Association between periodontitis and Alzheimer's disease and its impact on the self-perceived oral health status: a case-control study.

PURPOSE: To test the hypothesis that periodontitis is associated with AD and search whether periodontal and other variables would negatively impact the oral health-related quality of life (OHRQoL) perception. MATERIALS AND METHODS: Oral examinations and interview on self-perceived oral health status (Geriatric Oral Health Assessment Index (GOHAI) questionnaire (higher score corresponds to better perceived oral status)) were carried out and socio-demographic data were collected from outpatients with mild to moderate AD (cases, n = 50) and from their age- and sex-matched family caregivers (controls, n = 52). Full-mouth periodontal examination was performed. Significance of differences between groups was sought by chi-square, Student's t, or the Mann-Whitney test. The association between the variables periodontitis, probing depth (PD) ≥ 5 mm, and clinical attachment loss (CAL) ≥ 5 mm with the variable group was tested in binary logistic regression models (LRMs). LRMs were used to test the association of oral findings, demographics, and group with GOHAI. RESULTS: Cases had fewer teeth and greater CAL than controls. Cases had a superior percentage of sites with plaque, calculus, and bleeding on probing than controls. Cases had greater GOHAI scores than controls. Periodontitis was a variable most likely associated with AD (OR = 11.08, p < 0.001). None of the oral findings or demographics, but group, was associated with GOHAI (OR = 14.45, p < 0.001). CONCLUSION: Periodontitis is associated with AD, but not with patients' OHRQoL. CLINICAL RELEVANCE: Health care professionals must be aware that AD patients should have a periodic thorough oral examination and preventive intervention aiming at their welfare and maintenance of a pain-free functional dentition.

Perfil dos atendimentos no serviço de Periodontia da Faculdade de Odontologia da UFRJ / Profile of attendance in the Periodontics service of UFRJ Dental School

O estudo teve como objetivo conhecer o perfil do serviço de atendimento prestado pela disciplina de Periodontia II da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro, por meio de levantamento de dados dos atendimentos realizados em um período de 10 anos (2007 a 2016). Foram analisados o protocolo de atendimento, número total de procedimentos realizados por semestre e por estudante de graduação, número de exames periodontais, profilaxias, instruções de higiene oral, procedimentos de raspagem supragengivais, procedimentos de raspagem subgengival e alisamento radicular realizados por semestre. As informações relacionadas ao perfil dos usuários foram coletadas a partir do prontuário e incluíram dados sociodemográficos, diagnóstico das condições periodontais e condições sistêmicas associadas. No período estudado foram realizados 13.810 procedimentos clínicos, em média 690,5 por semestre. Em amostragem de 715 usuários a idade variou entre 12 e 85 anos, sendo a faixa etária predominante entre 45 e 64 anos, equivalente a 55,38% da amostra. Na amostra, 14,55% foram diagnosticados com gengivite e 85,45% com periodontite, sendo 93,94% dos casos periodontite crônica e 6,06% periodontite agressiva. Foram identificadas condições sistêmicas de saúde associadas aos quadros de doença periodontal. As condições mais relevantes informadas pelos pacientes foram hipertensão arterial (25,87%), doenças respiratórias como sinusite e rinite alérgica (13,29%), diabetes mellitus (10,35%) e tabagismo (7,70%). Foi possível conhecer em detalhes o funcionamento da clínica da disciplina de Periodontia II da FO/UFRJ e os resultados foram utilizados como base para melhorias no serviço. O perfil de saúde apresentado pelos usuários do serviço apontou para a necessidade de abordagem interprofissional (AU).

