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OBJECTIVE: To systematically evaluate randomized controlled trials (RCTs), with at least 6 months of follow-up, on whether professional mechanical plaque removal (PMPR) including supragingival scaling should be performed prior and separately from subgingival scaling and root planning (SRP) in nonsurgical periodontal therapy (NSPT), in terms of clinical and patient-reported outcomes (PROs) (CRD42020219759). METHODS: The MEDLINE, EMBASE, CENTRAL, LILACS and Web of Science electronic databases, as well as grey literature sources, were searched by two independent reviewers up to May 2023. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random-effects pairwise meta-analyses compared the changes in probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BoP) of a stepwise NSPT approach (PMPR prior and separately from SRP) and conventional one-step NSPT through mean differences (MDs) and associated confidence intervals (95% CI). RESULTS: Two RCTs were included, including data of 77 participants with severe periodontitis. One RCT presents high risk of bias and the other has some concerns. No significant differences were found between the stepwise approach and performing both steps simultaneously for any clinical outcomes, with overall very low certainty on evidence. No adverse effects were detected and there was no data on PROs. CONCLUSIONS: There is very-low certainty evidence of no significant difference on PPD and BoP reductions and CAL gain between supragingival scaling performed prior and separately from SRP and conventional one-step NSPT.
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Raspado Dental , Periodontitis , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Periodontitis/terapia , Aplanamiento de la RaízRESUMEN
This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.
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Odontología , Metaanálisis en Red , SesgoRESUMEN
Abstract This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.
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Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.
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Hipertensión , Periodontitis , Humanos , Aggregatibacter actinomycetemcomitans , Proyectos Piloto , Porphyromonas gingivalis , Fusobacterium nucleatum , Estudios Transversales , Prevotella intermediaRESUMEN
Abstract Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.
Resumo A periodontite e a hipertensão arterial são duas das patologias com maior prevalência global, as evidências relatadas até o momento têm sido favoráveis a uma associação entre elas. Este estudo transversal teve como objetivo avaliar e comparar contagem microbiológicas de pacientes hipertensos e normotensos com periodontite. Dados sociodemográficos, comportamentais, de saúde sistêmica e parâmetros clínicos periodontais foram avaliados. Contagens de A. actinomycetemcomitans, P. intermedia, P. gingivalis e F. nucleatum foram realizadas por reação em cadeia da polimerase em tempo real utilizando amostras de biofilme subgengival. Trinta e oito pacientes foram incluídos nesta análise preliminar, divididos em dois grupos: Grupo Normotenso (GN) (n = 14) e Grupo Hipertenso (GH) (n = 24). Pacientes diagnosticados com periodontite compuseram os dois grupos. A análise dos dados foi realizada com nível de significância de 5%. Não houve diferença significativa entre os grupos para o diagnóstico clínico de periodontite. Além disso, os hipertensos apresentaram maior contagem de P. intermedia, P. gingivalis e F. nucleatum quando comparados aos normotensos. Os parâmetros profundidade de sondagem, sangramento à sondagem e contagem de A. actinomycetemcomitans não apresentaram diferenças estatísticas entre os grupos. Com esses resultados preliminares, pode-se concluir que a presença de hipertensão arterial pode estar associada a uma maior quantidade de bactérias periodontopatogênicas de algumas espécies em indivíduos com periodontite.
