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OBJECTIVE: To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease's daily activities compared to the non-psoriatic ones. MATERIALS & METHODS: 296 individuals with psoriatic disease (PSO n = 210, APS n = 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. RESULTS: The prevalence of PE was higher in PsA (57.0%; OR = 2.67 95%CI 1.65-4.32; p<0.001) than in PSO (34.3%; OR = 1.05 95% CI 0.73-1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). CONCLUSION: Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.

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

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BACKGROUND: The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT). METHODS: The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses. RESULTS: Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively. CONCLUSIONS: After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

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AIM: To determine the impact of the degree of furcation involvement (FI) on the longevity of molar teeth and assess the risk variables (tooth- and patient-related factors) associated with the loss of molars (LM) in individuals treated for periodontitis and monitored in a private programme of supportive periodontal care (SPC). MATERIALS AND METHODS: The present retrospective cohort study included 222 individuals with 1329 molars under a 10-year monitoring period in SPC. Periodontal clinical parameters, FI, the type of molar, pulp vitality, and other variables of interest were collected at approximately 50 days after active periodontal therapy and after 10 years. The association of tooth- and patient-related factors with LM was assessed using a multilevel Cox regression analysis. RESULTS: Two-hundred and thirty-five molars were extracted during the SPC period of 12.4 ± 1.9 years. Age >50 years, male gender, diabetes, smoking, and non-compliance were identified as relevant patient-related factors for LM during SPC (p < .05). Significant tooth-related factors for LM were bleeding on probing (BoP) and probing depth (PD) ≥5 mm, tooth non-vitality, and class II and III FI (p < .05). CONCLUSIONS: Class III FI, tooth non-vitality, higher mean PD and BoP, age, male gender, diabetes, and smoking all strongly influenced the prognosis of molars during SPC.

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Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

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OBJECTIVES: To assess the presence of oral lesions and the impact of oral health-related quality of life (OHRQoL) on individuals with psoriasis. METHODS: This case-control study comprised 295 individuals with psoriasis and 359 controls. Oral examination to assess different types of oral lesions as angular cheilitis (AC), geographic tongue (GT), white (WP), and red plaque or red macule (RPM) was performed. To evaluate OHRQoL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. Data were analyzed using the chi-squared, Fisher, Kruskal-Wallis, Mann-Whitney, and Bootstrap Intervals tests. RESULTS: Individuals with psoriasis had significantly more oral lesions than controls (OR = 3.66, 95% CI: 2.33-5.85; p < .001) and higher global OIDP scores (12.17 case versus 6.93 controls; p = .008). Higher occurrence of GT (p < .001) and AC (p < .001) was observed in individuals with psoriasis. The final multivariate model demonstrated higher OIDP scores related to the following variables: alcohol use, diabetes, anxiolytics use, AC, and GT, showing worse OHRQoL. CONCLUSION: Psoriatic individuals had a higher frequency of AC and GT than controls. Worse OIDP scores in frequency and severity were observed in psoriatic individuals with oral lesions, revealing the negative impacts of these lesions on OHRQoL.

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AIM: To evaluate the periodontal condition and the impact of oral health on the quality of life (OHRQL) among individuals with and without psoriasis. METHODS: This case-control study comprised 295 individuals with psoriasis and 359 controls. A full mouth examination was performed for all periodontal clinical parameters. To evaluate OHRQL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. Data was analyzed using the chi-square, Fischer, Kruskal-Wallis, Mann-Whitney, and Bootstrap intervals tests to determine different profiles in relation to the OIDP. RESULTS: Individuals with psoriasis had a 1.40 greater chance of having periodontitis than controls (OR = 1.40 95%CI: 1.01-1.93; p = 0.019). Individuals with psoriasis with periodontitis (+P) had greater impacts on OHRQL (13.76 ± 15.58), when compared with those without periodontitis (-P) (4.83 ± 8.25; p < 0.001). Additionally, psoriasis +P stage III/IV patients (13.94 ± 15.68) had worse indicators than controls -P (9.49 ± 22.54; p = 0.001). The final multivariate model demonstrated higher OIDP scores related to the following variables: diabetes, anxiolytics use, periodontitis, and psoriasis, showing worse OHRQoL. CONCLUSIONS: This study demonstrated an important risk association between psoriasis and periodontitis, as both diseases demonstrated worse OHRQL indicators. Moreover, the severity of periodontitis and psoriasis significantly increased these negative impacts. CLINICAL RELEVANCE: Practical implications: Multidisciplinary interaction is desirable to improve the impact of these diseases on the QoL of individuals with psoriasis and periodontitis.