This study aimed to characterize the profile of dental attendance provided by the Periodontics II course offered by the Dental School of Odontology at the Federal University of Rio de Janeiro (FO/UFRJ). We collected ten years' worth of data on dental services (between 2007 and 2016). We analyzed the treatment protocol, the total number of procedures performed per semester and per undergraduate student, the number of periodontal examinations, prophylaxes, oral hygiene instructions, procedures, supragingival scaling procedures, subgingival scaling and root planing performed per semester. Information related to user profiles was collected from the patient's medical chart and included sociodemographic data, periodontal conditions diagnosis, and associated systemic conditions. In the period studied, 13,810 clinical procedures were performed at FO/UFRJ, with an average of 690.5 per semester. In a sample of 715 patients, the age ranged between 12 and 85 years old. The most predominant age range was between 45 and 64 years old, equivalent to 55.38% of the sample. In the sample, we diagnosed 14.55% of patients with gingivitis and 85.45% with periodontitis, of which 93.94% were chronical and 6.06% aggressive periodontitis. We identified systemic health conditions associated with periodontal diseases. The most relevant conditions informed by patients were arterial hypertension (25.87%); respiratory diseases, such as sinusitis and allergic rhinitis (13.29%); diabetes mellitus (10.35%), and tobacco use (7.70%). We characterized the functioning of the Periodontics II clinic of FO/UFRJ in detail, and our results will be used to improve the service provided for the population in Rio de Janeiro. The profile presented by service users pointed at the need for an interprofessional approach (AU).

Proposal for the teaching of the chemical control of supragingival biofilm.

The mechanical control of supragingival biofilm is accepted as one of the most important measures to treat and prevent dental caries and periodontal diseases. Nevertheless, maintaining dental surfaces biofilm-free is not an easy task. In this regard, chemical agents, mainly in the form of mouthwashes, have been studied to help overcome the difficulties involved in the mechanical control of biofilm. The aim of this paper was to discuss proposals for the teaching of supragingival chemical control (SCC) in order to improve dentists' knowledge regarding this clinical issue. Firstly, the literature regarding the efficacy of antiseptics is presented, clearly showing that chemical agents are clinically effective in the reduction of biofilm and gingival inflammation when used as adjuvant agents to mechanical control. Thus, it is suggested that the content related to SCC be included in the curricular grid of dental schools. Secondly, some essential topics are recommended to be included in the teaching of SCC as follows: skills and competencies expected of a graduate dentist regarding SCC; how to include this content in the curricular grid; teaching-learning tools and techniques to be employed; and program content.

Proposal for the teaching of the chemical control of supragingival biofilm

The mechanical control of supragingival biofilm is accepted as one of the most important measures to treat and prevent dental caries and periodontal diseases. Nevertheless, maintaining dental surfaces biofilm-free is not an easy task. In this regard, chemical agents, mainly in the form of mouthwashes, have been studied to help overcome the difficulties involved in the mechanical control of biofilm. The aim of this paper was to discuss proposals for the teaching of supragingival chemical control (SCC) in order to improve dentists' knowledge regarding this clinical issue. Firstly, the literature regarding the efficacy of antiseptics is presented, clearly showing that chemical agents are clinically effective in the reduction of biofilm and gingival inflammation when used as adjuvant agents to mechanical control. Thus, it is suggested that the content related to SCC be included in the curricular grid of dental schools. Secondly, some essential topics are recommended to be included in the teaching of SCC as follows: skills and competencies expected of a graduate dentist regarding SCC; how to include this content in the curricular grid; teaching-learning tools and techniques to be employed; and program content.

Association of T CD4 lymphocyte levels and chronic periodontitis in HIV-infected brazilian patients undergoing highly active anti-retroviral therapy: clinical results.

