Adjunctive effects of photodynamic therapy using indocyanine green in residual pockets during periodontal maintenance therapy: A split-mouth randomized controlled trial.

BACKGROUND: Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone. METHODS: A split-mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real-time polymerase chain reaction. RESULTS: Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls. CONCLUSIONS: Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels.

Oral Health-Related Quality of Life in Anticoagulated Patients with Warfarin Treatment: A Cross-Sectional Study.

To evaluate factors associated with oral health-related quality of life (OHRQoL) in patients under oral anticoagulant therapy with warfarin, a cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL using the short version of the Oral Health Impact Profile (OHIP-14) instrument. After calibration (Kappa > 0.60), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (worse OHRQoL) was associated with ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Demographic and clinical factors can negatively influence the perception of anticoagulated patients on OHRQoL.

Effects of topical application of 1% sodium alendronate gel in the surgical treatment of periodontal intrabony defects: A 6-month randomized controlled clinical trial.

BACKGROUND: Sodium alendronate (ALN) is an aminobisphosphonate and potent inhibitor of bone resorption. It has been suggested that ALN might be a promising carrier of biomolecules for periodontal bone repair. The aim of this randomized split-mouth clinical trial was to evaluate the effects of the topical application of 1% ALN gel in intrabony defects during the surgical treatment of patients with periodontitis. METHODS: Sixty-four intrabony defects from 32 patients with periodontitis were randomly treated with either 1% ALN gel or placebo gel during periodontal surgeries. Full-mouth periodontal examination was performed at baseline and at 3 and 6 months after surgical treatment. Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded as the clinical outcomes. Bone defects were evaluated by digital subtraction radiography (DSR) at baseline and 6 months post-treatment. Analyses were performed through Fisher, Kruskal-Wallis, and ANOVA tests and a generalized estimation equations method. RESULTS: Both ALN and placebo groups showed significant improvements in BOP, PD, and CAL after periodontal surgical procedures (P < 0.001). Intergroup analysis showed significantly better outcomes in the ALN group with higher PD reduction and clinical attachment gain. DSR showed positive effects on periodontal bone repair strongly associated in the ALN group (P < 0.001). CONCLUSION: Topical application of 1% ALN may be a promising and beneficial adjuvant for the treatment of intrabony defects during surgical periodontal therapy.

Impact of compliance during periodontal maintenance therapy on oral health-related quality of life: A 6-year follow-up.

OBJECTIVE: To evaluate the effects of compliance during periodontal maintenance therapy (PMT) in the oral impact on daily performance (OIDP) measures, as well as to determine and compare the periodontal condition of acceptable and irregular compliers. MATERIAL AND METHODS: From a 6-year prospective cohort study with 268 individuals under PMT, 232 individuals had complete periodontal clinical data and OIDP questionnaires completed between T1 (data was recorded after the first PMT appointment) and T2 (final data at the last PMT appointment), were determined to be eligible. Individuals were divided into two groups: 124 acceptable compliers (AC) and 108 irregular compliers (IC). Full-mouth periodontal examination and questionnaires were evaluated in 2 times, at T1 and T2. RESULTS: At T2, the periodontal status of the AC group was significantly better than the IC group. The IC group also presented with higher OIDP scores (63.31 ± 19.11) compared to the AC group (57.72 ± 15.30, p = 0.005). On analyzing the OIDP dimensions independently, both groups (AC and IC) presented with high scores in the functional, psychological and social performances; however, the impacts were significantly higher in IC group. CONCLUSION: The AC group presented with better periodontal conditions and lower OIDP, compared to the IC group. The discomfort and dissatisfaction with appearance, showed more influence on these daily impacts. CLINICAL SIGNIFICANCE: Acceptable compliers showed lower scores of OIDP when compared to erratic ones. Thus, clinicians could take the chance to gain advantage from the positive impacts of acceptable compliance in the OHRQL for subsequent patient-centred motivation during PMT.

Comparison of miRNA expression profiles in individuals with chronic or aggressive periodontitis.