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Objective: To assess the caries progression and the need for reintervention on occlusal ICDAS 4 lesions after different treatments. Material and Methods: The sample consisted of records of children treated in a public setting who had at least an occlusal ICDAS 4 lesion in primary and/or permanent molars. The radiographic images of ICDAS 4 lesions at the first and last appointments were classified as absence of radiolucency, radiolucent image at the enameldentin junction, at the outer half or inner of the dentin. The need for retreatment after different treatments (non-invasive - topical fluoride applications, oral hygiene instructions and dietary guidance, micro-invasive - resin-based sealant, or invasive - restoration) was assessed by reviewing clinical and radiographic records. The need for retreatment was defined as any complication requiring mending (e.g., caries progression, total loss of sealant, or restoration failure). The Poisson regression model was used to investigate the association between individual and tooth-related variables and the outcome. Results: Among the 111 lesions in 81 patients, most (73.0%) lesions were in primary molars. Most lesions (52.3%) did not exhibit radiolucency, whereas 29.7% had radiolucency at the outer half of the dentin. The mean follow-up was 18.8 ± 6.5 months. After follow-up, 82.9% of the lesions did not require retreatment. The prevalence of ICDAS 4 lesions that did not need retreatment was higher among lesions with radiolucency at dentin (p=0.01). Conclusion: Most occlusal ICDAS 4 lesions did not require reintervention, especially those exhibiting radiolucency in the outer half of the dentin (AU)
Objetivo: Avaliar a progressão de cárie e a necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos. Material e Métodos: A amostra consistiu de prontuários de crianças atendidas em ambiente público que apresentavam pelo menos uma lesão oclusal ICDAS 4 em molares decíduos e/ou permanentes. As imagens radiográficas de lesões ICDAS 4 na primeira e última consultas foram classificadas como ausência de radiolucidez, imagem radiolúcida na junção esmalte-dentina, em metade externa ou interna da dentina. A necessidade de retratamento após diferentes tratamentos (não invasivo aplicações tópicas de flúor, orientações de higiene e dieta, micro-invasivo selante resinoso ou invasivo restauração) foi avaliada por meio da revisão dos registros clínicos e radiográficos. A necessidade de retratamento foi definida como qualquer complicação que requer intervenção (por exemplo, progressão da lesão, perda total do selante ou falha na restauração). O modelo de regressão de Poisson foi utilizado para investigar a associação entre as variáveis individuais e dentárias e o desfecho. Resultados: Entre as 111 lesões em 81 pacientes, a maioria (73,0%) das lesões eram em molares decíduos. A maioria das lesões (52,3%) não exibiu radiolucidez, enquanto que 29,7% apresentaram radiolucidez em metade externa de dentina. O tempo de acompanhamento médio foi de 18,8 ± 6,5 meses. Após o acompanhamento, 82,9% das lesões não necessitaram de retratamento. A prevalência de lesões ICDAS 4 que não necessitaram de retratamento foi maior entre as lesões com radiolucidez em dentina (p=0,01). Conclusão: A maioria das lesões oclusais ICDAS 4 não requerem reintervenção, especialmente aquelas que exibem radiolucidez em metade externa da dentina.(AU)
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Humanos , Niño , Radiografía Dental , Caries Dental , Toma de Decisiones ClínicasRESUMEN
Purpose: To evaluate the effect of caries management on the periodontal status of preschool and school-age children.
Methods: Twenty-six four- to eight-year-old children with at least one primary molar with a deep carious lesion were selected to undergo a periodontal evaluation before and six months after dental treatment. Two examiners conducted the periodontal exams using the visible plaque index (VPI) and gingival bleeding index (GBI). Longitudinal changes were compared using paired t-test and Fisher's test. Poisson regression models were used to investigate the variables influencing GBI (α =five percent).
Results: There were no significant differences in the mean percentage of VPI-positive sites (55.8±26.9 percent to 54.5±29.8 percent; P =0.829) and GBI-positive sites (37.2±22.2 percent to 32.1±22.8 percent; P =0.222) before and after treatment. In contrast, the mean number of GBI sites decreased from 8.5±5.03 to 6.3±4.39 (P =0.026), while the percentage of patients presenting GBI of no more than 10 percent increased from 11.5 percent to 26.9 percent over time (P =0.013). Similar analyses for VPI did not show a statistical significance. Boys (P =0.037) and six- to eight-year-old children ( P =0.029) had lower reductions on GBI.
Conclusion: Caries management has a positive impact on the periodontal condition of children, especially on gingival bleeding.
