Influence of 3 calcium channel blockers on gingival overgrowth in a population of severe refractory hypertensive patients.

OBJECTIVE: The aim of the current study was to assess the association between 3 different calcium channel blockers (CCBs) (nifedipine, amlodipine and felodipine) and gingival overgrowth in patients with a diagnosis of severe refractory hypertension. METHODS: One hundred and sixty-two patients with severe refractory hypertension, taking CCBs, were selected. Gingival overgrowth was graded and periodontal measurements were recorded (probing pocket depth, clinical attachment level, plaque index and bleeding on probing). Unconditional multivariable binary logistic regression analyses were performed to assess the association between CCB intake and gingival overgrowth after adjusting for potential confounders. RESULTS: Of the 162 patients, 26 (16.0%) were current smokers and 101 (62.3%) were females. The mean age (SD) was 54.1 (8.5) years and the median age (range) 52.5 (39-78) years. Gingival overgrowth was observed in 55 patients (34.0%). Nifedipine was the most common medication (35.2%; 57 of 162). The results of multiple binary logistic regression showed statistically significant associations between CCB intake (exposure) and gingival overgrowth (outcome) after adjusting for the variables treatment time with antihypertensive and plaque index. Patients with gingival overgrowth were 2.5 (odds ratio = 2.46; 95% confidence interval: 1.04-5.82) and 4.0 (odds ratio = 3.90; 95% confidence interval: 1.47-10.35) times more likely to be taking nifedipine and amlodipine, respectively, than patients without gingival overgrowth. On the other hand, this significant association was not observed for felodipine. CONCLUSION: Nifedipine and amlodipine, but not felodipine, were associated with gingival overgrowth in patients with severe refractory hypertension.

Periodontal treatment in patients with chronic kidney disease: a pilot study.

BACKGROUND AND OBJECTIVE: This pilot cohort study evaluated the effect of periodontal treatment on renal function, metabolic markers and asymmetric dimethylarginine (ADMA) in patients with pre-dialysis chronic kidney disease (CKD) presenting chronic periodontitis. MATERIAL AND METHODS: Twenty-six patients with CKD and severe chronic periodontitis were selected. Periodontal parameters included plaque index, bleeding on probing, probing pocket depth and clinical attachment level. Estimated glomerular filtration rate (eGFR), triglycerides, total cholesterol, albumin and ADMA levels were evaluated at baseline, 90 and 180 d after periodontal therapy. eGFR was evaluated by the Modification of Diet in Renal Disease equation. RESULTS: All periodontal clinical parameters significantly improved (p < 0.05) 180 d after periodontal therapy. There was a significant improvement on the median values (25%; 75% percentiles) of eGFR from 34.6 (27; 44.7) mL/min/1.73 m2 on baseline to 37.6 (29.7; 57) mL/min/1.73 m2 on day 90, and to 37.6 (28.6; 56) mL/min/1.73 m2 (p < 0.05) on day 180. ADMA levels significantly reduced 180 d after periodontal treatment. No significant differences were observed at the median values of metabolic markers comparing baseline and 180 d after periodontal treatment. CONCLUSIONS: The results point to a link of kidney disease with endothelium dysfunction and periodontitis, suggesting that periodontal treatment may be beneficial to the course of CKD.

Serum creatinine and alkaline phosphatase levels are associated with severe chronic periodontitis.

BACKGROUND AND OBJECTIVE: Periodontitis may alter systemic homeostasis and influence creatinine and alkaline phosphatase levels. Therefore, the aim of this study was to evaluate the relationship between severe chronic periodontitis and serum creatinine and alkaline phosphatase levels. MATERIAL AND METHODS: One hundred patients were evaluated, 66 with severe chronic periodontitis (test group) and 34 periodontally healthy controls (control group). Medical, demographic and periodontal parameters were registered. Blood sample was collected after an overnight fast and serum creatinine and alkaline phosphatase levels were determined. RESULTS: There were significant differences between test and control groups in ethnicity, gender and educational level (p < 0.05). Patients with periodontitis showed a lower mean creatinine level (p < 0.05) and higher mean alkaline phosphatase level (p < 0.001) than the control group. There were significant correlations between periodontal parameters and serum creatinine and alkaline phosphatase levels. CONCLUSION: Severe chronic periodontitis was associated to lower creatinine and higher alkaline phosphatase levels.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP). MATERIALS AND METHODS: 50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively. RESULTS: Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G. CONCLUSION: The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

The impact of non-surgical periodontal treatment on serum levels of long chain-polyunsaturated fatty acids: a pilot randomized clinical trial.

