Preoperative oral practices and incidence of postoperative complications in hospital medical-surgical procedures: A meta-analysis

Background: Oral decay prior to a hospital medical-surgical procedure is a risk factor for the development of postoperative complications. However, perioperative oral practices as a protective factor have not been studied. This review aims to evaluate the effectiveness of perioperative oral practices in the reduction of risk of developing postoperative complications in in-hospital medical surgical procedures. Material and methods: This review and meta-analysis was conducted according to Cochrane guidelines. Medline, Scopus, Scielo, and Cochrane were consulted. Articles of the previous 10 years concerning adult patients undergoing perioperative oral practices prior to hospital medical-surgical procedures, were included. Data of the type of perioperative oral practice, type of postoperative complication and measures of effect on the development of complications were extracted. Results: Of a pool of 1470 articles, 13 were included for systematic review and 10 for meta-analysis. The most common perioperative oral procedures were focalized approach (FA), referred to only the elimination of infectious foci in the oral cavity and comprehensive approach (CA), referred to a integral approach of the patient's oral health, both of which were mainly performed in oncologic surgeries, both were effective in the reduction of postoperative complications (RR=0.48, [95% CI 0.36 - 0.63]). The most reported postoperative complication was postoperative pneumonia. Conclusions: Perioperative oral management proved to be a protective factor against the development of postoperative complications. (AU)

Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review.

Background: Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility. Objective: Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure. Methods: A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool. Results: A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41]. Conclusions: Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.

Introducción: La periodontitis es potencialmente dañina en el perioperatorio debido a que el biofilm genera un ambiente para que las bacterias se propaguen y colonicen otras áreas anatómicas, lo que puede generar un riesgo potencial de infección, retraso en la cicatrización, aumento de la morbilidad e incluso inducir avulsión en pacientes intubados, y aspiración o ingestión posterior de dientes con mayor movilidad. Objetivo: Asociar la presencia de periodontitis y complicaciones postoperatorias en pacientes sometidos a un procedimiento médico quirúrgico intrahospitalario. Métodos: Se realizó una revisión sistemática a partir de estudios extraídos de PubMed y Scopus el 10 de junio de 2020, basándose en la estrategia de búsqueda de Población, Intervención, Comparación y Resultados. Como criterios de inclusión, los estudios debían incluir todos los términos desagregados de la pregunta de investigación, tener una fecha de publicación menor a 15 años y la población objetivo debía haber sido sometida a intervenciones médico-quirúrgicas hospitalarias electivas. Los criterios de exclusión correspondieron a no presentar un diseño de estudio observacional analítico o experimental, no haber realizado un diagnóstico clínico periodontal de los sujetos de estudio y no expresar en los resultados la presencia de complicaciones médico-hospitalarias posoperatorias. Se evaluó la calidad de los artículos complementando la guía STROBE y Newcastle Ottawa, y el riesgo de sesgo complementando la guía STROBE y la herramienta del manual de Colaboración Cochrane. Resultados: Se obtuvo un total de 131 artículos, los cuales fueron sometidos a un proceso de selección, dando como resultado 5 estudios observacionales analíticos finales. Se realizó un metaanálisis y se determinó que la periodontitis fue un factor de riesgo de complicaciones posoperatorias después de procedimientos quirúrgicos con un OR = 4,76; IC95% [1,11-20,41]. Conclusiones: Optimizar las guías para evaluar la calidad y el riesgo de sesgo puede hacer compleja su comparación con otros estudios, sin embargo, se determinó de manera estadísticamente significativa que los pacientes con periodontitis tienen mayor riesgo de generar complicaciones posoperatorias luego de una cirugía médico hospitalaria.

Oral squamous cell carcinoma (OSCC) tumors from heavy alcohol consumers are associated with higher levels of TLR9 and a particular immunophenotype: Impact on patient survival.

