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OBJECTIVE: To evaluate cytokine levels of interleukin (IL)-1ß, IL-4, IL-6, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the gingival crevicular fluid (GCF) of periodontal sites in individuals with Down syndrome (DS) and analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A cross-sectional study was conducted with 49 DS patients and 32 individuals without DS (non-DS group). Periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and visible plaque index (VPI) were evaluated. The periodontal sites were classified as shallow, moderate, and deep. GCF was collected in all shallow sites and, when present, in moderate and deep sites for the analysis of cytokine levels. The cytokines, IL-1ß, IL-4, IL-6, IL-17a, TNF-α, and IFN-γ, were quantified using the Luminex® automatic analyzer system. RESULTS: The DS group presented greater severity of periodontitis compared to the non-DS group (P = 0.005). The DS group showed a significant direct correlation of IL-1ß and an inverse correlation of IFN-γ and IL-14 with all periodontal variables. In the analysis stratified by periodontal pocket depth, we observed a higher level of IFN-γ, IL-17a, IL-1ß, and IL-6 in the shallow sites, and IL-17a, IL-1ß, and IL-6 in deep pockets of DS group individuals. Multivariate models showed that higher levels of IL-1ß, IL-4, IL-6, and IL-17a were associated with Down syndrome even after adjusting for periodontal status, sex, and age. CONCLUSION: The findings suggest that people with DS have greater periodontal impairment and higher levels of cytokines in GCF, even in sites having clinical periodontal parameters similar to those of individuals without DS. These data reiterate the concept of an altered and less effective immune response in the population with DS in the face of a periodontal microbial challenge. CLINICAL RELEVANCE: Elevated periodontal inflammation burden can be observed with higher cytokine levels in the gingival crevicular fluid of people with Down syndrome, especially IL-1, IL-4, IL-6, and IL-17, regardless of the stage of periodontitis.

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BACKGROUND AND OBJECTIVE: Systemic metabolic status and periodontitis can be related in patients with Down syndrome (DS). The objective of this study was to identify metabolic indicators (anthropometric measurements, blood pressure, and serum markers) related to severity and extent of periodontitis in DS patients. METHODS: A cross-sectional study was conducted with 49 patients with DS. Periodontal evaluation included the periodontal probing depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and visible plaque index (VPI). Periodontitis severity was classified by the stages system. The extent of periodontitis was assessed as the percentage of sites with CAL ≥3 mm, CAL ≥4 mm, PPD ≥4 mm, and PPD ≥5 mm. The metabolic condition of the participants was determined by analyzing anthropometric parameters, blood pressure, and serum markers. Data were analyzed using the Mann-Whitney test, Spearman's correlation coefficient, and multivariate regression analysis. RESULTS: Periodontitis stage 3/4 was detected in 32.7% of patients, with high values of VPI (54.6 ± 35.8) and GBI (42.4 ± 33.3). The severity of periodontitis was related to higher mean corpuscular hemoglobin (ß = .291, p = .028) and mean corpuscular volume values (ß = .293, p = .046). Arm circumference measurements were inversely related to CAL ≥3 mm (ß = -.408, p = .023), PPD ≥4 mm (ß = -.475, p = .006), and PPD ≥5 mm (ß = -.443, p = .010). CONCLUSIONS: The findings suggest that the severity and extent of periodontitis may be related to some metabolic parameters in DS patients.

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ABSTRACT Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -γ was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-γ was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ≥0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p≥0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

RESUMO Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -γ. Resultados: A produção de IL-4, IL-10, IL-17 e INF-γ foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p≥0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p≥0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

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O presente trabalho relata a experiência de tutoria em educação a distância no Curso de Especialização em Saúde da Família da Universidade Aberta do SUS (UNASUS), na Universidade Federal do Maranhão (UFMA). O objetivo é destacar os aspectos relacionados à interação entre aluno e tutor, com ênfase na sua necessidade e positivas repercussões no seu desenvolvimento. Os processos comunicativos e interativos aconteceram em um Ambiente Virtual de Aprendizagem, com reconhecida importância do acompanhamento e orientação adequada do tutor como papel fundamental na satisfação e no aprendizado do aluno. Para isso, a experiência na tutoria foi pautada na busca da menor distância entre tutor e aluno, como meio facilitador desta relação, considerada o caminho para os melhores resultados no processo ensino-aprendizagem. Os principais pontos abordados foram as possíveis causas de distanciamento entre aluno e tutor e as condutas que podem ser adotadas para uma interação humanizada entre os atores envolvidos. Diante disso, o presente trabalho sugere que a qualidade da referida interação deve ser considerada como uma das principais metas do curso tendo em vista sua influência positiva exercida em todos os aspectos responsáveis pelo aprendizado do aluno.

This paper reports the experience tutoring in distance education in the Specialization Course in Family Health at the Open University of SUS (UNASUS), the Federal University of Maranhão (UFMA). The aim is to highlight the aspects related to the interaction between student and tutor, with emphasis on their need and positive impact on their development. Communicative and interactive processes happened in a Virtual Learning Environment, with recognized importance of monitoring and proper guidance of the tutor as a key role in meeting and student learning. For this, experience in mentoring was based on finding shortest distance between tutor and student, as a facilitator in this respect, considered the way to the best results in the teaching-learning process. The main points discussed were the possible causes of distance between student and tutor and behavior that can be adopted for a humane interaction between the actors involved. Therefore, this study suggests that the quality of student-tutor interaction should be considered as one of the main goals of the course given its positive influence in all aspects responsible for student learning.