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Susceptibilidad a Caries Dentarias , Caries Dental , Niño , Preescolar , Caries Dental/terapia , Índice de Placa Dental , Humanos , Masculino , Índice Periodontal , Instituciones AcadémicasRESUMEN
AIMS: SARS-CoV-2 RNA has been recovered from different sites in the human body, including the mouth. The present study aimed to investigate the presence of SARS-CoV-2 RNA in the dental biofilm of symptomatic patients who tested positive in nasopharyngeal and oropharyngeal (NASO/ORO) samples. MATERIALS & METHODS: An observational clinical study of individuals with flu-like symptoms was conducted between July and September 2020. Dental biofilm (BIO) samples were collected and analysed using real-time quantitative polymerase chain reaction (RT-qPCR) to determine the virus's presence. RESULTS: Seventy participants (40 ± 9.8 years of age, 71.4% female) tested positive for SARS-CoV-2 RNA in NASO/ORO samples and were included in the study. Among them, 13 tested positive in BIO samples (18.6%; 95% CI: [9.5, 27.7]). The median and interquartile range of cycle quantification (Cq) for NASO/ORO and BIO samples were 15.9 [6.9] and 35.9 [4.0] (p = .001), respectively. BIO-positive participants showed a higher virus load in NASO/ORO samples (p = .012) than those testing negative (Cq = 20.4 [6.1]). CONCLUSIONS: Dental biofilms from symptomatic COVID-19 patients harbour SARS-CoV-2 RNA and might be a potential reservoir with an essential role in COVID-19 transmission.
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COVID-19 , SARS-CoV-2 , Anciano , Biopelículas , Femenino , Humanos , Masculino , ARN Viral , Reacción en Cadena en Tiempo Real de la Polimerasa , Carga ViralRESUMEN
AIM: Assessment of Oral Health Impact Profile (OHIP-14) during a randomized controlled trial of supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions only (test) or in conjunction with subgingival instrumentation (control). METHODS: OHIP-14 was assessed at baseline, 6, 12, 18 and 24 months. Data from 62 participants (50.97 ± 9.26 years, 24 smokers) were analysed by GEE and Logistic regression. OHIP-14 means, effect size, floor and ceiling effect and minimal important difference were calculated. Sum of OHIP-14 (severity), numbers of responses (extent) "fairly often" (FO) or "very often" (VO) and percentage of people (prevalence) reporting FO or VO were computed. RESULTS: At baseline, low scores of OHIP-14 were observed for test (7.67 ± 9.27) and control (6.51 ± 7.47) with a decreasing trend during SPT, without differences between or intra-groups over time. At 6 months, a difference was observed in the OHIP-14 prevalence (p = .03), without differences in severity and extent. Smoking status and plaque >15% (moderate oral hygiene) at 24 months were associated with higher OHIP-14 prevalence scores at that point of time (p = .038 and p = .034, respectively). CONCLUSION: Patients submitted to two different modalities of SPT maintained low OHIP-14 scores over 2 years of care.
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Salud Bucal , Calidad de Vida , Atención Odontológica , Humanos , Higiene Bucal , Encuestas y CuestionariosRESUMEN
BACKGROUND: Acid sphingomyelinase deficiency (ASMD) is a rare group of autosomal recessive disorders. This report provides the first detailed description of the periodontal condition and treatment response in a patient with chronic visceral ASMD. CASE DESCRIPTION: A 49-year-old white woman with ASMD showed elevated visible plaque index (VPI), gingival bleeding index (GBI), and bleeding on probing (BOP) at 100% of sites. Periodontal pocket depths (PPD) were mostly shallow to moderate (at 96% of sites), whereas the loss of clinical attachment (CAL) was moderate to severe (54% and 46% of sites, respectively, at 4-6 mm and ≥7 mm categories). Periapical radiographs revealed the presence of furcation involvement and intra-bony defects. The periodontal diagnosis was periodontitis stage IV, generalized, grade C. Ninety days after the end of the supra and subgingival control (e.g., cause-related therapy), marked reduction was observed for all periodontal indicators: VPI (-83%), GBI (-79%), BOP (-85%), elimination of sites PPD ≥7 mm, 27% increase in sites PPD 1-3 mm (from 64% to 91%), and gain of clinical attachment (gain of 11% CAL 1-3 mm and 25% CAL 4-6 mm; and a reduction of 36% CAL ≥7 mm). PRACTICAL IMPLICATIONS: Despite the severity of the initial periodontal condition, the patient with chronic visceral ASMD responded well to the non-surgical periodontal treatment.
