Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes.

OBJECTIVES: This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics. MATERIAL AND METHODS: Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR. RESULTS: Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05). CONCLUSIONS: Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year. CLINICAL RELEVANCE: There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02643771.

Prescrições medicamentosas realizadas por cirurgiões-dentistas ­ estudo transversal / Drug prescriptions performed by dentists: cross-sectional study

A presente pesquisa tem por objetivo analisar informações sobre as prescrições de medicamentos pelos cirurgiões-dentistas especialistas e clínicos gerais, nos grupos dos seguintes medicamentos: analgésicos, anti-inflamatórios e antibióticos. A realização desse estudo transversal compreendeu nos meses de janeiro e fevereiro do ano 2018, cuja amostra foi composta por 100 cirurgiões-dentistas da cidade de Natal/RN, de ambos os sexos, tanto especialistas quanto clínicos gerais do serviço público e privado. Estes, responderam a um questionário sobre suas prescrições e, através deles, foram obtidos alguns resultados. A amostra foi composta por uma faixa etária de 24 a 69 anos, pela maioria dos cirurgiões-dentistas especialistas, atuantes no serviço público, com mais de 10 anos de formado, dos quais, 83% prescrevem terapêutica medicamentosa todos os dias ou entre 1 a 3 vezes na semana. Os entrevistados possuem uma predileção pela dipirona, nimesulida, dexametasona e amoxicilina. Entretanto, apesar da frequência de prescrições desses profissionais, foi observado nos analgésicos 81% de posologias inadequadas. Nesse sentido, a presente pesquisa mostrou que os cirurgiões-dentistas são profissionais que necessitam da terapêutica medicamentosa no seu dia a dia, porém, muitos não estão totalmente qualificados para isso, sendo responsáveis por um alto percentual de erros de medicação tanto nas indicações quanto nas posologias (AU).

The main researches on drug prescriptions for dental surgeons and general practitioners are in the groups of the following drugs: analgesics, anti-inflammatories, and antibiotics. The edition of this cross-sectional study was carried out in January and February of 2018, and was reviewed with the participation of 100 dentists in the city of Natal/RN, of both sexes, in addition to general and private clinical care. They answered a questionnnaire about their prescriptions and achievements and, through them, some result were obtained. The sample consisted of a series of 24-69 years old, by the majority of specialist dental surgeons, acting in the public service, with more than 10 years of training, which times in the week. The interviewees have a predilection for dipyrone, nimesulide, dexamethasone, and amoxicillin. However, there was a shock of experience in the professional world, 81% of inadequate dosages were observed in analgesics. In this sense, the present research showed that dental surgeons are professionals who have drug therapy in their daily lives, although many are not totally focused on this, being responsible for a high percentage of medication errors in the sense in the dosages (AU).

Tratamento do bruxismo com toxina botulínica tipo A ­ relato de caso / Treatment of bruxism with botulinum toxin type A ­ case report

O presente trabalho tem o objetivo de relatar o caso de uma paciente diagnosticada com bruxismo do sono, a qual foi tratada com aplicação de toxina botulínica tipo A. A paciente SBL, 53 anos, compareceu ao consultório odontológico queixando-se de fortes dores faciais e cefaleia matutina. A paciente fazia uso de placa semiflexível para dormir, a qual foi imediatamente substituída por uma placa rígida de acrílico, ajustada de acordo com os critérios de oclusão mutuamente protegida. Devido à dificuldade da paciente em aderir ao uso da placa, optou-se pelo tratamento com toxina botulínica tipo A. O medicamento foi injetado em três pontos do músculo masseter, bilateralmente, na quantidade de 5U em cada ponto. No quinto dia após a aplicação, os primeiros sinais clínicos do efeito do medicamento foram percebidos pela paciente, que foi instruída a suspender o uso da placa miorrelaxante. No retorno de 30 dias, a sensibilidade positiva à palpação do masseter e articulação temporomandibular não estava mais presente. A paciente relatou extrema satisfação com o tratamento, considerando o procedimento indolor e sem efeitos adversos. A frequência das dores reduziu consideravelmente. O tratamento com toxina botulínica mostrou-se eficaz, pouco invasivo e livre de efeitos colaterais, devendo ser considerada uma importante opção para o controle da dor muscular e prevenção dos desgastes dentários em pacientes bruxômanos (AU).

This study aims to report the case of a patient diagnosed with sleep bruxism, who was treated with botulinum toxin type A. Patient SBL, 53 years old, reported strong facial pain and headache during the morning. The patient had been using a semi-flexible splint to sleep, which was immediately replaced by a rigid acrylic splint, adjusted according to the criteria of mutually protected occlusion. Due to patient difficulty to adhere to splint use, the option for the treatment was botulinum toxin type A. The drug was injected in three points of the masseter muscle, bilaterally, 5U at each point. On the fifth day after application, the first clinical signs of drug effect were noticed by the patient, who was instructed to discontinue the use of the occlusal splint. After thirty days, the positive sensitivity of the masseter muscle palpation and temporomandibular joint were not present. The patient reported extreme satisfaction with the treatment, considering it painless and without side effects. The frequency of pain reduced considerably. The treatment with botulinum toxin was effective, minimally invasive, and free of side effects and should be considered an important option for the control of muscle pain and prevention of tooth wear in patients with bruxism (AU).