BACKGROUND AND OBJECTIVE: Our group recently found higher levels of serum long chain-polyunsaturated fatty acids (LC-PUFAs) in patients with chronic periodontitis compared to controls. However, the effect of periodontal treatment on LC-PUFA serum levels has not been investigated. The primary aim of the present study was to investigate the impact of periodontal treatment on LC-PUFA serum levels. A secondary aim was to assess the effect of dietary ω-3 supplementation on clinical outcome. MATERIAL AND METHODS: The test group was composed of 10 patients with generalized chronic periodontitis (mean age 44 ± 6.4 years) treated with scaling and root planing associated with 4 mo of ω-3 supplementation eicosapetaenoic acid (EPA) plus docosahexaenoic acid (DHA), 3 g/d. The placebo group was composed of 11 patients (47.9 ± 10.5 years) that received scaling and root planing plus placebo. The periodontal examination included probing depth, clinical attachment level, bleeding on probing and visible plaque index. Docosapentaenoic acid (DPA), EPA, DHA and arachidonic acid (AA) were detected using gas chromatograph. RESULTS: In the placebo group, all LC-PUFAs levels reduced significantly (DHA, DPA and AA, p = 0.004; EPA, p = 0.008). In the test group, only DPA and AA showed a significant reduction (p = 0.005). Moreover, a significant decrease in the ratios AA/EPA and AA/DHA (p = 0.005) was observed in the test group. CONCLUSION: Non-surgical periodontal treatment reduced significantly the serum levels of all analyzed LC-PUFAs except those presented in the supplementation. The ω-3 dietary supplementation had no effect on clinical outcome of treatment.

Extent and severity of chronic periodontitis in chronic kidney disease patients.

UNLABELLED: BACKGROUND AND OBJECTVE: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross-sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. MATERIAL AND METHODS: Forty CAPD patients (mean age 52±12 years), 40 HD patients (mean age 50±10 years), 51 predialysis patients (mean age 54±11 years) and 67 healthy individuals (mean age 50±7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥4 mm were considered to have generalized chronic periodontitis. RESULTS: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. CONCLUSION: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.

Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study.

OBJECTIVE: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. STUDY DESIGN: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non-hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. RESULTS: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). CONCLUSIONS: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.

Effect of non-surgical treatment on chronic and aggressive periodontitis: clinical, immunologic, and microbiologic findings.

BACKGROUND: Our goal was to examine differences in clinical, microbiologic, and immunologic responses to non-surgical mechanical therapy in patients with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). METHODS: Twenty patients with GCP and 14 patients with GAgP were evaluated. Clinical data, gingival crevicular fluid (GCF), and subgingival plaque samples were collected at baseline and 3 months after non-surgical periodontal treatment. Levels of 40 subgingival species were measured using checkerboard DNA-DNA hybridization. GCF interleukin (IL)-1ß, -4, and -8 and interferon-γ (IFN-γ) were analyzed using a multiplexed bead immunoassay, and elastase activity was measured using an enzymatic assay. The significance of changes with time was examined using the Wilcoxon rank sum test. Changes in clinical, microbiologic, and immunologic parameters after therapy were compared between groups using the Mann-Whitney U test. RESULTS: After periodontal therapy, we found significant improvements for all clinical parameters in both groups. We also observed significant reductions in elastase activity in shallow and deep sites from the GAgP group and in deep sites from the GCP group. Microbiologic data showed significant reductions in proportions of orange and red complexes and an increase in proportions of Actinomyces species in both clinical groups. When the clinical, microbiologic, and immunologic responses after therapy were compared between groups, only minor differences were found. CONCLUSION: This study fails to show any significant differences between severe forms of GCP and GAgP in response to non-surgical periodontal treatment.

Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis.

BACKGROUND AND OBJECTIVE: Previous studies have reported an increased prevalence/severity of chronic periodontitis in patients with inflammatory bowel disease. However, the pathogenesis of periodontal lesions in such patients has not been characterized. The aim of this pilot study was to characterize the pattern of expression of cytokines in the gingival crevicular fluid and serum from patients with untreated chronic periodontitis and Crohn's disease, ulcerative colitis and systemically healthy controls. MATERIAL AND METHODS: Fifteen patients with Crohn's disease, 15 patients with ulcerative colitis and 15 controls participated in the study. All subjects had been diagnosed with untreated chronic periodontitis. The clinical parameters evaluated were clinical attachment loss, bleeding on probing and percentage of plaque. The gingival crevicular fluid was sampled from four shallow and four deep periodontal sites of each patient. The concentrations of the cytokines interleukin (IL)-1ß, IL-4, IL-6, IL-10, IL-12p40, IL-12p70, interferon-γ and tumor necrosis factor-α were measured using a commercially available Lincoplex kit and the concentration of IL-18 was measured using an ELISA. RESULTS: Multiple comparisons analysis showed that clinical attachment loss, bleeding on probing, percentage of plaque and volume of gingival crevicular fluid were similar across the groups. The concentration of IL-4 in the gingival crevicular fluid differed significantly between groups in shallow sites (p = 0.046), with higher values found for the controls. In serum, the concentration of IL-18 was also significantly different between groups, with lower values found for controls (p = 0.018). CONCLUSION: This study showed a higher concentration of IL-18 in serum, but not in the gingival crevicular fluid, from periodontitis patients with Crohn's disease or ulcerative colitis compared with controls. The expression of cytokines was similar in the gingival crevicular fluid from patients with untreated chronic periodontitis who also had Crohn's disease or ulcerative colitis and in systemically healthy controls with untreated chronic periodontitis.