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Abstract Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

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BACKGROUND: Prospective studies investigating the influence of adjuvants to oral hygiene procedures on the recurrence of periodontitis (RP) during periodontal maintenance therapy (PMT) programs have not been previously reported. The aim of this study was to compare the effect of oral irrigator devices or interdental brushes as adjuncts to toothbrushing associated with dental flossing to improving periodontal condition and reducing RP among individuals under PMT. METHODS: From a 6-year prospective PMT cohort study (n = 268), 142 individuals who attended at least one PMT visit within 12 months were determined to be eligible. According to oral hygiene adjuvants use, they were categorized into three groups: 1) manual brushing/dental flossing + interdental brushes (BDF + Ib; n = 44); 2) manual brushing/dental flossing + oral irrigator (BDF + Oi; n = 36); and 3) only manual brushing/dental flossing (BDF; n = 62). Full-mouth periodontal examination and oral hygiene habits were evaluated at two time points: T1 (after active periodontal therapy) and T2 (6 years). RESULTS: RP was significantly higher among BDF when compared with BDF + Ib and BDF + Oi. The final logistic model in T2 for RP included the following items: manual brushing/dental flossing alone (odds ratio [OR] = 1.94); age > 50 years (OR = 1.98), smoking (OR = 3.51), bleeding on probing >30% sites (OR = 4.10), and the interaction between manual brushing/dental flossing alone and smoking (OR = 6.1). A protective effect on RP was observed in BDF + Oi individuals (OR = 0.52). CONCLUSIONS: BDF + Ib and BDF + Oi individuals presented lower rates of RP and better periodontal condition when compared to BDF individuals. Including these adjuvants to conventional oral hygiene have shown to improve biofilm control during PMT leading to a better periodontal status maintenance.