Oral squamous cell carcinoma (OSCC) is one of the most frequent types of oral cancer in developing countries and its burden correlates with exposure to tobacco and excessive alcohol consumption. Toll like receptors (TLRs) are major sensors of inflammatory stimuli, from both microbial and sterile causes and as such, they have been related to tumor progression and metastasis. Here, we evaluated the expression of TLR2, 4 and 9 as well as CD3+, CD8+ and Granzyme B+ cell infiltration by immunohistochemistry in oral samples of 30 patients with OSCC, classified according to their consumption of alcohol. Our findings indicate that there is a significant association between heavy alcohol consumption and tumors with higher expression levels of TLR9. Moreover, patients with TLR9high tumors, as well as those who indicated high consumption of alcohol exhibited a diminished overall survival. TCGA data analysis indicated that TLR9high tumors express a significant increase in some genes related with the oral cavity itself, inflammation and tumor promotion. Our analysis of tumor infiltrating leukocytes demonstrated that the major differences perceived in heavy alcohol consumers was the location of CD8+ T cells infiltrating the tumor, which showed lower numbers intratumorally. Our data suggest the existence of a pathogenic loop that involves alcohol consumption, high TLR9 expression and the immunophenotype, which might have a profound impact on the progression of the disease.

Reexamination of delays in diagnosis of oral cancer following an intervention program in Cordoba, Argentina.

OBJECTIVE: We compare the results of delay in oral cancer diagnosis before and after a campaign directed toward dentists and raising awareness of the population to achieve early diagnosis of oral cancer in Córdoba, Argentina. The campaign included training dentists in diagnostic skills and a public awareness program through media and networks. STUDY DESIGN: Clinical records (period 1: before intervention program, n = 70; period 2: after intervention program, n = 60) of patients presenting with oral squamous cell carcinoma treated in 2 referral centers were analyzed. Records included first symptoms, first consultation with a health professional, and the time when treatment was formulated. RESULTS: Oral cancer diagnosis at early stages increased from 27% (period 1) to 40% (period 2). Biopsy at first consultation was indicated in 6% of patients in period 1 and in 23.3% in period 2 (odds ratio = 4.68; 95% confidence interval, 1.87-11.73; P < .05). Professional delay at early stage decreased from 72% in period 1 to 36.8% in period 2. During period 1, for initial stage cancer, the average patient and professional delays were 2.7 and 2.9 months, respectively (P = .06); in period 2, patient delay was 2.67 months and professional delay was 1.34 months (P = .005). CONCLUSION: The intervention program helped to improve early-stage diagnosis from 27% to 40% by reducing professional delays.

Oral Human Papillomavirus: a multisite infection

BACKGROUND: The Human Papillomavirus (HPV) has different strategies for persist in the cells. This characteristic has led us to consider the presence of the virus in tissues of the oral cavity that had no clinical signs of infection. The aim of this study was to detect the presence of DNA-HPV at multiple sites of the oral cavity. MATERIAL AND METHODS: A case-control study was designed: Oral Squamous Carcinoma Group (OSCG), healthy n=72 and Control Group (CG), n=72, healthy volunteers paired by sex and age with OSCG. Four samples were taken from OSCG: saliva, biopsy, brush scraping of lesion and contralateral healthy side. In CG a saliva sample and a scratch of the posterior border of tongue were collected. HPV was detected by PCR using Bioneer Accuprep genomic DNA Extraction kit, and consensus primers MY09 and MY11. Chi square test was applied. RESULTS: 432 samples were obtained from 144 individuals. DNA-HPV was detected in 30 (42%) of OSCG subjects and 3 (4%) of CG. Two or more positive samples were obtained in 67% of the OSCG, 67% in saliva and 60% in biopsy; in CG 100% of the individuals were positive in the two samples. CONCLUSIONS: HPV is frequently present in oral cavity as a multifocal infection, even without the presence of clinical lesions

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Sexually transmitted infections in oral cavity lesions: Human papillomavirus, Chlamydia trachomatis, and Herpes simplex virus.