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Enfermedades de las Encías , Enfermedad de Niemann-Pick Tipo A , Periodontitis , Índice de Placa Dental , Raspado Dental , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Pérdida de la Inserción Periodontal , Bolsa PeriodontalRESUMEN
OBJECTIVE: The aim was to evaluate the association between oral health-related quality of life (OHRQol) and periodontal status in patients with leukemia. METHODS: A total of 55 patients with leukemia (42.09 ± 16.57 years, 27.3% females) answered the Oral Health Impact Profile, short version (OHIP-14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP-14 scores were analysed, and the prevalence of high scores was identified for each group. RESULTS: A total mean OHIP-14 score of 13.18 was observed for the entire sample. The corresponding total mean OHIP-14 scores for patients with moderate (n = 18), absent/mild (n = 24), and severe periodontitis (n = 13) were 17.11, 12.50, and 9.00 (P = 0.061), respectively. A higher prevalence of high scores was found for the 'feeling ill-at-ease' question (psychological discomfort domain) for absent/mild and moderate periodontitis patients, whereas those with severe periodontitis had higher prevalence on the 'feeling embarrassed' question (psychosocial disability domain). In the adjusted analysis, hospitalisation was associated with higher OHIP-14 scores (ß = 8.49; 95% CI 1.89-15.08; P = 0.013). Higher OHIP-14 scores were not significantly associated with either patients presenting >15% sites with gingival bleeding or those with moderate/severe periodontitis. CONCLUSION: Leukemia was associated with a negative influence on OHRQoL. However, this association was better explained by the patient's systemic condition than by an impact of its periodontal condition. Nonetheless, patients with leukemia presented with gingivitis and/or periodontitis, pointing to the need for oral health care for these individuals.
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Gingivitis , Leucemia/complicaciones , Femenino , Humanos , Masculino , Salud Bucal , Calidad de Vida , Encuestas y CuestionariosRESUMEN
CONTEXT AND AIM: Gingival crevicular fluid (GCF) volume reflects the level of periodontal inflammation. This secondary analysis aimed to evaluate the GCF volume in patients submitted to non-surgical periodontal therapies under a split-mouth design. MATERIALS AND METHODS: GCF volume of 25 participants (47.24 ± 6.47 years) with moderate-to-severe chronic periodontitis was collected at Days 0, 30, 60, 90, 120, 270, and 450. The participants were submitted to three different non-surgical therapies randomly assigned per quadrant [GI: supragingival control (Supra) as only intervention (one quadrant); GII: Supra plus scaling and root planing (SRP) on Day 0 (two quadrants); GIII: Supra on Day 0 and SRP 30 days later (one quadrant)]. During treatment (0-60 days) and maintenance (90-450 days) participants were submitted to supragingival plaque control reinforcements. GCF volumes were analyzed after logarithmic transformation (log10) and linear models were used for intra- and inter-group comparisons, considering the data dependence. RESULTS: Baseline GCF volumes were similar between groups (GI: 0.39 ± 0.22 µl; GII: 0.42 ± 0.26 µl; GIII: 0.41 ± 0.14 µl;P > 0.05). At Day 60, GCF volumes were significantly reduced (GI: 0.20 ± 0.13 µl; GII: 0.18 ± 0.11 µl; GIII: 0.22 ± 0.13 µl; P < 0.001), without inter-groups differences. These results were maintained along maintenance period (P > 0.05). Even in sites bleeding on probing (BOP) + the means of GCF volume did not differ between groups (P > 0.05). CONCLUSIONS: All therapies determined reductions on the GCF volume along time. Supragingival plaque control modulated the subgingival area during the study, reinforcing the importance of this control over the subgingival inflammatory response.
