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OBJECTIVE: This study aimed to examine whether Sjögren syndrome (SS) is related to periodontal status. STUDY DESIGN: A systematic review was performed on the basis of PRISMA (PROSPERO: CRD42017055202). A search was performed in the PubMed/MEDLINE, LILACS, Web of Science, and Science Direct databases. Hand searches and review of the gray literature were also performed. Three researchers independently selected studies, extracted data, and assessed methodologic quality. Studies that correlated primary and/or secondary SS with plaque index, gingival index, probing depth, and bleeding on probing were included. The risk of bias was estimated on the basis of the Newcastle-Ottawa scale. RESULTS: Seventeen studies were included in the review and 9 included in the meta-analysis, with a total of 518 and 544 patients, with or without SS, respectively. The mean difference of plaque index (0.29; 95% confidence interval [CI] 0.17-0.41), gingival index (0.52; 95% CI 0.14-0.89), and bleeding on probing (9.92; 95% CI 4.37-15.47) were larger in patients with SS than in controls. In primary SS (0.47; 95% CI 0.10-0.83) and secondary SS (0.74; 95% CI 0.10-1.38), only the mean gingival index was larger compared with that in control group. The majority of the included studies were judged as having a high risk of bias. CONCLUSIONS: The present review did not provide strong evidence that periodontal status is affected by SS.

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Introducción: toda enfermedad está basada en trastornos a nivel molecular, por lo que el profesional de la salud debe interpretar las variadas manifestaciones internas de las enfermedades producidas por alteraciones de las biomoléculas que interactúan sistémicamente, en las cuales tienen un papel importante el estrés oxidativo. Objetivo: realizar una revisión bibliográfica sobre el estrés oxidativo y las enfermedades que afectan a la cavidad bucal. Métodos: se realizó una revisión bibliográfica en el periodo comprendido entre septiembre de 2014 a enero de 2016. Se consultaron las bases de datos de sistemas referativos, como MEDLINE, PubMed y SciELO con la utilización de descriptores como oxidative stress in oral deseases y su contraparte en español. Se incluyeron artículos en idioma inglés y español y publicaciones de los últimos cinco años, solo seis con mayor tiempo de publicación. Se revisaron 110 artículos, y se circunscribió el estudio a 49 que enfocaron estas temáticas de manera más integral. Análisis e integración de los resultados: tiene el estrés oxidativo gran relación con la enfermedad periodontal, la mucositis, los estados pulpares, síndrome de Sjögren, síndrome de ardor bucal, aftas bucales y lesiones premalignas como leucoplasia y liquen plano bucal. Conclusiones: existe relación entre el estrés oxidativo y muchas enfermedades que afectan la cavidad bucal, lo que influye en la patogenia de estas(AU)

Introduction: the basis of disease is the occurrence of disorders at the molecular level, so the health professional should be able to understand the varied internal manifestations of a disease caused by alterations in the biomolecules that systemically interact and the important role that the oxidative stress plays in this process. Objective: to make a literature review on the oxidative stress and the diseases affecting the oral cavity. Methods: a literature review was made in the period of September 2014 through January 2016. MEDLINE, PubMed and SciELO databases were consulted; the subject headings were oxidative stress in oral diseases in Spanish and in English. Several articles in English and Spanish and publications of the last five years, in addition to 6 articles published prior to this period, were all included. A total of 110 articles were reviewed, but for the study, 49 were selected on account of a more comprehensive approach on these topics.Data analysis and integration: the oxidative stress is closely related to periodontal disease, mucositis, pulpal diseases, Sjögren syndrome, burning mouth syndrome, oral aphthas and premalignant lesions such as leukoplakia and oral lichen planus. Conclusions: there is association of the oxidative stress and many other diseases affecting the oral cavity, which has an impact on the pathogenesis of many diseases(AU)