OBJECTIVES: MicroRNAs (miRNAs) may play an important role in inflammatory response. However, the involvement of miRNAs in the pathogenesis of periodontitis is unclear. The present study aimed to compare the miRNA expression profiles in individuals with chronic (CP) or aggressive (AP) periodontitis. MATERIALS AND METHODS: Eighteen non-smoker individuals (CP = 9 and AP = 9) without any history of systemic diseases or previous periodontal therapies were selected at the Clinics of Periodontology from the Federal University of Minas Gerais. Gingival tissue samples were collected during the initial periodontal therapy. miRNAs were isolated, and expression patterns of 754 miRNAs were assessed with a quantitative miRNA PCR array. miRNAs expression profiles were compared between CP and AP groups. RESULTS: There were no differences observed in the miRNAs expression profiles between CP and AP (p > 0.05). According to the microarray analyses, the most expressed miRNAs in both groups were hsa-miR-1274b, hsa-let-7b-5p, hsa-miR-24-3p, hsa-miR-19b-3p, hsa-miR-720, hsa-miR-126-3p, hsa-miR-17-3p and hsa-miR-21-3p. CONCLUSION: Findings suggested no differences in miRNAs expression profiles between chronic and aggressive forms of periodontitis. The overexpression of specific miRNAs could provide insights into the pathogenesis of both forms of the disease.

Relationship Between Quality of Complete Dentures and User Satisfaction at 1 and 5 Years Postinsertion.

AIMS: To evaluate the effects of complete denture (CD) quality and user satisfaction on the use of CDs provided by primary care services at 1 and 5 years postinsertion. MATERIALS AND METHODS: A random sample of 233 individuals were evaluated regarding the use of maxillary and/or mandibular CDs at 1 and 5 years after insertion; at both time points, denture quality, integrity, and user satisfaction were measured. The covariates included age, gender, marital status, years of education, family income, past use of CD, time since maxillary teeth loss, mandibular ridge height, and frequency of return visits to the dentist after receiving the prostheses. The effect of the variables on the use of CDs throughout the period was estimated using logistic regression models with random effects in the intercept. RESULTS: Overall, 64.9% and 64.1% of the participants were using their CD at 1 and 5 years, respectively. Of those who used the pair of prostheses at 5 years, 86.3% reported using them in the first evaluation. Use of CDs at 1 year was greater among users with some degree of education, higher satisfaction, and those whose CD had adequate stability and free functional space. Use of CDs at 5 years was greater in satisfied users and those with a stable CD. CONCLUSION: Denture quality and user satisfaction were associated with the use of CDs after 1 and 5 years. CD use was greater in individuals who had used it for 1 year, indicating greater abandonment in the first year than in other periods.

Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis.

BACKGROUND: To the best of the authors' knowledge, there is no systematic review of the potential association between periodontitis and gestational diabetes mellitus (GDM) in the current literature. The aim of the present systematic review and meta-analysis is to search for scientific evidence regarding the association between periodontitis and GDM. METHODS: The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD2014010728) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in three electronic databases without restrictions regarding language or date of publication. From 190 studies selected, 15 underwent full-text analysis. Eight studies were eligible (five cross-sectional and three case-control studies), and seven were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). RESULTS: There was a significant association between periodontitis and GDM in the meta-analyses of four cross-sectional studies (OR 1.67, 95% CI 1.20 to 2.32) and two case-control studies (OR 2.66, 95% CI 1.52 to 4.65). However, sensitivity tests for case-control studies showed a lack of consistency in data; when including one case-control study, the significance was null (meta-analysis of three case-control studies: OR 1.69, 95% CI 0.68 to 4.21). CONCLUSIONS: There was substantial clinical, methodologic, and statistical heterogeneity among the studies. The scientific evidence cannot affirm a positive association between periodontitis and GDM. Future studies with different designs in distinct populations should be conducted to investigate this association.

Clinical and Microbiologic Evaluation of Scaling and Root Planing per Quadrant and One-Stage Full-Mouth Disinfection Associated With Azithromycin or Chlorhexidine: A Clinical Randomized Controlled Trial.