BACKGROUND: Controversial data regarding the association between immunosuppression and prevalence/ severity of periodontal diseases in HIV infection have been reported. Thus, the aim of this study was to test the hypothesis that lower T CD4 lymphocyte levels are not related to a higher prevalence of chronic periodontitis in HIV-infected Brazilians undergoing highly active anti-retroviral therapy (HAART). METHODS: Sixty-four HIV-infected patients under HAART were classified as having chronic periodontitis; i.e., > or = three sites with probing depth (PD) and/or clinical attachment level (CAL) > or = 5 mm or periodontal healthy (no sites with PD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Bleeding on probing, plaque accumulation, PD, and CAL were registered at six sites/tooth at baseline and 4 months after therapy. Epidemiological features and levels of T CD4 lymphocytes were obtained from medical records. Significance of differences in periodontal clinical parameters within and between groups were determined using Wilcoxon signed-rank and Mann-Whitney or independent sample t tests. Associations between T CD4 levels and clinical parameters were determined using the chi square test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The overall T CD4 lymphocyte mean levels was 333 +/- 254 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet the prevalence of chronic periodontitis was relatively low (36%). In addition, patients with periodontitis presented a moderate disease (mean PD = 2.2 +/- 0.10; mean CAL = 2.6 +/- 0.13) and responded successfully to periodontal therapy. These subjects showed higher levels of T CD4 cells, but lower counts of neutrophils than periodontally healthy patients. Among periodontally healthy and chronic periodontitis patients, 41.7% and 22.9%, respectively, had low levels of T CD4 lymphocytes. No significant differences between periodontal status and epidemiological and immunological parameters were observed. CONCLUSION: Based on these results, the hypothesis that lower T CD4 lymphocyte levels are not associated with higher prevalence of chronic periodontitis in HIV-infected Brazilians under HAART cannot be rejected.

Association of T CD4 lymphocyte levels and subgingival microbiota of chronic periodontitis in HIV-infected Brazilians under HAART.

OBJECTIVE: The aim of this study was to determine the subgingival microbiota of HIV-infected patients with chronic periodontitis and different T CD4 lymphocyte levels under HAART. STUDY DESIGN: 64 HIV+ patients (mean age 34.5 +/- 7.3; 75% males) were distributed into Group I: chronic periodontitis (> or = 3 sites with probing pocket depth (PPD) and/or clinical attachment level (CAL) > or = 5 mm); and Group II: periodontal health (no sites with PPD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Periodontal clinical parameters were evaluated at 6 sites/tooth in all teeth at baseline and 4 months after therapy. The levels of T CD4 were obtained from the patient's medical record. Subgingival plaque samples were taken from the 6 sites with the largest pocket depth in each subject of Group I, and 6 randomly selected sites in subjects of Group II. The presence of 22 subgingival species was determined using the checkerboard DNA-DNA hybridization method. Significant microbiological differences within and among groups were sought using Wilcoxon signed-rank and Mann-Whitney tests, respectively. Relationships between T CD4 levels and microbiological parameters were determined using Kruskal-Wallis test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The T CD4 lymphocyte mean level was 333 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet, the prevalence of chronic periodontitis was relatively low (36%). Several periodontal pathogens, in particular T. forsythensis (P < .05), were more prevalent in HIV-positive patients with periodontitis than in HIV-positive subjects with periodontal health. Most of the species decreased in frequency after therapy, particularly P. gingivalis (P < .05). E. faecalis and F. nucleatum were significantly more prevalent in the subgingival microbiota of patients with chronic periodontitis and lower levels of T CD4 (P < .05), while beneficial species tended to be more frequently detected in individuals with T CD4 counts over 500 cells/mm3. CONCLUSION: The subgingival microbiota of HIV-infected patients with chronic periodontitis include a high prevalence of classical periodontal pathogens observed in non-infected individuals. Furthermore, the severe immunosuppression seems to favor the colonization by these species, as well as by species not commonly found in the subgingival microbiota.

Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro, Brazil.

Avulsions are very common in a school setting. Teachers are often requested to help in such emergency situations. A survey consisting of seven simple questions regarding dental avulsion was answered by 60 teachers from five different elementary schools in Rio de Janeiro, Brazil, in order to evaluate their knowledge on the subject and establish a guideline to be followed when an accident of this type happens. A lack of technical information was observed among the teachers; most of them answered intuitively rather than on an informative basis. This study showed the need of a more effective communication between dental professionals and school teachers in order to better handle dental emergencies.