Assuntos

RESUMO

Introducción: toda enfermedad está basada en trastornos a nivel molecular, por lo que el profesional de la salud debe interpretar las variadas manifestaciones internas de las enfermedades producidas por alteraciones de las biomoléculas que interactúan sistémicamente, en las cuales tienen un papel importante el estrés oxidativo. Objetivo: realizar una revisión bibliográfica sobre el estrés oxidativo y las enfermedades que afectan a la cavidad bucal. Métodos: se realizó una revisión bibliográfica en el periodo comprendido entre septiembre de 2014 a enero de 2016. Se consultaron las bases de datos de sistemas referativos, como MEDLINE, PubMed y SciELO con la utilización de descriptores como oxidative stress in oral deseases y su contraparte en español. Se incluyeron artículos en idioma inglés y español y publicaciones de los últimos cinco años, solo seis con mayor tiempo de publicación. Se revisaron 110 artículos, y se circunscribió el estudio a 49 que enfocaron estas temáticas de manera más integral. Análisis e integración de los resultados: tiene el estrés oxidativo gran relación con la enfermedad periodontal, la mucositis, los estados pulpares, síndrome de Sjögren, síndrome de ardor bucal, aftas bucales y lesiones premalignas como leucoplasia y liquen plano bucal. Conclusiones: existe relación entre el estrés oxidativo y muchas enfermedades que afectan la cavidad bucal, lo que influye en la patogenia de estas.(AU)

Introduction: the basis of disease is the occurrence of disorders at the molecular level, so the health professional should be able to understand the varied internal manifestations of a disease caused by alterations in the biomolecules that systemically interact and the important role that the oxidative stress plays in this process. Objective: to make a literature review on the oxidative stress and the diseases affecting the oral cavity. Methods: a literature review was made in the period of September 2014 through January 2016. MEDLINE, PubMed and SciELO databases were consulted; the subject headings were oxidative stress in oral diseases in Spanish and in English. Several articles in English and Spanish and publications of the last five years, in addition to 6 articles published prior to this period, were all included. A total of 110 articles were reviewed, but for the study, 49 were selected on account of a more comprehensive approach on these topics. Data analysis and integration: the oxidative stress is closely related to periodontal disease, mucositis, pulpal diseases, Sjögren syndrome, burning mouth syndrome, oral aphthas and premalignant lesions such as leukoplakia and oral lichen planus. Conclusions: there is association of the oxidative stress and many other diseases affecting the oral cavity, which has an impact on the pathogenesis of many diseases(AU)

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RESUMO

A síndrome de Sjõgren primária (SSp) é uma doença crônica autoimune sistêmica que pode levar à hipossalivação e afetar negativamente o ambiente oral. Os objetivos deste estudo foram detectar a influência da SSp nos níveis de biomarcadores inflamatórios na saliva e no fluido gengival nas amostras de pacientes com periodontite crônica, avaliar o efeito do tratamento periodontal não cirúrgico sobre os valores do índice clínico de avaliação da atividade sistêmica de pacientes com SSp e do índice reportado pelo paciente com SSp. Amostras de fluido gengival, saliva e os parâmetros clínicos periodontais que consistiram de medida da profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletadas no início do estudo e 45 dias após a terapia periodontal não-cirúrgica de pacientes sistemicamente saudáveis com periodontite crônica (PC, n = 7) e pacientes com SSp e periodontite crônica (SP, n = 7). Pacientes periodontalmente saudáveis com SSp (SC, n = 7) e sistemicamente saudáveis (C, n = 7) também foram avaliados no início do estudo. Os grupos C, PC e SC foram pareados em gênero, idade e critério socioeconômico com o grupo SP. Os níveis de interleucina-8 (IL-8), IL-10 e IL-1ß foram avaliados por ensaio multiplex. Os níveis de atividade da doença foram medidos usando o Gold Standard da literatura chamado Índice Eular de atividade da síndrome de Sjõgren (ESSDAI). Já para avaliação dos sintomas reportados pelo paciente com SSp foi utilizado o Índice Eular reportado pelo paciente com Sjõgren (ESSPRI).