Aplicação da toxina botulínica tipo A na correção do sorriso gengival / Application of botulinum toxin type A in a correction of gummy smile

O presente trabalho tem o objetivo de relatar o caso de uma paciente diagnosticada com sorriso gengival, a qual foi tratada com aplicação de toxina botulínica tipo A. Paciente do gênero feminino, 23 anos, procurou atendimento odontológico relatando insatisfação com a quantidade de gengiva exposta durante o sorriso. O diagnóstico foi de sorriso gengival com origem no excesso de crescimento vertical da maxila. O tratamento com cirurgia ortognática, indicado quando há desarmonia do sorriso devido a um problema ósseo, foi prontamente rejeitado pela paciente. Assim, sugeriu-se a aplicação da toxina botulínica tipo A com o objetivo de relaxar os músculos elevadores do lábio superior e da asa do nariz e os elevadores do lábio superior (músculos ELSAN), diminuindo a faixa de gengiva exposta ao sorrir. No terceiro dia após a aplicação, os primeiros sinais clínicos do efeito do medicamento foram percebidos pela paciente, a qual relatou efeito máximo após 14 dias. A mesma relatou extrema satisfação com o tratamento, considerando o procedimento indolor e sem efeitos adversos. Consultas de retorno foram realizadas com 15, 90, 120 e 150 dias. Aos 120 dias, o efeito do tratamento ainda estava presente. No último retorno, constatou-se o fim da ação do medicamento e retorno à situação inicial. Desta maneira, a toxina botulínica tipo A mostrou-se como uma alternativa de tratamento eficaz, simples e minimamente invasiva para o sorriso gengival de origem óssea (excesso de crescimento vertical da maxila) (AU).

This study aims to report the case of a patient diagnosed with gummy smile, who was treated with botulinum toxin type A. A female patient, 23 years old, sought dental care reporting dissatisfaction with the amount of gum exposed during smile. The diagnosis was gummy smile with origin in excess of vertical maxillary growth. The orthognathic surgery treatment indicated, when there is smile disharmony due to a bone problem, was promptly rejected by the patient. Thus, it was suggested the application of botulinum toxin type A in order to relax the upper lip levator muscles and the bridge of the nose and upper lip lifts (ELSAN muscles), reducing the gum strip exposed to smile. On the third day after application, the first clinical signs of drug effect was noticed by the patient, who reported maximum effect after 14 days. The patient reported extreme satisfaction with treatment, considering the painless and without side effects procedure. Return visits were conducted with 15, 90, 120, and 150 days. After 120 days, the treatment effect was still present. In the final examination, there was the end of the action of the drug and return to starting position. It was concluded that the botulinum toxin type A has proved to be an alternative effective, simple and minimally invasive treatment for gummy smile of bone origin (excessive vertical maxillary growth) (AU).

Th2 cells and the ifn-γ R1 subunit in early and advanced experimental periodontitis in rats; an immunohistochemical study

Aim: To evaluate the involvement of Th2 cells in different periods of the active phase of experimental periodontal disease and expression of the R1 subunit of the receptor for IFN-γ during the early and advanced progression of the disease. Methods: Experimental periodontitis was induced in 30 male Wistar rats by placing cotton ligatures around the mandibular first molars. The rats were then randomly assigned into two groups: G1=15 and G2=15, in group G1, ligatures were maintained for 2 days, a period that corresponds to the initial stage of periodontal disease in rats, in G2 ligatures were left for 15 days, a period that corresponds to the advanced stage of periodontal disease. The contra-lateral teeth served as controls (unligated). An immunohistochemical investigation of the gingival tissue was performed to detect the presence of the Th2 specific transcription factor (GATA3). Results Light microscopy analysis revealed a decreased expression of GATA-3-positive cells when bone loss progressed. IFN-γ R1 was detected at an early stage during the active phase of disease, but the expression of positive cells remained unaltered during the remaining period of the study.

Resposta celular Th1/Th2 na doença periodontal experimental, em ratos: um estudo imuo-histoquímico / Cellular reply Th1/Th2 in the experimental periodontal illness, rats: a imuno-histoquímico study

A resposta do hospedeiro tem um importante papel na patogênese periodontal. Mediadores como as citocinas liberadas por células inflamatórias durante a resposta imune, frente a um ataque bacteriano, desempenham papéis antagônicos que podem culminar com a proteção ou não do tecido agredido, o que fundamenta o paradigma da resposta Th1/Th2 na doença periodontal. Na tentativa de esclarecer a participação das células Th2, em diferentes tempos, na fase ativa da doença periodontal, bem como observar se o microambiente encontrava-se preparado para uma resposta Th1, induziu-se doença periodontal experimental em 30 ratos Wistar machos, através da colocação de ligaduras de algodão ao redor dos primeiros molares mandibulares. Os animais foram divididos, aleatoriamente, em dois grupos: Grupo 1(G1=15) e Grupo 2 (G2=15). em G1 as ligaduras foram mantidas por 2 dias, que configurou o estágio inicial da doença periodontal e no G2, as ligaduras foram mantidas por 15 dias, que foi considerado o estágio avançado da doença periodontal. Os dentes...