Objective: Provide evidence of HPV, C. trachomatis, and HSV infection in the oral cavity from patients with different types of stomatological lesions. Materials and Methods: Oral swabs samples were collected from a total of 318 patients. The infectious agents were analyzed using the PCR technique. HPV genotyping and HSV type were studied using the RFLP method. Results: We studied 137 benign lesions (B), 96 potentially malignant disorders (PMD) and 85 oral squamous cell carcinomas (OSCC). The prevalence of HPV was 34%. The most frequently genotypes detected were 6 low risk and 16 high risk. The prevalence of C. trachomatis was 16% and HSV 3%. Co-infections were detected mostly in benign lesions as following: HPV-C. trachomatis in 4%, C. trachomatis- HSV in 1.8% and HPV-HSV in 0.3%. Conclusion: This report is the first contribution to the identification and genotype characterization of HPV in a scenario little studied in our area, and it also contributes to improving our understanding on sexually transmitted infectious agents and their associations with the oral cavity. Besides, we detect the presence of C. trachomatis and HSV and co-infection with HPV in the oral cavity, which they should be taken into account for diagnostic and treatment purposes.

Study of virulence factor of Candida species in oral lesions and its association with potentially malignant and malignant lesions.

OBJECTIVE: The aim of this study was to explore the association between malignant and premalignant lesions and the virulence factor profile of Candida spp. recovered from different oral lesions. DESIGN: Candida spp. isolated from malignant lesions (squamous cell carcinoma, OC, n = 25), atypical lichen planus (AL, n = 11), chronic candidiasis (CC, n = 25), and asymptomatic carriers (WI, n = 15, control strains.) Isolates were identified in chromogenic medium, colony morphology and biochemical tests. The lipolytic and proteinase activity was determined on supplemented agar with olive oil and BSA, respectively. The biofilm formation with XTT reduction assay and cellular surface hydrophobicity (CSH) by water-hydrocarbon method were performed. RESULTS: All isolates recovered from oral lesions produced the four virulence factors studied with significantly higher levels than in WI isolates. Interestingly, lipolytic activity was absent in WI isolates. The proteolytic activity was similar in AL and OC isolates. OC isolates showed significantly higher CSH values than other clinical isolates. Non-albicans species showed higher biofilm formation than C.albicans (P = 0.03.) There were no significant differences in virulence factors among species. A strong positive correlation was found between proteinase and lipase activity (r = 0.90, P < 0.0001), and between hydrophobicity and biofilm (R = 0.81, P < 0.0001.) CONCLUSIONS: Our results indicate that OC Candida isolates exhibited a significant higher attributes of virulence than other lesions fungus isolates, providing evidence about the association between Candida pathogenicity and lesions severity.

Dentists' perceptions of HIV/AIDS: psychometric properties of a first questionnaire for dentistry

Aim: The present study outlines the testing the first questionnaire to the field of dentistry to evaluate dentists' perceptions of HIV/AIDS, and its psychometric properties. Methods: A first questionnaire developed to evaluate dentists' perceptions of HIV/AIDS at this cross-sectional study contained 33 items in its original version. Randomly subsample of 251 Argentine dentists was invited to participate in the study. A four-factor structure (Transmission, Oral Manifestations, Dentists' practice, and Infection Controls) was tested through exploratory and confirmatory factor analysis, as well reliability was assessed. Results: The deletion of eight items from the original questionnaire improved the goodness of fit for the instrument. The retained 25 items revealed an acceptable reliability (internal consistency of 0.68), while the four factors revealed a Cronbach's alpha coefficient of 0.53 for Transmission factor items, 0.71 for Oral Manifestations factor items, 0.59 for Dentists' Practice factor items, and 0.48 for Infection Controls factor items. Higher scores were observed on the Oral Manifestations factor items, but convergent and discriminant validity was compromised for the others factors. Conclusions: The findings presented here demonstrate the value of this first questionnaire with 25 items as a starting point for further inquiry. However, it would be desirable to add more items and a replication of the questionnaire is suggested to determine the stability of its psychometric properties

Alcohol y salud: ¿Alcohol y salud?: revisión bibliográfica / Alcohol and health: alcohol and health?: review of the literature