BACKGROUND: Conflicting data about the protocol of choice for non-surgical periodontal therapy with adjuvant use are still reported. This study aims to evaluate, through clinical and microbiologic parameters, the systemic use of azithromycin (AZ) and chlorhexidine (CHX) as adjuvants to non-surgical periodontal treatment performed by one-stage full-mouth disinfection (FMD) within 24 hours or conventional quadrant scaling (QS) in four weekly sections. METHODS: In this randomized controlled trial, 85 patients diagnosed with chronic periodontitis underwent different treatment protocols, in six groups: three FMD groups and three QS groups, each with no adjuvants, with CHX, and with AZ. Clinical periodontal parameters were recorded, and total and quantitative bacterial counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Streptococcus oralis were measured with real-time polymerase chain reaction at baseline and 90 and 180 days after treatment. RESULTS: In all groups, a significant reduction was observed in the percentage of periodontal diseased sites, gingival index, plaque index, and clinical attachment level gain at 90 days, demonstrating effectiveness of the treatment, independently of the adjuvant. The FMD with CHX group showed higher reduction in probing depth and percentage of periodontal diseases sites, as well as lower total bacterial count, than all the other groups at 180 days. CONCLUSIONS: The adjuvant use of AZ did not provide any significant benefit, independently of the treatment protocol. The adjuvant use of CHX showed a more expressive and significant improvement in clinical and microbiologic parameters, especially in the FMD protocol, followed by QS.

Progression of periodontitis and tooth loss associated with glycemic control in individuals undergoing periodontal maintenance therapy: a 5-year follow-up study.

BACKGROUND: Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. METHODS: A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full-mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5-year interval. RESULTS: Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). CONCLUSIONS: PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.

Association between periodontitis and gestational diabetes mellitus: a case-control study.

BACKGROUND: Some studies have reported an association between gestational diabetes mellitus (GDM) and periodontitis. The aim of the present study is to analyze this potential association and the influence of risk variables associated with GDM. METHODS: This case-control study includes 360 women, 90 with GDM and 270 controls. Participants received a full-mouth periodontal examination with a record of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Periodontitis is defined as the presence in ≥4 teeth of ≥1 sites with PD ≥4 mm and CAL ≥3 mm associated with BOP. The influence of risk variables in the occurrence of GDM is tested through univariate analysis and multivariate logistic and multinomial regression. Odds ratio (ORs) and respective confidence intervals (CIs) are calculated and reported. RESULTS: The prevalence of periodontitis was 40% in the case group (GDM) and 46.3% in the control group. There was a lack of association between periodontitis and GDM (OR = 0.74; 95% CI = 0.40 to 1.38). The multivariate final logistic regression model retained the following as significant variables associated with GDM: maternal age (OR = 2.65; 95% CI = 1.97 to 3.56), chronic hypertension (OR = 3.16; 95% CI = 1.35 to 7.42), and body mass index (OR = 1.99; 95% CI = 1.41 to 2.81). CONCLUSIONS: A high prevalence of periodontitis was found among cases and controls, with no association between periodontitis and GDM. The present study suggests the need for implementation of health policies directed to the periodontal care of pregnant women.

Evaluation of self-reported measures for prediction of periodontitis in a sample of Brazilians.

BACKGROUND: Questionnaires including self-reported measures have become effective as a means of accessing many diseases. The aim of the present study is to evaluate the performance of a set of self-reported periodontal measures on estimating the prevalence of periodontitis. METHODS: The sample comprised 284 individuals, aged 18 to 60 years, from Belo Horizonte, Brazil. Full-mouth periodontal examinations were performed and periodontal parameters were recorded. Periodontitis was categorized as no or mild, moderate, and severe. Each participant answered 18 questions covering sociodemographic variables, known risk factors, and self-reported periodontal measures. Questions were globally tested through logistic regression analysis. RESULTS: The complete final model for moderate periodontitis included age, dental flossing, and gum disease (sensitivity = 23.1%; specificity = 98%; area under the receiver operating characteristic curve = 75.4%). The complete final model for severe periodontitis included all previously cited variables in addition to the number of teeth (sensitivity = 36.4%; specificity = 96.9%; area under the receiver operating characteristic curve = 85.3%). CONCLUSIONS: Self-reported periodontal measures showed a moderate predictive value for periodontitis prevalence. The use of these measures could be a good strategy in investigating prevalence of periodontal disease.