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Apesar de dados emergentes, a literatura aponta uma associação de risco entre a psoríase e periodontite, apoiada no fato destas duas doenças imunomediadas apresentarem caminhos etiopatogênicos similares e comuns fatores de risco. Por outro lado, estudos da presença de lesões bucais em indivíduos psoriáticos são limitados e escassos. Adicionalmente, o impacto da saúde bucal (presença de periodontite e lesões bucais) na qualidade de vida (QV) em indivíduos psoriáticos ainda não foi reportado. O objetivo deste estudo foi avaliar a condição periodontal, lesões bucais e o impacto da saúde oral autorrelatada na qualidade de vida (OHRQL) de indivíduos psoriáticos em relação a indivíduos não-psoriáticos. Assim, este estudo caso-controle incluiu 295 indivíduos com psoríase e 359 controles sendo aprovado pelo Comitê de Ética e Pesquisa (CAAE 20156019.0.0000.5149). Foi realizado um exame de boca completa para todos os parâmetros clinicos periodontais e coletados dados demográficos e comportamentais de interesse. Adicionalmente, verificou-se a presença/ausência dos tipos mais frequentes de lesão oral em psoriáticos [como queilite angular (QA), língua geográfica (LG), placas brancas (PB), amarelas (PA), vermelhas (PV), e formas anulares ou áreas difusas de eritema]. Para avaliar OHRQL foi aplicado o questionário Oral Impacts on Daily Performance (OIDP). Os dados foram analisados pelos testes de Qui-quadrado, Fischer, Kruskal-Wallis, Mann-Whitney quando adequados, e Intervalos de Bootstrap com o objetivo de determinar perfis diferenciados em relação ao OIDP. Observou-se alta prevalência de periodontite em psoriáticos (41%) quando comparado aos controles (33,1%). Indivíduos psoriáticos apresentaram uma razão de chance de 1.40 maior para a ocorrência de periodontite que os controles (IC95% 1,01-1,9; p=0,019), maiores valores de IMC e uso de antidepressivos (p<0.001), diabetes, uso de álcool (p=0.001) e de ansiolíticos (p=0.006). Psoriáticos com periodontite (+P) apresentaram significativamente maiores impactos na OHRQL (13,76±15,58), quando comparado aos sem periodontite (-P) (4,83 ±8,25; p<0,001). Adicionalmente, indivíduos psoriáticos +P estágio III/IV (13,94±15,68) apresentaram piores indicadores de OIDP que os controles +P (9,49±22,54; p=0,001). Indivíduos com psoríase mostraram significativamente mais lesões bucais do que controles (OR = 3.66, 95% CI: 2.33­5.85; p<0.001). Maior ocorrência de (1) LG (OR = 8,20, IC 95%: 2,08­54,01; p <0,001) e (2) QA (OR = 4,38; IC95%: 2,23­9,15; p <0,001) foram observadas em indivíduos com psoríase. Indivíduos psoriáticos com lesões bucais apresentaram maior OIDP global, quando comparados aos controles (11,15 versus 7,63; p = 0,009). No modelo multivariado final para a ocorrência de maiores escores do OIDP, caracterizando pior OHRQL, as seguintes variáveis permaneceram significativas: uso de álcool e ansiolíticos, diabetes, lesões QA e LG. Este estudo demonstrou uma importante associação de risco entre psoríase, periodontite e presença de lesões bucais, sendo que indivíduos psoriáticos com estas doenças apresentaram de forma significativa piores indicadores de OHRQL. Uma interação multidisciplinar (médicos e cirurgiões-dentistas) deve ser incentivada para melhorar o impacto dessas doenças na QV dos indivíduos com psoríase e periodontite.

Despite emerging data, the literature points to a risk association between psoriasis and periodontitis, supported by the fact that these two immune-mediated diseases have similar etiopathogenic pathways and common risk factors. On the other hand, studies on the presence of oral lesions in psoriatic individuals are limited and scarce. In addition, the impact of oral health (presence of periodontitis and oral lesions) on quality of life (QOL) in psoriatic individuals has not yet been reported. The aim of this study was to evaluate the periodontal condition, oral lesions and the impact of self-reported oral health on the quality of life (OHRQL) of psoriatic individuals in relation to nonpsoriatic individuals. Thus, this case-control study comprised 295 individuals with psoriasis and 359 controls and was approved by the Ethics and Research Committee (CAAE 20156019.0.0000.5149). A full mouth examination was performed for all periodontal clinical parameters, and demographic and behavioral data of interest were collected. In addition, the presence / absence of the most frequent types of oral lesions in psoriatics was assessed [such as angular cheilitis (AC), geographic tongue (GT), fissured tongue (FT), white (WP), yellow (YP), red plaques (RP), gray / translucent plaques and annular forms or diffuse areas of erythema]. To evaluate OHRQL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. The data were analyzed using the Chi-square, Fischer, Kruskal-Wallis, Mann-Whitney tests when appropriate, and Bootstrap intervals to determine different profiles in relation to the OIDP. There was a high prevalence of periodontitis in psoriatics (41%) when compared to controls (33.1%). Psoriatic individuals had a 1.40 greater chance of having periodontitis than controls (95% CI 1.01-1.9; p = 0.019), higher BMI values and use of antidepressants (p <0.001), diabetes, alcohol (p = 0.001) and anxiolytics use (p = 0.006). Psoriatics with periodontitis (+ P) showed significantly greater impacts on OHRQL (13.76 ± 15.58), when compared to those without periodontitis (-P) (4.83 ± 8.25; p <0.001). Additionally, psoriatic individuals + P stage III / IV (13.94 ± 15.68) had worse indicators of OIDP than controls + P (9.49 ± 22.54; p = 0.001). Individuals with psoriasis had significantly more oral lesions than controls (OR 3.66, 95% CI: 2.33­ 5.85; p<0.001). Higher occurrence of (1) GT (OR = 8.20, 95% CI: 2.08­54.01; p <0.001) and (2) QA (OR = 4.38; 95% CI: 2.23­9.15; p <0.001) was observed in individuals with psoriasis. Psoriatic individuals with oral lesions had higher global OIDP when compared to controls (11.15 versus 7.63; p = 0.009). In the final multivariate model for the occurrence of higher OIDP scores, characterizing worse OHRQL, the following variables remained significant: use of alcohol and anxiolytics, diabetes. This study demonstrated an important risk association between psoriasis, periodontitis and the presence of oral lesions, and psoriatic individuals with these diseases had significantly worse OHRQL indicators. A multidisciplinary interaction (doctors and dentists) should be encouraged to improve the impact of these diseases on the QOL of individuals with psoriasis and periodontitis.

