Carlos Heitor Cunha Moreira

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum

BACKGROUND AND OBJECTIVE A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1β and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1β in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Relationship between cytokine levels in serum and gingival crevicular fluid (GCF) in pregnant women

BACKGROUND Periodontal disease has been linked to systemic diseases/disorders and a low-grade systemic inflammatory status originated from periodontitis has been proposed as a possible explanation for this association. This study evaluates the relationship, early in pregnancy, between gingival crevicular fluid (GCF) and serum levels of a panel of cytokines that have been implicated in PTB and periodontal disease. METHODS One hundred pregnant women aged 18-35 years old with a gestational age up to 20 weeks were included (mean±SD gestational age:16.1±3.5 weeks). Four periodontal sites per subject were randomly selected for GCF collection. Serum and GCF levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNF-α were analyzed using a cytometric bead array. Regression and correlation analyses were used to assess the relationship between serum and GCF cytokine levels. RESULTS Participants had widespread periodontal inflammation but limited periodontal destruction. Cytokine levels were significantly higher in GCF than serum for all cytokines but IL-10. GCF levels had small but significant effect on serum levels for IL-10 (β=0.34±0.09, p<0.01), IL-12p70 (β=0.48±0.08, p<0.01) and TNF-α (β=0.29±0.09, p<0.01). Periodontal probing depth and bleeding on probing were significantly associated with GCF levels for IL-1β, IL-6 and IL-8; however, they had negligible effect on serum cytokine levels. Correlation between GCF and serum levels was non-significant, except for IL-12p70, which showed a significant but small correlation between the two sources (r=0.32, p=0.001). CONCLUSIONS GCF cytokine levels were not strongly associated with serum cytokine levels in pregnant women with widespread periodontal inflammation but limited periodontal destruction.

Periodontal status and its correlation with haematological parameters in patients with leukaemia

AIM This cross-sectional study evaluated periodontal status in patients with leukaemia and its correlation with haematological parameters. METHODS Patients with different types of leukaemia and minimum age of 14 years were eligible. Calibrated examiners assessed Seymour index (SI), plaque index (PlI), gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) and performed an interview. Haematological parameters were obtained from haemogram performed on the same day of the periodontal examinations. RESULTS Sixty-eight patients were evaluated, which corresponded to an 85% response rate. Periodontal parameters were in agreement with plaque accumulation (PlI 1.28 ± 0.5, GI 0.74 ± 0.4, PD 2.27 ± 0.6, BOP 33%, CAL 2.31 ± 1.6). PlI and CAL were statistically lower in acute leukaemia (1.13 ± 0.61 and 1.96 ± 1.7) in comparison with chronic leukaemia (1.46 ± 0.44 and 2.74 ± 1.4). Moreover, older age (95% confidence interval [CI]: 0.27-1.56), higher educational level (CI: -1.94 to -0.64) and smoker (CI: 0.39-1.96) were associated with CAL. Correlation between periodontal and haematological parameters was not observed. Correlations between GI x SI and PD x SI were statistically significant (r(S) = 0.390, p = 0.001; r(S) = 0.517, p = 0.000 respectively). CONCLUSIONS Periodontal parameters were consistent with plaque accumulation and did not correlate with haematological parameters irrespective of the leukaemia type.

Frequency of mechanical removal of plaque as it relates to gingival inflammation: a randomized clinical trial.

AIM This single blind, randomized clinical trial evaluated the relationship between frequency of mechanical removal of plaque (MRP) and gingival inflammation. MATERIALS & METHODS Fifty-two patients (maximum 5% of sites with gingival bleeding and no history of periodontitis) were randomized to different frequencies of MRP: 12, 24, 48 and 72 h. Plaque index (PlI) and gingival index (GI) were evaluated at baseline, 15 and 30 days. Intra- and inter-group differences were determined by repeated measures anova and mixed models anova, respectively, both followed by Tukeys test. RESULTS The mean GI between baseline and 30 days remained statistically unchanged in the 12 h (0.51 ± 0.17 versus 0.63 ± 0.23, p = 0.137) and 24 h (0.43 ± 0.19 versus 0.59 ± 0.21, p = 0.052) groups, but increased significantly in the 48 h (0.48 ± 0.18 versus 0.84 ± 0.21, p = 0.001) and 72 h (0.55 ± 0.20 versus 0.94 ± 0.25, p = 0.000) groups. At 30 days, the average percentage of sites with GI scores of 1 and 2 was significantly higher in the 48 and 72 h than in the 12 and 24 h groups (p < 0.05). CONCLUSIONS Frequencies of mechanical removal plaque up to 24 h may prevent an increase in the severity of gingival inflammation over a period of 30 days in patients with no history of periodontitis.