Progression of periodontitis in a sample of regular and irregular compliers under maintenance therapy: a 3-year follow-up study.

BACKGROUND: To our knowledge, prospective studies (matched for sex, smoking, and diabetes) that investigated the influence of compliance in the progression of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs were not previously reported. METHODS: A total of 58 regular complier (RC) and 58 erratic complier (EC) individuals were recruited from a prospective cohort with 238 patients under PMT and matched by sex, diabetes, and smoking habits. A full-mouth periodontal examination that included bleeding on probing (BOP), probing depths (PDs), clinical attachment levels, and number of teeth were determined at all PMT visits during a 3-year interval. The influence of variables of interest was tested through multivariate logistic regression. RESULTS: The progression of periodontitis and tooth loss was significantly lower among RC compared to EC patients. A higher progression of periodontitis was observed among EC patients who smoked. The final logistic model for the progression of periodontitis in the RC group included smoking (odds ratio [OR]: 4.2) and >30% of sites with BOP (OR: 2.8), and the final logistic model for the progression of periodontitis in the EC group included smoking (OR: 7.3), >30% of sites with BOP (OR: 3.2), PDs of 4 to 6 mm in 10% of sites (OR: 3.5), diabetes (OR: 1.9), and number of lost teeth (OR: 3.1). CONCLUSIONS: RC patients presented a lower progression of periodontitis and tooth loss compared to EC patients. This result highlighted the influence of the pattern of compliance in maintaining a good periodontal status. Moreover, important risk variables such as smoking and diabetes influenced the periodontal status and should be considered when determining the risk profile and interval time for PMT visits.

Oral impact on daily performance, personality traits, and compliance in periodontal maintenance therapy.

BACKGROUND: To our knowledge, the association between personality traits and oral health impacts on daily activities among patients under periodontal maintenance was not previously evaluated. The present study aims to determine the oral health impacts among regular- and erratic-complier patients and their correlations with personality traits by means of the oral impacts on daily performance (OIDP) and the neuroticism extraversion openness five-factor inventory (NEO FFI-R) instruments. METHODS: A total of 58 regular and 58 erratic compliers matched by sex, diabetes, and smoking were recruited from a cohort of 238 participants under periodontal maintenance. Periodontal examinations and questionnaire applications were performed in recalls during a 3-year interval. The influence of variables of interest on the OIDP was evaluated through univariate and multivariate linear regression analyses. RESULTS: The periodontal status of regular compliers was significantly better than that of erratic compliers. Erratic compliers presented higher OIDP scores (36.34 ± 6.64) compared to regular compliers (30.45 ± 7.72). Higher scores of neuroticism and conscientiousness (R(2) = 68%; P <0.001) were associated with higher OIDP scores among regular compliers, whereas among erratic compliers, lower scores of neuroticism, higher openness, and extraversion (R(2) = 77%; P = 0.001) were associated with higher OIDP scores. CONCLUSION: Personality traits, mainly neuroticism, showed significant influences on OIDP among patients under periodontal maintenance.

Maternal periodontal disease and preterm or extreme preterm birth: an ordinal logistic regression analysis.