Os parâmetros clínicos melhoraram após a terapia periodontal (p <0,05). No entanto, o NCI em pacientes com SSp não melhorou significativamente após a terapia (p> 0,05). Houve um aumento nos níveis de IL-1ß, IL-8 e diminuição dos níveis de IL-10 nas amostras de saliva de pacientes do grupo SC em comparação ao grupo C (p <0,05). Já em relação ao fluido gengival, pacientes do grupo SC tiveram maiores níveis de IL-1ß em comparação com o grupo C (p<0,05). Além disso, o tratamento periodontal não cirúrgico resultou num aumento dos níveis de IL-10 no fluido gengival no grupo SP e grupo PC em relação ao valor basal (p <0,05). O fluxo salivar foi significativamente aumentado após o tratamento periodontal apenas em pacientes do grupo SP (p = 0,039). Além disso, o tratamento periodontal não influenciou o índice ESSDAI (p = 0,35) e levou a uma diminuição significativa no índice ESSPRI (p = 0,03). Os presentes dados demonstraram que a SSp influencia os níveis salivares e de fluido gengival de biomarcadores inflamatórios em favor de um perfil próinflamatório, no entanto, este perfil parece não aumentar susceptibilidade dos indivíduos SSp à destruição periodontal. Além disso, os presentes dados demonstraram que o tratamento periodontal não-cirúrgico tem um impacto positivo sobre o fluxo salivar e sobre o índice ESSPRI de pacientes com SSp. Sugere-se assim que o tratamento periodontal pode melhorar a qualidade de vida de indivíduos com SSp.

Primary Sjõgren's syndrome (pSS) is a chronic systemic autoimmune disease that might lead to hyposalivation and negatively affect the oral environment. The aims of this study were to detect the influence of pSS on the levels of inflammatory biomarkers in salivary and gingival crevicular fluid (GCF) samples of patients with chronic periodontitis and to evaluate the effect of non-surgical periodontal treatment on the disease activity index of patients with pSS, and on the reported index of patients with pSS. GCF and salivary samples and clinical parameters consisting of measuring probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were collected at baseline and 45 days after non-surgical periodontal therapy from systemically healthy patients with chronic periodontitis (PC, n=7) and patients with pSS with chronic periodontitis (SP, n=7). Periodontally healthy patients with pSS (SC, n=7) and systemically healthy (C, n=7) were also evaluated at baseline. The groups C, PC and SC were pared on gender, years and socioeconomic status with the SP group. The levels of interleukin-8 (IL-8), IL-10, and IL-1ß were measured by using multiplex immunoassays. Disease activity levels were measured by using the Gold Standard called Eular Sjõgren's syndrome disease activity index (ESSDAI). Also to evaluate the symptoms reported by the pacients with pSS we used the Eular Sjõgren's syndrome patient reported index (ESSPRI).

The clinical parameters improved significantly after periodontal therapy (p<0.05). However, CAL in pSS patients was not statistically improved after therapy (p>0.05). There was an increased expression of IL-1ß, IL-8 and decreased levels of IL-10 in the salivary samples of patients in the group SC compared to the group C (p<0.05). The GCF, patients in the group SC had bigger levels of IL-1ß in comparation with the C group (p<0.05). Moreover, nonsurgical periodontal treatment resulted in increased levels of IL-10 on GCF in the groups SP and PC in relation to the baseline (p<0.05). Salivary flow was significantly increased post-treatment only in the SP's group patients (p=0.039). In addition, periodontal treatment did not influence ESSDAI index (p=0.35) and led to a statistically significant decrease on the ESSPRI index (p=0.03). The present data demonstrated that pSS influences the salivary and GCF levels of inflammatory biomarkers in favour of a proinflammatory profile, however, this profile might doesn't increase the susceptibility of pSS subjects to periodontal breakdown. In addition, the present data demonstrated that non-surgical periodontal treatment has a positive impact on the salivary flow and ESSPRI index of pSS patients. Thus suggesting that periodontal treatment may improve the quality of life of pSS subjects.

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En sus formas primaria o secundaria el sindrome de Sjogren o exocrinopatia autoinmune es una de las enfermedades de tejido conectivo mas comun. La variedad primaria (no asociada a ninguna otra enfermedad autoinmune) es sin embargo mal conocida en Colombia. Se presentan diez casos de ella, de cuyo analisis resaltan la heterogeneidad de las manifestaciones clinicas extraglandulares, la constante afectacion de las secreciones exocrinas variable en severidad y extension (sindrome sicca), y las caracteristicas alteraciones inmunologicas: hipergammaglobulinemia G, anticuerpos antinucleares positivos, pero ausencia de anti-DNA, RNP y Sm, factor reumatoide no necesariamente positivo, y sobre todo HLD-B8 negativo en todos los pacientes, lo cual pareceria diferenciar este grupo de los descritos en otras partes. Una cuidadosa correlacion entre el sindrome sicca (xerostomia, queratoconjuntivitis sicca), los sintomas de compromiso sistemico extraglandular y las alteraciones inmunologicas permiten establecer el diagnostico diferencial sin mayores dificultades.

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