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Raspado Dental , Líquido del Surco Gingival , Humanos , Índice Periodontal , Bolsa Periodontal , Aplanamiento de la RaízRESUMEN
AIM: Evaluate supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions as sole intervention (test) or combined with subgingival instrumentation removing/disrupting the subgingival biofilm (control). MATERIAL AND METHODS: Sixty-two treated periodontitis patients (50.97 ± 9.26 years, 24 smokers) were randomly assigned to receive, every 3 months during 2 years, either test or control treatment. Examination included periodontal probing depth (PPD), bleeding on probing (BOP) and clinical attachment loss (CAL). Generalized estimating equations were used for analyses. RESULTS: Baseline demographics and smoking were similar between groups. However, at baseline, mean PPD was greater in test group than in control group (2.32 mm vs. 2.17 mm, p = .03), but similar after 2 years (2.23 mm vs. 2.15 mm, respectively). With time, significant PPD and BOP decrease and CAL increase were observed although without significant differences between groups. At sites ≥ 5 mm, PPD decrease was greater in test group than in control group irrespective of sex and smoking habit (p = .034). The distribution of sites gaining or losing attachment ±2 mm was similar between groups. CONCLUSION: Oral prophylaxis with oral hygiene instructions alone or in combination with subgingival instrumentation was able to maintain the previously obtained periodontal condition to a comparable extent during 2 years of SPT.
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Periodontitis , Biopelículas , Humanos , Pérdida de la Inserción PeriodontalRESUMEN
The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by â¼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.
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Cálculos Dentales/epidemiología , Cálculos Dentales/etiología , Gingivitis/epidemiología , Gingivitis/etiología , Adulto , Distribución por Edad , Brasil/epidemiología , Estudios Transversales , Femenino , Hemorragia Gingival/epidemiología , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Índice Periodontal , Prevalencia , Factores de Riesgo , Distribución por Sexo , Fumar/efectos adversos , Fumar/epidemiología , Factores Socioeconómicos , Cepillado Dental/estadística & datos numéricosRESUMEN
Abstract: The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by ∼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.
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Humanos , Masculino , Femenino , Adulto , Cálculos Dentales/etiología , Cálculos Dentales/epidemiología , Gingivitis/etiología , Gingivitis/epidemiología , Factores Socioeconómicos , Cepillado Dental/estadística & datos numéricos , Brasil/epidemiología , Fumar/efectos adversos , Fumar/epidemiología , Modelos Lineales , Índice Periodontal , Hemorragia Gingival/epidemiología , Prevalencia , Estudios Transversales , Factores de Riesgo , Distribución por Sexo , Distribución por Edad , Persona de Mediana EdadRESUMEN
O objetivo desse estudo foi discutir as evidências atuais sobre a associação entre a doença periodontal (DP) e a hipertensão arterial (HA). Por meio de uma revisão de literatura, analisou-se a relação entre ambas as doenças a partir de dados epidemiológicos, bem como o impacto destas em marcadores clínicos e inflamatórios. A HA é uma condição crônica caraterizada pelo aumento da pressão sanguínea nas artérias e acomete grande parte da população mundial. Uma interação entre fatores genéticos e ambientais tem sido reconhecida como responsável por esta elevação da pressão arterial (PA). Mecanismos inflamatórios e a liberação de substâncias vasoativas resultam em alterações no endotélio vascular, refletindo em uma diminuição da elasticidade dos vasos, e também contribuindo para a formação inicial da aterosclerose, o que resulta na elevação da PA. Paralelamente, a DP, sendo uma doença infecto-inflamatória, tem sido apontada como capaz de contribuir com a carga sistêmica de mediadores inflamatórios e, neste sentido, poderia estar relacionada à HA, inclusive com uma associação bidirecional. Estudos sugerem que a HA pode afetar vasos do periodonto, alterando a vascularização local e interferindo no processo de agressão-defesa dos tecidos de suporte, determinando o agravamento da DP. De fato, maior prevalência de DP em pacientes hipertensos é reportada, além da elevação sérica de indicadores inflamatórios (p. ex. proteína c reativa e fibrinogênio), que atuam na progressão da HA, em pacientes periodontais. Dessa forma, uma ligação entre a DP e a HA parece plausível, no entanto, uma associação causal ainda não está estabelecida. (AU)