BACKGROUND: Despite previous studies addressing the link between preterm or low birth weight infants and maternal periodontitis, extreme preterm births have received far less attention. This study is designed to address the possible association between maternal periodontal disease and preterm or extreme preterm birth. METHODS: Immediately after childbirth, 1,207 women underwent an examination in which periodontal disease was assessed according to two alternative definitions: 1) four or more teeth with at least one site showing probing depth (PD) >or=4 mm and clinical attachment loss (AL) >or=3 mm, and 2) at least one site showing PD and clinical AL >or=4 mm. For each of these definitions, two types of multivariate analysis were conducted: a linear regression analysis for the number of gestation weeks, and a more specific ordinal logistic regression analysis for the ordinal variable gestation time categorized as normal (term) (n = 1,046 women) or mild-moderate (n = 146 women) or extreme preterm (n = 15 women). RESULTS: Periodontal disease was associated with fewer weeks of gestation by linear regression (definition 1: P = 0.012; definition 2: P <0.001) and with preterm (n = 161; mild-moderate and extreme) or extreme preterm births (n = 15) by ordinal logistic regression (definition 1: odds ratio [OR] = 1.83, 95% confidence interval [CI]: 1.28 to 2.62; definition 2: OR = 2.37, 95% CI: 1.62 to 3.46). CONCLUSION: Our findings suggest that periodontal disease is associated with a premature or extremely premature birth.

Association of functional gene polymorphism IL-1beta in patients with external apical root resorption.

INTRODUCTION: External apical root resorption (EARR) is a frequent complication of orthodontic treatment. Interleukin 1beta (IL-1beta) is a potent stimulus for bone resorption and osteoclastic cell recruitment during orthodontic tooth movement. The purpose of this study was to assess the association between a polymorphism in the IL-1beta genes and EARR during orthodontic treatment. METHODS: The sample included 61 Brazilian orthodontic patients, divided into 2 groups according to the presence (affected group, n = 23) or absence (control group, n = 38) of EARR in the central and lateral maxillary incisors in the posttreatment period. DNA was obtained from buccal swab cells. The polymorphism was analyzed by the polymerase chain reaction followed by digestion with restriction enzyme. The polymerase chain reaction products were analyzed in 10% polyacrylamide gel and stained with silver. RESULTS: There were significant statistical differences (P <0.05) among the frequencies of the alleles and genotypes of the IL-1beta gene polymorphism between the affected and unaffected groups, suggesting that allele 1 predisposed the subjects to EARR (odds ratio = 4.0). CONCLUSIONS: The polymorphism of the IL-1beta gene is associated with root resorption in the studied population.

Prevalence, severity, and risk variables associated with gingival overgrowth in renal transplant subjects treated under tacrolimus or cyclosporin regimens.

BACKGROUND: Some reports suggest that the prevalence and severity of gingival overgrowth (GO) is lower in patients taking tacrolimus (Tcr) than in those taking cyclosporin A (CsA). The present study was conducted to determine the prevalence and severity of GO in a group of renal transplant recipients treated with Tcr in comparison to those treated with CsA and to evaluate the risk variables associated with the development of GO in these two drug regimens. METHODS: A cross-sectional study was conducted in a public hospital in Belo Horizonte City, Brazil. Demographic, pharmacological, and periodontal data were recorded for each subject. Variables from 134 subjects taking Tcr were compared to 451 subjects taking CsA using independent sample t, chi(2) statistic, or Mann-Whitney tests. The effects of potential risk factors on GO severity were determined using forward and backward stepwise regression analysis. RESULTS: Subjects taking CsA showed a higher mean GO score (29.03% +/- 22.9%) compared to subjects taking Tcr (16.9% +/- 3.4%) (P = 0.0038). In the Tcr group, 17.9% of the subjects had clinically significant GO compared to 38.1% in the CsA group (P = 0.045). In the multivariate final model, papillary bleeding index, azathioprine dosage, and concomitant use of calcium channel blockers (CCB) were significant variables associated with severity of GO in Tcr and CsA groups. In addition, previous CsA use also remained significant for GO in subjects under a Tcr regimen. CONCLUSIONS: The prevalence and severity of GO is lower in transplant subjects taking Tcr compared to CsA. GO severity in both groups was strongly associated with the papillary bleeding index, highlighting the role of inflammation in this condition. Concomitant CCB use, azathioprine dosage, and previous CsA use in the Tcr group reinforces the possible synergistic effects of these pharmacological variables on GO severity.