El consumo excesivo de bebidas alcohólicas constituye un serio problema sanitario y social. En los últimos años se han destacado sus propiedades anticancerosas, antioxidantes y protectoras contra la enfermedad cardíaca coronaria, lo que ha generado controversias entre beneficios y perjuicios de su consumo. Los efectos tóxicos sobre el sistema nervioso central lideran el cuadro de la intoxicación aguda, mientras que los efectos del consumo crónico afectan prácticamente todo el organismo, alterando numerosas funciones aún en etapas tempranas de la vida. Los profesionales de las ciencias de la salud tienen un rol clave en la prevención de los daños producidos por este hábito tan difundido.

Effect of two mouthwashes on salivary ph.

To analyze the effect of two mouthwashes on salivary pH and correlate it with age, buffer capacity and saliva flow rate in healthy volunteers, a crossover phase IV clinical study involving three age-based groups was designed. Two commercial mouthwashes (MW), Cool Mint ListerineR (MWa) and Periobacter R (MWb) were used. The unstimulated saliva of each individual was first characterized by measuring flow rate, pH, and buffer capacity. Salivary pH was evaluated before rinsing with a given MW, immediately after rinsing, 5 minutes later, and then every 10 min (at 15, 25, 35 min) until the baseline pH was recovered. Paired t-test, ANOVA with a randomized block design, and Pearson correlation tests were used. Averages were 0.63 mL/min, 7.06, and 0.87 for flow rate, pH, and buffer capacity, respectively. An immediate significant increase in salivary pH was observed after rinsing, reaching average values of 7.24 (MWb) and 7.30 (MWa), which declined to an almost stable value 15 minutes. The great increase in salivary pH, after MW use shows that saliva is a dynamic system, and that the organism is capable of responding to a stimulus with changes in its composition. It is thus evident that pH of the external agent alone is not a good indicator for its erosive potential because biological systems tend to neutralize it. The results of this study enhance the importance of in vivo measurements and reinforce the concept of the protective action of saliva.

Effect of two mouthwashes on salivary pH

Etários de adultos voluntarios sanos, para analizar el efecto de dos colutorios sobre el pH salival y relacionarlo con la edad la capacidad buffer y el flujo salival. Se utilizaron dos marcascomerciales de colutorios (MW), ListerineCoolMint® (MWa) y eriobacter® (MWb). Primero se caracterizó la saliva sin estimular de cada individuo, se le midió el volumen minuto, el pH y la capacidad buffer. El pH salival se evaluó antes del buche con cada MW, inmediatamente después del enjuague bucal, 5 minutos después y luego cada 10 minutos (a los 15,25, 35 min) hasta que el pH inicial se recuperó. Para el análisis estadístico de los datos se utilizaron: ANOVA en bloque,test t apareado y el test de correlación de Pearson. Al caracterizar la saliva, se obtuvieron los siguientes valores promedio: 0.63 mL/min, 7.06 y 0.87 de volumen minuto,pH, y capacidadbuffer. Luego del enjuague se observó un incremento inmediato y significativo del pH salival alcanzando valores de 7.24 (MWb) y 7.30 (MWa) para descender a un valor estable luegode 15 minutos. El importante incremento del pH salival luego del uso del colutorio, muestra que la saliva es un sistema dinámico y que el organismo es capaz de responder a estímulos con cambios en su composición. Se hace evidente que el pH del agente externo, no es un buen indicador de su potencialerosivo sobre los elementos dentarios ya que los sistemas biológicos tienden a neutralizarlo. Los presentes resultadosponen de manifiesto la importancia de las mediciones en vivo y refuerzan el concepto de la función protectora de la saliva...