The objective of this study was to discuss current evidence about the association between periodontal disease (PD) and arterial hypertension (AH). Through a literature review, the relationship between both diseases was analyzed from epidemiological data, as well as their impact on clinical and inflammatory markers. AH is a chronic condition characterized by increased blood pressure in the arteries and affects a large part of the world population. An interaction between genetic and environmental factors has been recognized as responsible for this elevation of blood pressure (BP). Inflammatory mechanisms and the release of vasoactive substances results invascular endothelium alterations, reflecting in a decrease of the elasticity of the vessels, and also contributing to the initial formation of atherosclerosis, which results in the elevation of BP. At the same time, PD, which is an infectious-inflammatory disease, has been identified as able to contribute to the systemic burden of inflammatory mediators and, in this sense, could be related to AH, including with a bidirectional association. Studies suggested that AH can affect periodontal vessels, changing the local vascularization and interfering in the aggressive-defense process of the supporting tissues, which determines the aggravation of PD. In fact, a higher prevalence of PD is reported in hypertensive patients, in addition to serum elevation of inflammatory indicators (e.g. c-reactive protein and fibrinogen), which act in the progression of AH, in periodontal patients. Thus, a link between PD and AH seems plausible; however, a causal association is not yet established. (AU)
Asunto(s)
Periodontitis , Estudios Transversales , Presión Arterial , HipertensiónRESUMEN
This study aimed to investigate the differences in the subgingival microbiological outcomes between periodontal patients submitted to a supragingival control (SPG) regimen as compared to subgingival scaling and root planing performed combined with supragingival debridement (SPG + SBG) intervention during the periodontal maintenance period (PMP). A systematic literature search using electronic databases (MEDLINE and EMBASE) was conducted looking for articles published up to August 2016 and independent of language. Two independent reviewers performed the study selection, quality assessment and data collection. Only human randomized or non-randomized clinical trials with at least 6-months-follow-up after periodontal treatment and presenting subgingival microbiological outcomes related to SPG and/or SPG+SBG therapies were included. Search strategy found 2,250 titles. Among these, 148 (after title analysis) and 39 (after abstract analysis) papers were considered to be relevant. Finally, 19 studies were selected after full-text analysis. No article had a direct comparison between the therapies. Five SPG and 14 SPG+SBG studies presented experimental groups with these respective regimens and were descriptively analyzed while most of the results were only presented graphically. The results showed that both SPG and SPG+SBG protocols of PMP determined stability in the microbiological results along time. Nevertheless, new studies comparing these interventions in PMP are needed, especially if the limitations herein discussed could be better controlled.
Asunto(s)
Raspado Dental/métodos , Desbridamiento Periodontal/métodos , Enfermedades Periodontales/microbiología , Enfermedades Periodontales/prevención & control , Femenino , Humanos , Masculino , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract This study aimed to investigate the differences in the subgingival microbiological outcomes between periodontal patients submitted to a supragingival control (SPG) regimen as compared to subgingival scaling and root planing performed combined with supragingival debridement (SPG + SBG) intervention during the periodontal maintenance period (PMP). A systematic literature search using electronic databases (MEDLINE and EMBASE) was conducted looking for articles published up to August 2016 and independent of language. Two independent reviewers performed the study selection, quality assessment and data collection. Only human randomized or non-randomized clinical trials with at least 6-months-follow-up after periodontal treatment and presenting subgingival microbiological outcomes related to SPG and/or SPG+SBG therapies were included. Search strategy found 2,250 titles. Among these, 148 (after title analysis) and 39 (after abstract analysis) papers were considered to be relevant. Finally, 19 studies were selected after full-text analysis. No article had a direct comparison between the therapies. Five SPG and 14 SPG+SBG studies presented experimental groups with these respective regimens and were descriptively analyzed while most of the results were only presented graphically. The results showed that both SPG and SPG+SBG protocols of PMP determined stability in the microbiological results along time. Nevertheless, new studies comparing these interventions in PMP are needed, especially if the limitations herein discussed could be better controlled.
