Terapia adjunta com agentes biológicos na periodontite experimental / Adjunctive therapy with biological agents in experimental periodontitis

A presente dissertação foi dividida em dois estudos. O primeiro estudo teve como objetivo desenvolver uma revisão de literatura de trabalhos pré-clínicos que resumisse o papel de diversos fármacos usados para prevenção e tratamento da doença periodontal experimental e destaca a ação direcionada de todos os fármacos com propriedades antirreabsortivas. Além disso, esta revisão fornece uma avaliação oportuna e crítica para o uso científico racional dos medicamentos antirreabsortivos e imunomoduladores em estudos pré-clínicos, o que ajuda a entender a base para sua aplicação clínica. Pode-se concluir a partir dos achados descritos, que fitoterápicos, suplementação com ômega 3 e probióticos tem ganhado cada vez mais atenção devido às suas atividades moduladoras e antirreabsortivas e a ausência de efeitos colaterais, sendo considerados alternativas promissoras como adjuvantes da raspagem subgengival e alisamento radicular em pacientes suscetíveis. O segundo estudo, objetivou-se realizar uma revisão sistemática sobre os potenciais benefícios de agentes biológicos como adjuvantes no tratamento da periodontite experimental em modelos animais, respondendo a seguinte questão: qual é o potencial protetor dos agentes biológicos contra a reabsorção óssea alveolar durante a progressão da periodontite experimental? Os critérios de elegibilidade dos estudos foram baseados na estratégia PI/ECOS, ou seja, P = periodontite; I/E agentes biológicos; C mesma exposição/intervenção; I = exceto sobre o uso de agentes biológicos; e S = resultados secundários (inflamação). Como resultado, 5236 estudos foram selecionados inicialmente por meio de buscas manuais nas bases de dados incluídas . Após a leitura dos resumos e dos textos e de acordo com os critérios de inclusão, 39 estudos que atenderam aos critérios de inclusão foram incluídos neste estudo. Vinte e três agentes biológicos foram avaliados nos estudos incluídos. A maioria dos estudos utilizou o modelo de ligadura de periodontite experimental (PE) para testar o uso de produtos biológicos como estratégias preventivas ou terapêuticas. As dosagens dos produtos biológicos e os períodos de indução da doença variaram com base no modelo de periodontite utilizado. Como principal resultado de todos os estudos, a perda óssea alveolar pôde ser significativamente inibida com a aplicação de produtos biológicos e a redução de mediadores pró-inflamatórios quando comparados aos controles tratados. Em conclusão, essa revisão sistemática demonstrou que os agentes biológicos possuem efeitos benéficos na redução da perda óssea e na diminuição da inflamação durante a progressão da periodontite em modelos animais. (AU)

This MSc dissertation was divided into two studies. The first study aimed to develop a literature review including preclinical studies summarizing the role of various compounds used for the prevention and treatment of periodontitis and highlights the targeted action of all drugs with antiresorptive properties. In addition, this review provided a timely and critical assessment for the rational scientific use of antiresorptive and immunomodulatory drugs in preclinical studies, which helps to understand the basis for their clinical application. It can be concluded from the findings described, that phytotherapeutics, omega-3 supplementation, and probiotics have gained increasing attention due to their modulating and antiresorptive activities and the absence of side effects, and are considered promising alternatives as adjuvants to subgingival scaling and root planing in susceptible patients. In the second study, the aim was to perform a systematic review on the benefits of biological agents as adjuvants in the treatment of experimental periodontitis in animal models, answering the following question: What is the protective potential of biological agents against alveolar bone resorption during the course of experimental periodontitis progression? The criteria for eligibility of the studies were based in PI/ECOs strategy, as such (P) animal models with periodontitis; (I/E) biological agents with protective potential against bone resorption in periodontitis (prevention) or additional benefit as an adjunctive in the treatment of periodontitis; (C) same intervention/exposition as the intervention group (I), except for the use biological agents; (O) alveolar bone resorption (primary outcomes). Secondary outcomes: periodontal parameters, effectiveness of periodontitis-treatment, and adverse effects; (s) no restriction for study design on primary studies (exclusion criteria: randomized clinical trials, clinical studies, and different types of review studies). Study quality was assessed using Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) Risk of Bias tool. As a result, 5236 initial results from datasets, registries, and manual searches resulted in 39 suitable studies that met the inclusion criteria. Twenty-three biological agents were evaluated in the included studies. Most studies used the ligation model of experimental periodontitis (EP) to test the use of biologics as preventive or therapeutic strategies. The dosages of the biologics and periods of disease induction varied based on the PE model used. As the main outcome of all studies, alveolar bone loss could be significantly inhibited with the application of biologics and the reduction of pro-inflammatory mediators when compared to treated controls. Taken together, this systematic review demonstrated that biologics have beneficial effects in reducing bone loss and decreasing inflammation during the progression of periodontitis in animal models. (AU)

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety.

This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety

Abstract This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.