Nitric oxide synthase 2 (NOS2) expression in histologically normal margins of oral squamous cell carcinoma

The activity of Nitric Oxide Synthase 2 (NOS2) was found in oral squamous cell carcinomas (OSCC) but not in normal mucosa. Molecular changes associated to early carcinogenesis have been found in mucosa near carcinomas, which is considered a model to study field cancerization. The aim of the present study is to analyze NOS2 expression at the histologically normal margins of OSCC. Study DESIGN: Eleven biopsy specimens of OSCC containing histologically normal margins (HNM) were analyzed. Ten biopsies of normal oral mucosa were used as controls. The activity of NOS2 was determined by immunohistochemistry. Salivary nitrate and nitrite as well as tobacco and alcohol consumption were also analyzed. The Chi-squared test was applied. RESULTS: Six out of the eleven HNM from carcinoma samples showed positive NOS2 activity whereas all the control group samples yielded negative (p = 0.005). No statistically significant association between enzyme expression and tobacco and/or alcohol consumption and salivary nitrate and nitrite was found. CONCLUSIONS: NOS2 expression would be an additional evidence of alterations that may occur in a state of field cancerization before the appearance of potentially malignant morphological changes

Development of questionnaire on dentists' knowledge of HIV/AIDS / Desenvolvimento de um questionário sobre HIV/AIDS para dentistas

Aim: This study aimed to construct and evaluate the cross-cultural adaptation of DK-HIV-Q in an Argentine Spanish version. Methods: A translation and back translation of the DK-HIV-Q questionnaire were completed, as the original questionnaire had been formulated in Portuguese by a Brazilian researcher. The DKHIV- Q was tested in two pilot studies conducted with Argentine dentists. Results: The committee of experts, consisting of three bilingual dentists, an epidemiology dentist, a general clinical dentist, and an oral pathology specialist, fully agreed on the conceptual relevance of the general domain and the 4-domain structure for the DK-HIV-Q, such as the declarative knowledge of the transmission of HIV/AIDS, the declarative knowledge of oral manifestations of HIV/AIDS, the procedural knowledge of proper dental practice, and the procedural knowledge of infection control measures. A final version of the DK-HIV-Q showed a satisfactory degree of semantic accuracy and semantic equivalence with the original version, and proved to be satisfactorily conceptual and useful as an initial indicator for a subsequent study of construct validity. Conclusion: This study described the specific details of the construction of the DK-HIV-Q and aspects of the content validity process, which is one of the main procedures to be considered by healthcare researchers and professionals who are interested in using reliable and appropriate measurements and instrument scales for given population groups, such as HIV/AIDS patients.

Objetivo: O objetivo deste estudo foi construir o DK-HIV-Q na versão espanhola Argentina e avaliar sua adaptação transcultural. Materiais e Métodos: Foi realizada a tradução e a retro-tradução, porque o DK-HIV-Q foi feito em português pela pesquisadora brasileira. O DK-HIV-Q foi testado em dois estudospiloto entre dentistas argentinos. Resultados: O comitê de especialistas, composto por três cirurgiõesdentistas bilíngues, um epidemiologista, um clínico geral e um especialista em patologia oral, concordaram completamente com a relevância conceitual do domínio geral e com a estrutura de quatro domínios para o DK-HIV-Q, que foram conhecimento declarativo dos métodos de transmissão do HIV, conhecimento declarativo das manifestações orais de HIV/AIDS, conhecimento processual de práticas gerais odontológicas, e conhecimento processual de controle de infecção. A versão final do DKHIV- Q mostrou um grau satisfatório de precisão e de equivalência semânticas com a versão original e provou ser satisfatoriamente conceitual e útil como um indicador inicial para realizar um estudo posterior de validade de construto. Conclusão: Este estudo descreveu detalhes da construção do DK-HIV-Q e aspectos do processo de validade de conteúdo, um dos procedimentos a serem considerados por pesquisadores de saúde e profissionais que estão interessados em usar medidas confiáveis e adequadas e escalas de instrumentos para determinados grupos de população, tais como pacientes com HIV/AIDS.

Nitric oxide synthase 2 (NOS2) expression in histologically normal margins of oral squamous cell carcinoma.