Asunto(s)
Humanos , Masculino , Femenino , Raspado Dental/métodos , Desbridamiento Periodontal/métodos , Enfermedades Periodontales/microbiología , Enfermedades Periodontales/prevención & control , Factores de Tiempo , Resultado del TratamientoRESUMEN
As doenças periodontais de maior prevalência são aquelas relacionadas à presença da placa bacteriana, hoje entendida como um biofilme dental. A compreensão da dinâmica deste reacendeu antigas discussões que, desde então, buscavam determinar quais as formas elegíveis e preferíveis para o tratamento daquelas doenças. Sob o conceito de "placa dentária", o tratamento da gengivite, mas principalmente o da periodontite, ora levaram ao extremo da tentativa de eliminação de toda e qualquer "placa", ora conduziram ao uso, até hoje indiscriminado, de antibióticos. Atualmente, o conceito de biofilme dental, entendido como comunidades microbianas com mecanismos interdependentes de autorregularão, nutrição e comunicação, a ponto de manterem um sinergismo que vai ao encontro da sua subsistência, alterou a forma não só de entender a etiologia das doenças periodontais, mas de como tratá-las. Neste conceito, o papel dos microrganismos não necessariamente aponta para tipos bacterianos específicos como causadores da doença, mas para as doenças periodontais como uma infecção oportunista. Paralelamente, o biofilme supragengival passou a significar mais do que o fator etiológico das gengivites, passando a ser compreendido, também, como fundamental modulador do ambiente subgengival. Neste cenário, a terapia periodontal passa por desafios inerentes a uma mudança conceitual, tais como compreender o significado do controle supragengival para a prevenção, tratamento e manutenção dos resultados terapêuticos. Portanto, esta revisão teve por objetivo apresentar a plausibilidade biológica do controle do biofilme supragengival como fundamental para a terapia periodontal e, além disto, discutir resultados de estudos sob o conceito de doença periodontal como uma infecção oportunista.
The most prevalent periodontal diseases are those associated with the presence of dental plaque, nowadays understood as a dental biofilm. The comprehension of the biofilm dynamics rekindled old discussions that, since then, sought to determine the eligible and preferred therapies for periodontal diseases. Under the concept of "dental plaque", the gingivitis treatment, and also the periodontitis one were based on the elimination of every and any plaque or of some bacteria species. The later determining the indiscriminate use of antibiotics. Currently, the biofilm concept, understood as microbial communities with interdependent mechanisms of self-regulation, nutrition and communication and involved in a synergism to render its subsistence, changed the way not only to understand the periodontal diseases etiology but, in special, the way to treat them. Under this concept, the role of microorganisms not necessarily points to specific bacteria infecting the sites and causing diseases, but to periodontal diseases as an opportunist infection linked to a retro feeding process between the dental biofilm and the host. Alongside, the supragingival biofilm has meant more than the etiologic factor of gingivitis, but also as an important modulator of subgingival environment. In this sense, the periodontal therapy is challenged by conceptual trends, such as the comprehension of the meaning of supragingival control for the prevention, treatment and maintenance of therapeutic results. Therefore, the present review aimed to revise the role of the supragingival biofilm control to periodontal condition, and, also, to discuss results of studies under the concept of periodontal diseases as opportunists infections.
Asunto(s)
Periodontitis , Placa Dental , Higiene Bucal , Raspado DentalRESUMEN
The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the test versus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.