por meio de um questionário estruturado e foi validada pela mensuração de monóxido de carbono expirado (CO). Dentre os 52 indivíduos que permaneceram até o exame de 12 meses, 22 (42,31%), 17 (32,69%) e 17 (32,69%) não estavam fumando após 3, 6 e 12 meses, respectivamente. Concluiu-se que a terapia antitabágica realizada por uma equipe multidisciplinar que inclui dentistas resultou em alta taxa de cessação de tabagismo

Smoking is the leading risk factor of several chronic diseases, including periodontitis. Although it is acknowledged that dentists have potential to help smoking patients to quit, their role in tobacco control is not completely defined. The aim of this prospective 12-month study was to evaluate the effect of a multidisciplinary smoking cessation program in quitting smoking in subjects with periodontal disease. Two-hundred and one (201) subjects were screened, and 93 were included and received non-surgical periodontal treatment and smoking cessation therapy. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists during periodontal maintenance sessions at 3, 6 and 12 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and it was validated by exhaled carbon monoxide (CO) measurements. Among the 52 individuals that remained up to the 12-months examination, 22 (42.31%), 17 (32.69%) and 17 (32.69%) were not smoking at 3, 6 and 12 months, respectively. It is concluded that smoking cessation therapy performed by a multidisciplinary team including dentists resulted in high quit rates

Perfis microbianos subgengivais e doenças periodontais em uma população isolada brasileira / Subgingival microbial profiles and periodontal diseases in an isolated population from Brazil

OBJETIVOS: investigar a prevalência e a presença de distintos perfis microbianos no biofilme subgengival e avaliar o seu papel no diagnóstico e risco das doenças periodontais destrutivas em uma população isolada brasileira sem acesso à tratamento periodontal e tradição ao uso de métodos de higiene bucal. MATERIAL E MÉTODOS: A população-alvo consistiu de todos os indivíduos com 12 ou mais anos de idade (N= 264) residentes na microárea Cajaíba, identificados por meio de um censo. Estes indivíduos foram entrevistados por meio de um questionário estruturado e submetidos a um exame periodontal completo que consistiu na avaliação de 6 sítios por dente em toda a boca e na coleta de amostras do biofilme subgengival em 4 sítios por indivíduo. A detecção dos micro-organismos A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia e C. rectus, bem como a distribuição dos sorotipos e presença do clone JP2 do A. actinomycetemcomitans foram avaliadas por meio da reação em cadeia da polimerase (PCR). RESULTADOS: A. actinomycetemcomitans foi detectado em 25% dos indivíduos, enquanto que P. gingivalis T. forsythia, P.intermedia e C. rectus foram detectados em 64%, 59%, 38% e 90% dos indivíduos, respectivamente. Entre as amostras positivas para o A. actinomycetemcomitans (n=42), 18 (42%) representaram o sorotipo a, 2 (5%) o sorotipo b, 19 (46%) o sorotipo c, 1 (2%) o sorotipo e, e 4 (10%) foram não-sorotipáveis. O clone JP2 do A

actinomycetemcomitans não foi detectado em nenhum indivíduo desta população. Dois perfis microbianos subgengivais foram identificados: (perfil 1) nenhum dos microrganismos estudados, com exceção do C. rectus (n = 31), e (perfil 2) co-ocorrência de P. gingivalis e T. forsythia (n = 77). O perfil 1 demonstrou valores de sensibilidade extremamente baixos, enquanto que o perfil 2 apresentou valores de sensibilidade variados na identificação dos desfechos subrrogados periodontais avaliados, e valores de baixos a moderados para a especificidade. Os seguintes perfis subgengivais estiveram associados com a prevalência de perda clínica de inserção (NCI) e profundidade de sondagem (PS) nos modelos finais de regressão logística múltipla, ajustados para variáveis demográficas, biológicas e comportamentais: T. forsythia (PS e NCI 5 mm, e 7 mm), P. gingivalis (NCI 7 mm) e o perfil 2 (PS 5 mm e NCI 7 mm). CONCLUSÕES: Os micro-organismos periodontais estudados foram prevalentes nessa população isolada. Esta população apresentou predominância dos sorotipos a e c do A. actinomycetemcomitans. Dois perfis microbianos subgengivais puderam ser identificados nesta população isolada. Porém, eles não foram superiores ao diagnóstico de parâmetros clínicos periodontais específicos, quando adicionados à informação clínica tradicional. Perfis microbianos subgengivais apresentando T. forsythia como indicador de risco foram significativamente associados com o aumento da PS e do NCI nessa população isolada.