UNLABELLED: The activity of Nitric Oxide Synthase 2 (NOS2) was found in oral squamous cell carcinomas (OSCC) but not in normal mucosa. Molecular changes associated to early carcinogenesis have been found in mucosa near carcinomas, which is considered a model to study field cancerization. The aim of the present study is to analyze NOS2 expression at the histologically normal margins of OSCC. STUDY DESIGN: Eleven biopsy specimens of OSCC containing histologically normal margins (HNM) were analyzed. Ten biopsies of normal oral mucosa were used as controls. The activity of NOS2 was determined by immunohistochemistry. Salivary nitrate and nitrite as well as tobacco and alcohol consumption were also analyzed. The Chi-squared test was applied. RESULTS: Six out of the eleven HNM from carcinoma samples showed positive NOS2 activity whereas all the control group samples yielded negative (p=0.005). No statistically significant association between enzyme expression and tobacco and/or alcohol consumption and salivary nitrate and nitrite was found. CONCLUSION: NOS2 expression would be an additional evidence of alterations that may occur in a state of field cancerization before the appearance of potentially malignant morphological changes.

Development of questionnaire on dentists’ knowledge of HIV/AIDS

Aim: This study aimed to construct and evaluate the cross-cultural adaptation of DK-HIV-Q in an Argentine Spanish version. Methods: A translation and back translation of the DK-HIV-Q questionnaire were completed, as the original questionnaire had been formulated in Portuguese by a Brazilian researcher. The DKHIV-Q was tested in two pilot studies conducted with Argentine dentists. Results: The committee of experts, consisting of three bilingual dentists, an epidemiology dentist, a general clinical dentist, and an oral pathology specialist, fully agreed on the conceptual relevance of the general domain and the 4-domain structure for the DK-HIV-Q, such as the declarative knowledge of the transmission of HIV/AIDS, the declarative knowledge of oral manifestations of HIV/AIDS, the procedural knowledge of proper dental practice, and the proceduralknowledge of infection control measures. A final version of the DK-HIV-Q showed a satisfactory degreeof semantic accuracy and semantic equivalence with the original version, and proved to be satisfactorilyconceptual and useful as an initial indicator for a subsequent study of construct validity. Conclusion: Thisstudy described the specific details of the construction of the DK-HIV-Q and aspects of the content validity process, which is one of the main procedures to be considered by healthcare researchers and professionals who are interested in using reliable and appropriate measurements and instrument scales for given populationgroups, such as HIV/AIDS patients.

Effect of two mouthwashes on salivary ph. / Effect of two mouthwashes on salivary ph.

To analyze the effect of two mouthwashes on salivary pH and correlate it with age, buffer capacity and saliva flow rate in healthy volunteers, a crossover phase IV clinical study involving three age-based groups was designed. Two commercial mouthwashes (MW), Cool Mint ListerineR (MWa) and Periobacter R (MWb) were used. The unstimulated saliva of each individual was first characterized by measuring flow rate, pH, and buffer capacity. Salivary pH was evaluated before rinsing with a given MW, immediately after rinsing, 5 minutes later, and then every 10 min (at 15, 25, 35 min) until the baseline pH was recovered. Paired t-test, ANOVA with a randomized block design, and Pearson correlation tests were used. Averages were 0.63 mL/min, 7.06, and 0.87 for flow rate, pH, and buffer capacity, respectively. An immediate significant increase in salivary pH was observed after rinsing, reaching average values of 7.24 (MWb) and 7.30 (MWa), which declined to an almost stable value 15 minutes. The great increase in salivary pH, after MW use shows that saliva is a dynamic system, and that the organism is capable of responding to a stimulus with changes in its composition. It is thus evident that pH of the external agent alone is not a good indicator for its erosive potential because biological systems tend to neutralize it. The results of this study enhance the importance of in vivo measurements and reinforce the concept of the protective action of saliva.

Daily biofilm control and oral health: consensus on the epidemiological challenge--Latin American Advisory Panel.