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BACKGROUND: The association between periodontitis and immuno-mediated inflammatory diseases has been widely studied and recognized each more over the past few years. The aim of this study was to evaluate the potential association between psoriasis and periodontitis, as well as the influence of risk variables in this association. METHODS: This case-control study included 756 individuals, 397 with psoriasis, and 359 controls. A full-mouth periodontal examination was performed, recording therefore plaque index, probing depth, clinical attachment level, and bleeding on probing. The influence of risk variables was tested by univariate analysis and multivariate logistic regression. RESULTS: A high prevalence of periodontitis was observed among cases (46.1%) when compared to controls (33.1%). Individuals with psoriasis presented a 1.72 higher chance of having periodontitis than controls (OR = 1.72; 95% CI 1.28-2.32; p < 0.001) in the univariate analysis, but with no significance in the multivariate model. The prevalence of periodontitis increased significantly according to the severity of psoriasis [mild form (44.4%); moderate (46.3%); and advanced (47.1%)] when compared to the control group (33.1%). The final multivariate logistic model showed that the number of teeth (OR = 1.08; 95% CI 1.01-1.14; p = 0.018), smoking (OR = 1.91; 95% CI 1.19-3.07; p = 0.008), and body mass index (OR = 1.13; 95% CI 1.11-1.16; p < 0.001) remained significantly associated with the occurrence of periodontitis. CONCLUSIONS: The prevalence of periodontitis was higher in individuals with psoriasis than in controls. Severity of psoriasis also presented a strong relationship with all periodontal clinical parameters.

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OBJECTIVES: To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status. MATERIALS AND METHODS: Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Levels of IL-6, IL-10, IL-1ß, TNF-α, and MMP-8 were quantified through ELISA. RESULTS: RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1ß, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC. CONCLUSIONS: The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis. CLINICAL RELEVANCE: Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.

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Abstract: oral health is an integral part of an individual's general health, interfering with all dimensions of life: functional, aesthetic, psychological, social, physical, nutritional, and even psychosocial. hence oral health is directly related to quality of life. periodontitis is one of the most prevalent oral diseases and one of the major causes of tooth loss, impacting negatively on self-reported individuals' quality of life. periodontal maintenance therapy aims to effectively minimize the recurrence of periodontal disease, as well as the incidence of tooth loss. in periodontal literature, studies associated with quality of life indicators, presented in the form of questionnaires aimed at measuring the impact of periodontitis and tooth loss on self-reported individual's quality of life, highlight the "oral impacts on daily performance" (OIDP) and "oral health impact profile" (OHIP). as such, this study presents a critical review of the literature and describes the impact of periodontal disease and tooth loss on the quality of life of patients undergoing periodontal maintenance therapy.

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