AIMS: To investigate the prevalence and describe the subgingival microbial profiles of selected periodontal pathogens in the subgingival biofilm; and assess their role as possible diagnostic markers or risk indicators for destructive periodontal diseases in a periodontally untreated and isolated population from Brazil. MATERIAL AND METHODS: The target population consisted of all subjects aged 12 years (n=264) in an isolated Brazilian population. A full-mouth clinical examination was conducted, and pooled subgingival plaque samples were obtained from four sites per subject. PCR analyses were performed to identify the following microorganisms: A. actinomycetemcomitans, P. gingivalis, T. forsythia, P. intermedia and C. rectus, as well as the A. actinomycetemcomitans serotype distribution and JP2 clone detection. RESULTS: A. actinomycetemcomitans was detected in 25% of the subjects, whereas P. gingivalis, T. forsythia, P.intermedia and C. rectus were detected in 64%, 59%, 38% and 90% of the subjects, respectively. From the A. actinomycetemcomitans positive isolates (n=42), 18 (42%) were serotype a, 2 (5%) b, 19 (46%) c, 1 (2%) e, and 4 (10%) were non-serotypeable. None of the strains belonged to the JP2 clone. Two specific subgingival microbial profiles were identified: (1) In one, only C. rectus could or not be present (n = 31), while in the other, (2) Co-occurrence of T. forsythia and P. gingivalis was observed (n = 77). Profile 1 showed very low sensitivity values, and profile 2 showed varying sensitivity values for the identification of the various periodontal states, and considerably low to moderate specificity values. The following subgingival profiles were significantly associated with the prevalence of periodontal attachment loss (CAL) and probing depth (PD) in the final multiple logistic regression models adjusted for demographic, biological and behavioral variables: ..

Periodontal disease in adults with untreated congenital growth hormone deficiency: a case-control study.

AIM: The aim of this study was to investigate the possible associations between isolated growth hormone deficiency (IGHD) and periodontal attachment loss (PAL) in adults affected by congenital IGHD. MATERIALS AND METHODS: Forty-five previously identified IGHD subjects were eligible for this study. The final study sample comprised 32 cases (gender:20M/12F; age:44.8 ± 17.5) matched for age, gender, diabetes, smoking status and income to 32 controls (non-IGHD subjects). Participants were submitted to a full-mouth clinical examination of six sites per tooth and were interviewed using a structured, written questionnaire. Periodontitis was defined as proximal PAL≥5 mm affecting ≥30% of teeth. RESULTS: No significant differences were observed in the percentage of sites with visible plaque between IGHD and non-IGHD subjects (59.4% versus 46.9%, p=0.32). IGHD subjects had significant less supragingival calculus (31.3% versus 59.4%, p=0.02) and more bleeding on probing (71.9% versus 18.8%, p<0.01) than controls. PAL≥5 mm was significantly more prevalent (100% versus 71.9%, p<0.01) and affected more teeth (30.5% versus 6.7%, p<0.01) in cases than in controls. After adjusting for supragingival calculus, IGHD cases had a higher likelihood of having periodontitis than controls (OR=17.4-17.8, 95% CI=2.3-134.9, p=0.004-0.005). CONCLUSION: Congenital IGHD subjects have a greater chance of having PAL.

A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters.

AIM: The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis. MATERIALS AND METHODS: Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data. RESULTS: Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p>0.05). CONCLUSION: Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up.

Prevalence and distribution of serotype-specific genotypes of Aggregatibacter actinomycetemcomitans in chronic periodontitis Brazilian subjects.

OBJECTIVE: Previous studies have suggested that Aggregatibacter actinomycetemcomitans is involved in the aetiology of aggressive periodontitis as well as chronic periodontitis. In addition, some authors have also reported that serotype-specific antigens of A. actinomycetemcomitans determine the severity of disease. This study aimed to elucidate the prevalence of A. actinomycetemcomitans and the distribution of A. actinomycetemcomitans serotypes in Brazilian subjects with chronic periodontitis. DESIGN: A total of 486 individuals were enrolled in this survey. All patients received clinical examinations that included periodontal pocket depth, clinical attachment loss, plaque, and gingival indexes. Subgingival samples were taken for microbial analysis. The genomic DNA of A. actinomycetemcomitans was provided by PCR. RESULTS: Out of 486 subjects examined, A. actinomycetemcomitans was isolated in 85 (17.5%) individuals. Out of 85 positive samples, 68 were infected by at least 1 serotype, 7 by mixed infection, and 10 were non-serotyped. Serotypes d and f were not detected. Serotype c showed the highest prevalence (52.9%), followed by serotype a (31.8%). CONCLUSIONS: Intragroup analysis revealed that, in slight/moderate periodontitis, serotypes c and a were significantly more prevalent than serotypes b and d-f; the prevalence of serotype c in severe periodontitis was significantly greater than that of serotypes a and b. Our data were similar in Asian and Eurasian populations.

Risk indicators for aggressive periodontitis in an untreated isolated young population from Brazil.

This study aimed to assess the prevalence of aggressive periodontitis (AgP), and to investigate the association between demographic, socioeconomic and behavioral risk indicators with AgP in an untreated and isolated young population in Southeastern Brazil. For this cross-sectional survey, 134 subjects aged 12-29 years were selected by a census. Of those eligible, 101 subjects received a full-mouth clinical examination, and were interviewed using a structured written questionnaire. Cases were defined as individuals with 4 or more teeth with attachment loss > 4 mm or > 5 mm in the age groups 12-19 and 20-29, respectively. Overall, 9.9% of the subjects presented AgP (10.3% of the 12-19-year-olds and 9.7% of the 20-29-year-olds). The only risk indicator significantly associated with AgP in this isolated population was a high proportion of sites (> 30%) presenting supragingival calculus [OR = 23.2]. Having experienced an urgency dental treatment was a protective factor for AgP [OR = 0.1]. The authors concluded that this isolated and untreated population from Brazil presented a high prevalence of AgP. Local plaque-retaining factors played a major role in the prevalence of AgP in this isolated population, and should be included in further studies evaluating this destructive periodontal disease form.