Effect of the Etching Duration and Ultrasonic Cleaning on Microtensile Bond Strength Between Feldspathic Ceramic and Resin Cement

This study assessed the effect of different etching durations of feldspathic ceramic with hydrofluoric acid (HF) and ultrasonic cleaning of the etched ceramic surface on the microtensile bond strength stability of resin to a feldspathic ceramic. The research hypotheses investigated were: (1) different etching times would not affect the adhesion resistance and (2) ultrasonic cleaning would improve the adhesion. Ceramic blocks (6 × 6 × 5 mm) (N = 48) were obtained. The cementations surfaces were duplicated in resin composite. The six study groups (n = 8) were: G1—Etching with 10% aqueous HF (30 s) + silane; G2—10% HF (1 min) + silane; G3—10% HF (2 min) + silane; G4—10% HF (30 s) + ultrasonic cleaning (4 min) in distilled water +silane; G5—10% HF (1 min) + ultrasonic cleaning + silane; G6—10% HF (2 min) ultrasonic cleaning + silane. The cemented blocks were sectioned into microbars for the microtensile test. The etching duration did not create significant difference among the groups (p = .156) but significant influence of ultrasonic cleaning was observed (p = .001) (Two-way ANOVA and Tukeys test, p > 0.05). All the groups after ultrasonic cleaning presented higher bond strength (19.38–20.08 MPa) when compared with the groups without ultrasonic cleaning (16.21–17.75 MPa). The bond strength between feldspathic ceramic and resin cement was not affected by different etching durations using HF. Ultrasonic cleaning increased the bond strength between ceramic surface and resin cement, regardless of the etching duration.

Criteria adopted by dentists to indicate the extraction of periodontally involved teeth

When dealing with patients with periodontal disease of variable severities, dentists must often choose between treating and restoring the involved tooth or indicating its extraction. Different criteria have been adopted in this decision-making process. The purpose of this study was to evaluate the criteria adopted by dentists to indicate the extraction of teeth with periodontitis. Dentists were interviewed at their private practices in three cities of the state of Rio Grande do Sul, Brazil. The evaluated criteria included severity of attachment loss, tooth mobility, furcation involvement, prosthetic planning, periodontal-endodontic lesion, possible systemic involvement due to the presence of periodontitis, referral to a periodontist for evaluation, radiographic bone loss greater than 50%, presence of extensive caries, socio-economic and cultural status of the patient, among others. The most often adopted criteria to indicate the extraction of periodontally affected teeth were the presence of mobility (37.5%), severity of attachment loss (24.3%) and radiographic bone loss greater than 50% (21.2%). The results of the present study demonstrated the difficulties faced by dentists to indicate the extraction of teeth with severe attachment loss, in addition to the establishment of an adequate prognosis. Aspects associated with the past disease were still the most often reported to indicate the extraction of teeth for periodontal reasons.

Gingival inflammation and platelet count in patients with leukemia: preliminary results

Leukemia has been associated with oral manifestations. However, the available literature on this topic consists of mostly reports of cases, without data about the periodontal parameters that may be under the influence of hematologic factors. The aim of this cross-sectional study was to assess the correlation between the Gingival Index and Bleeding on Probing with the platelet count in patients with leukemia. Patients with diagnosis of any kind of leukemia, at any stage of treatment, having a minimum age of 14 years, treated at the Department of Hematology-Oncology of the University Hospital of Santa Maria, Brazil, between December 2009 and March 2010, were assessed. Excluded patients were: edentulous, with orthodontic appliances, with psychomotor disturbances, requiring antibiotic prophylaxis for the examinations, or those using medications associated with gingival swelling. Two trained and calibrated examiners evaluated the Plaque Index, Gingival Index (GI), Probing depth, Bleeding on Probing (BOP), and Clinical Attachment Loss. Hematologic data were collected from a blood test performed on the same day as the periodontal examination. Thirty-seven patients (26 males), aged between 15 and 80 years (mean age 41.7 ± 18.31) were evaluated. Correlation between platelet count and BOP (p > 0.05), or between platelet count and GI (p > 0.05), were both weak (Pearsons correlation coefficient r = 0.171 and r = -0.003, respectively) and not statistically significant. It can be concluded from the preliminary results that the low platelet count was not correlated with the higher prevalence of gingival and periodontal bleeding in patients with leukemia.