Increased interleukin-18 in gingival crevicular fluid from periodontitis patients.

INTRODUCTION: This study aimed to measure the levels of interleukin-18 (IL-18) in inflamed shallow sites and inflamed deep sites in patients with periodontitis and to compare the data with results from inflamed shallow sites in patients with gingivitis. A secondary aim was to examine the composition of the subgingival microbiota in the sampled sites. METHODS: Gingival crevicular fluid was collected from five gingivitis sites and five periodontitis sites from 18 patients with chronic periodontitis, and from five gingivitis sites from 15 patients with gingivitis. Samples from each site category were pooled and IL-18 levels were measured using an enzyme-linked immunosorbent assay. The subgingival microbiota was analyzed by checkerboard DNA-DNA hybridization. RESULTS: All clinical parameters and gingival crevicular fluid volumes were higher in periodontitis sites compared with gingivitis sites from patients with periodontitis and gingivitis. The total amount of IL-18 was higher in periodontitis sites than gingivitis sites in both periodontitis (P = 0.018) and gingivitis (P = 0.002) patients and was higher in gingivitis sites from periodontitis patients than in those from gingivitis patients (P = 0.015). There were higher levels of Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola (red complex species) in periodontitis sites compared with gingivitis sites in both the periodontitis and gingivitis patients (P < 0.001). CONCLUSION: Levels of IL-18 were higher in patients with chronic periodontitis compared with patients with gingivitis, even at sites with similar pocket depths. The presence of similar levels of red complex species in gingivitis sites from periodontitis patients and from gingivitis patients suggested that the higher levels of IL-18 were not associated with a different microbial challenge.

High concentration of residual aluminum oxide on titanium surface inhibits extracellular matrix mineralization.

In the present study we characterized titanium (Ti) surfaces submitted to different treatments and evaluated the response of osteoblasts derived from human alveolar bone to these surfaces. Five different surfaces were evaluated: ground (G), ground and chemical etched (G1-HF for 60 s), sand blasted (SB-Al(2)O(3) particles 65 mum), sand blasted and chemical etched (SLA1-HF for 60 s and SLA2-HF for 13 s). Surface morphology was evaluated under SEM and roughness parameters by contact scanning instrument. The presence of Al(2)O(3) was detected by EDS and the amount calculated by digital analyses. Osteoblasts were cultured on these surfaces and it was evaluated: cell adhesion, proliferation, and viability, alkaline phosphatase activity, total protein content, and matrix mineralization formation. Physical and chemical treatments produced very different surface morphologies. Al(2)O(3) residues were detected on SB and SLA2 surfaces. Only matrix mineralization formation was affected by different surface treatments, being increased on rough surface (SLA1) and reduced on surface with high amount of Al(2)O(3) residues (SB). On the basis of these findings, it is possible to conclude that high concentration of residual Al(2)O(3) negatively interfere with the process of matrix mineralization formation in contact with Ti implant surfaces.

Prevalence and distribution of cervical dentine hypersensitivity in a population in Rio de Janeiro, Brazil.

The prevalence, distribution and possible causal factors of cervical dentine hypersensitivity were studied in a population from a Marine Dental Clinic in the city of Rio de Janeiro, Brazil. A total of 635 patients were examined for the presence of cervical dentine hypersensitivity by means of a questionnaire and intraoral tests (air and probe stimuli). There were 157 patients (25%) reporting to have hypersensitive teeth, but only 108 patients (17%) were diagnosed as having cervical dentine hypersensitivity. The prevalence of hypersensitivity was higher among females than males, but this difference was not statistically significant. Most females with hypersensitivity were aged 20-49 and most males were aged 40-59. Incisors and premolars had the highest prevalence of dentine hypersensitivity to air and probe stimuli, while molars had the lowest. The presence and history of dentine hypersensitivity were positively correlated with previous exposure to periodontal treatment. Only a few of the patients who claimed to have dentine hypersensitivity had tried treatment with desensitizing toothpastes or sought professional help.