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Both Systemic Lupus Erythematosus (SLE) and periodontal disease (PD) present a similar immunological profile mainly characterized by altered cytokine levels. In this study we sought to investigate the salivary levels of inflammatory cytokines and their association with PD in SLE patients. 60 patients with SLE and 54 systemically healthy individuals underwent a full periodontal clinical examination. They were then grouped according to their periodontal status. Stimulated saliva was collected in order to evaluate the salivary levels of interferon (IFN-γ), Interleukin (IL)-10, IL-17, IL-1ß, and IL-4. Systemically healthy individuals with periodontitis (group P) presented higher levels of cytokines when compared to systemically healthy individuals, with no periodontal disease (group S) (p<0.05). Additionally, in the P group, patients presented similar levels of cytokines to those of the patients with SLE, regardless of the presence of PD (p>0.05), for most of the analyzed cytokines. There was a positive correlation in SLE patients, including IL-1ß and all periodontal clinical parameters (p<0.05), and between IL-4 and gingival bleeding index and the presence of biofilm (p<0.05). Thus, our results confirmed, that patients with PD showed higher salivary levels of cytokines and, in SLE patients, the increased levels of salivary cytokines were observed even in the absence of periodontitis. IL-1ß and IL-4 salivary levels were also positively correlated with periodontal status indicating their potential as markers of the amount and extent of periodontal damage in patients with SLE.

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Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis. Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -g was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-g was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ³0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p³0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -g. Resultados: A produção de IL-4, IL-10, IL-17 e INF-g foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p³0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p³0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

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OBJECTIVE: This study aims to evaluate the association between early childhood caries (ECC) and maternal caries status, and the maternal perception of ECC risk factors. MATERIALS AND METHODS: A cross-sectional study was carried out with 77 mother-child pairs, the children ranging from 12 to 36 months of age and their mothers, who were seeking dental care at a health center in São Luís, Maranhão, Brazil. Data collection was conducted using a specific questionnaire for mothers. Oral clinical examination of the mother-child binomial to assess caries incidence, gingival bleeding (GB) and visible plaque was done. Home visits were performed in 10% of the sample in order to observe the environmental conditions, dietary habits and dental hygiene practices. RESULTS: The findings showed that the caries prevalence in children was 22.5 times higher in the mother who had decayed tooth (prevalence ratio [PR] = 22.5, confidence interval [CI] 95% = 3.2-156.6, P < 0.001). GB also was observed in 14 mothers and children, the PR in pair was 12.2 (CI95% = 1.6-88.9, P < 0.001). The variables are related for the mother-child binomial in regression linear analysis. CONCLUSION: The maternal caries status was associated with ECC.

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Introdução: o desenvolvimento de materiais e técnicas na Odontologia Restauradora tem como finalidade a obtenção de um confiável vedamento marginal, pois a microinfiltração ainda é um dos principais motivos de insucesso das restaurações. Objetivo: analisar "in vitro" o efeito da configuração cavitária e do tipo de sistema adesivo na microinfiltração em restaurações classe V, em esmalte, com resina composta. Material e método: foram selecionados 60 dentes bovinos, confeccionadas 30 cavidades na face vestibular de forma retangular e 30 de forma circular, sendo então divididos aleatoriamente em seis grupos, conforme a forma geométrica e o sistema adesivo utilizado: Magic Bond, Adper Single Bond 2 e Clearfil SE BOND. Os dentes foram restaurados com resina composta Z-350, utilizando um incremento, fotopolimerizado por 40 segundos, e feito o acabamento/polimento com disco Sof-Lex. Posteriormente, os dentes foram armazenados em água destilada à temperatura ambiente por sete dias e impermeabilizados com esmalte cosmético, deixando uma margem de 1 mm ao redor da restauração. Foram imersos, então, em solução aquosa de nitrato de prata a 50% por um período de duas horas no escuro, lavados com água corrente, colocados em solução reveladora por seis horas, lavados, seccionados no centro da restauração e as fatias foram analisadas na lupa estereoscópica de 25× de aumento. Os dados foram submetidos à análise estatística não paramétrica de Kruskal-Wallis (p < 0,05). Resultado: não houve diferença estatisticamente significante para ambos os fatores analisados (p = 0,233 e p = 0,158). Conclusão: a forma da cavidade não influenciou na microinfiltração; todos os adesivos comportaram-se de maneiras semelhantes quanto à microinfiltração.

Introduction: the development of materials and techniques in restorative dentistry aims to achieve a good marginal sealing because microleakage is still one of the main reasons for failure of restorations. Objective: To analyze "in vitro" the effect of cavity configuration and the type of adhesive system on microleakage of class V resin composite, in enamel. Material and method: 60 bovine teeth were selected, and 60 cavities were prepared on the buccal surface, 30 rectangular and 30 rounded shaped. They were randomly divided in 6 groups according to the geometric form and the bonding system used: Magic Bond, Adper Single Bond 2 and Clearfil SE BOND. The teeth were restored with Z-350 composite resin, using one increment, lightcured for 40 seconds and polished with a Sof-Lex disc. After that the teeth were stored in distilled water at room temperature for seven days and further sealed with nail varnish, leaving a 1 mm window around the restoration margin. They were then immersed in 50% aqueous silver nitrate solution for 2 hours in the dark, rinsed under tap water, placed in revealing solution for 6 hours under fluorescent light, washed, sectioned in the center of the restoration and the slices were viewed under stereoscopic glasses at 25× magnification. The data were submitted to Kruskal-Wallis non-parametric test (p < 0.05). Result: no statistically significant difference for either factor analyzed (p = 0.233 and p = 0.158) was observed. Conclusion: the cavity shape did not influence in microleakage; all the adhesives behaved in similar manners as to microleakage.

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