The associations of socioeconomic status and social capital with gingival bleeding among schoolchildren

OBJECTIVE The aim of this study was to assess the associations of gingival bleeding with individual and community social variables among schoolchildren. METHODS This cross-sectional study evaluated a representative, multistage, random sample of 1,134 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. The participants were examined clinically, and full-mouth gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding). The childrens parents or guardians answered questions regarding their socioeconomic status and social capital, and an assessment of the associations was performed using multilevel Poisson regression models. RESULTS The prevalence of gingival bleeding was 96.21 percent. The multilevel adjusted assessment revealed that socioeconomic, clinical, and social capital variables at the individual level were associated with higher levels of gingival bleeding. Children whose fathers had a low educational level, children who had dental plaque and dental crowding, and children who never/almost never attended religious meetings exhibited significantly higher levels of gingival bleeding than their counterparts. This social gradient remained significant even after adjusting for contextual-level covariates. CONCLUSION The results indicate that the socioeconomic status and features of social capital are associated with the levels of gingival bleeding among schoolchildren.

Combined effect of end-rounded versus tapered bristles and a dentifrice on plaque removal and gingival abrasion

Two previous clinical studies evaluated the effect of end-rounded versus tapered bristles of soft manual brushes on the removal of plaque and gingival abrasion. However, the combined effect of an abrasive dentifrice on these outcomes has yet to be understood. The purpose of the present study was to compare the incidence of gingival abrasion and the degree of plaque removal obtained after the use of toothbrushes with tapered or end-rounded bristles in the presence or absence of an abrasive dentifrice. The study involved a randomized, single-blind, crossover model (n = 39) with a split-mouth design. Subjects were instructed to refrain from performing oral hygiene procedures for 72 hours. Quadrants were randomized and subjects brushed with both types of toothbrushes using a dentifrice (relative dentin abrasion = ± 160). Plaque and gingival abrasion were assessed before and after brushing. After 7 days, the experiment was repeated without the dentifrice. The average reduction in plaque scores and the average increase in the number of abrasion sites were assessed by repeated-measures ANOVA and Bonferronis post-hoc tests. End-rounded bristles removed significantly more plaque than tapered bristles, regardless of the use of a dentifrice. The dentifrice did not improve plaque removal. In the marginal area (cervical free gingiva), no difference in the incidence of gingival abrasion was detected between toothbrush types when used with a dentifrice (p ≥ 0.05). However, the dentifrice increased the incidence of abrasion (p < 0.001), irrespective of the toothbrush type tested. End-rounded bristles therefore removed plaque more effectively without causing a higher incidence of gingival abrasion when compared with tapered bristles. An abrasive dentifrice can increase the incidence of abrasion, and should be used with caution by individuals who are at risk of developing gingival recession.

Periodontitis and breast cancer: A case‐control study

OBJECTIVES The aim of this case-control study was to evaluate the association between periodontitis and breast cancer in a sample of adult Brazilian women. METHODS This was a hospital-based study, which included 67 cases and 134 controls (1:2). Women were selected consecutively between April, 2013 and June, 2015 among those attending the Department of Gynecology at the University Hospital of Santa Maria. Cases were selected among women diagnosed with breast cancer (ICD-10 C50), and controls were matched for age (±2 years), and smoking status (never, former and current smoker). Conditional logistic regression was used to model the association between periodontitis and breast cancer with and without adjustment for potential confounders. Four case definitions for periodontitis were used. RESULTS Cases had significantly greater clinical attachment loss than controls (P=.04). After adjusting for important covariates, women diagnosed with periodontitis had two to three times higher odds of breast cancer than women without periodontitis depending on the case definition of periodontitis (P<.05). CONCLUSIONS A significant association was observed between periodontitis and breast cancer.