Our understanding of dental plaque biofilm has evolved since the nonspecific plaque hypothesis that considered plaque as a nonspecific mass of native microorganisms that, because of lack of oral hygiene, builds up in proportions great enough to overcome the host resistance threshold and affect the tooth structure and tooth supporting tissues. A great diversity of microorganisms-over 700 species-was detected in the oral cavity, and evidence shows that the investigation of specific microorganisms or associations of microorganisms as etiological agents for periodontal diseases and caries is not a simplistic approach. Although clinical evidence shows that oral mechanical hygiene is fundamental to prevent and control caries and periodontal disease, it is important to highlight that optimal control is not achieved by most individuals. Thus the complementary use of chemotherapeutic agents has been investigated as a way to overcome the deficiencies of mechanical oral hygiene habits, insofar as they reduce both plaque formation and gingival inflammation, and represent a valid strategy to change the biofilm and maintain dental and periodontal health. The role of the dental professional is to monitor patients and offer them the best recommendations to preserve oral health throughout their life. With this in mind, chemical control should be indicated as part of daily oral hygiene, together with mechanical procedures, for all individuals who present supragingival and/or subgingival biofilm, taking into account age, physical and/or psychological limitations, allergies, and other factors.

Daily biofilm control and oral health: consensus on the epidemiological challenge - Latin American Advisory Panel

Our understanding of dental plaque biofilm has evolved since the nonspecific plaque hypothesis that considered plaque as a nonspecific mass of native microorganisms that, because of lack of oral hygiene, builds up in proportions great enough to overcome the host resistance threshold and affect the tooth structure and tooth supporting tissues. A great diversity of microorganisms-over 700 species-was detected in the oral cavity, and evidence shows that the investigation of specific microorganisms or associations of microorganisms as etiological agents for periodontal diseases and caries is not a simplistic approach. Although clinical evidence shows that oral mechanical hygiene is fundamental to prevent and control caries and periodontal disease, it is important to highlight that optimal control is not achieved by most individuals. Thus the complementary use of chemotherapeutic agents has been investigated as a way to overcome the deficiencies of mechanical oral hygiene habits, insofar as they reduce both plaque formation and gingival inflammation, and represent a valid strategy to change the biofilm and maintain dental and periodontal health. The role of the dental professional is to monitor patients and offer them the best recommendations to preserve oral health throughout their life. With this in mind, chemical control should be indicated as part of daily oral hygiene, together with mechanical procedures, for all individuals who present supragingival and/or subgingival biofilm, taking into account age, physical and/or psychological limitations, allergies, and other factors.

Nucleolar organizer regions (AgNOR) and subepithelial vascularization as field cancerization markers in oral mucosa biopsies of alcoholic and smoking patients.

OBJECTIVE: The aim of this study was to show that variations in nucleolar organizer regions (AgNOR) and the increase in subepithelial vascularization could reveal changes related to markers of field cancerization in alcoholic and smoking patients who have not yet expressed clinical or histological malignant lesions. STUDY DESIGN: Quantitative variations in epithelial AgNOR and in the vascularization of the underlying connective tissue were assessed by image analysis in histologically normal biopsy specimens from alcohol drinkers and smoking patients (DS). AgNORs were evidenced by silver staining and vessel walls were labeled by immunohistochemical demonstration of the CD34 antigen. Samples of oral mucosa of nonalcoholic, nonsmoking patients (NDS) obtained during surgical procedures served as controls. Eight parameters related to number, volume, and shape of nuclei and AgNORs, and 4 parameters related to number and diameter of vascular sections were evaluated. Differences between DS and NDS groups were statistically evaluated by means of ANOVA test and posterior Bonferroni comparisons. RESULTS: The morphometric analysis revealed more irregular-shaped AgNORs in the superficial and suprabasal layers of the oral mucosa of DS patients. The suprabasal layers also exhibited a significantly larger number of AgNORs. The normal oral mucosa of DS patients exhibited a greater vascular density, with predominance of small-caliber blood vessels underlying the basement membrane. CONCLUSION: The variations in AgNOR and epithelial vascularization would be practical biomarkers to evaluate changes underlying the augmented risk of cancerization in oral mucosa.