Cassiano Kuchenbecker Rösing

Azithromycin as an adjunctive treatment of aggressive periodontitis: 12-months randomized clinical trial

AIM To assess the effect of systemic azithromycin as a supplement to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). MATERIAL AND METHODS Twenty-four individuals (13-26 years old) underwent a plaque control program, and then were treated with SRP. Subjects were assigned randomly into two groups; the test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. The periodontal status at baseline and 12 months was compared using the Wald test, and adjusting for the effect of clustering of teeth within subjects. RESULTS There were no significant differences in visible plaque, gingival bleeding, and supragingival calculus between groups throughout the study. Periodontal probing depth (PPD) and clinical attachment level improved significantly from baseline to 12 months in both groups, with the test group showing significantly more reduction in mean PPD compared with controls (2.88 mm versus 1.85 mm, respectively, p=0.025). Subjects administering azithromycin showed a higher percentage of teeth with attachment gain >or=1 mm (81.34 versus 63.63, p=0.037), whereas the controls had higher percentage of teeth with attachment loss >or=1 mm (11.57 versus 2.24, p=0.015). CONCLUSIONS The adjunctive use of azithromycin has the potential to improve periodontal health of young patients with AgP.

Association Among Menopause, Hormone Replacement Therapy, and Periodontal Attachment Loss in Southern Brazilian Women

BACKGROUND The aim of the present study was to evaluate the association among menopause, hormone replacement therapy (HRT), and periodontal attachment loss (PAL). METHODS Three hundred twenty-eight women (40 to 69 years old) who participated in a previous oral survey in South Brazil were included. Women who reported not having their monthly menstrual cycles for >or=12 months were classified as postmenopausal. Postmenopausal women were categorized according to HRT. Women with >or=30% teeth with PAL >or=5 mm were classified as having periodontitis. The data were analyzed using a multivariable logistic regression model and adjusted for age, smoking, socioeconomic status, and dental care. RESULTS The prevalence of periodontitis was significantly greater among postmenopausal women not using HRT (HRT-) than among premenopausal women (64.4% versus 46.3%; P = 0.005). Similarly, the multivariable analysis demonstrated a significantly higher chance of having periodontitis in postmenopausal HRT- women than in premenopausal women (odds ratio [OR], 2.1; 95% confidence interval [CI]: 1.1 to 4.0). In contrast, no significant differences were observed in the prevalence of periodontitis between postmenopausal women using HRT (HRT+) and premenopausal women (48.8% versus 46.3%; P = 0.77). After adjusting for cofactors, postmenopausal HRT+ women did not have a greater likelihood of having periodontitis than premenopausal women (OR, 1.2; 95% CI: 0.6 to 2.5). No significant differences in tooth loss were observed among the study groups after adjusting for confounders. CONCLUSIONS Postmenopausal HRT- women had a greater chance of having periodontitis than premenopausal women. In contrast, postmenopausal HRT+ women and premenopausal women had similar periodontal status. HRT may have a beneficial effect on periodontal health.

Comparison of histometric and morphometric analyses of bone height in ligature-induced periodontitis in rats

The purpose of this study was to compare histologic and morphometric procedures of bone height measurement. Microscopic measurements are the most frequent methods in periodontal studies with animals, but have limited capacity to identify bone levels associated with both healthy tissues and periodontal disease. Ligatures were placed in the maxillary left second molars of 10 male 60-day-old Wistar rats for 30 days. Left and right maxillary sides of 5 rats were processed for histologic analysis (H), sectioned buccolingually, and stained with HE. The maxillae of the other 5 rats were defleshed and used for morphometric analysis (M). Histometric measurements from the cementoenamel junction to the bone crest were performed. Standardized photographs were used for morphometric analysis. The t test was used for dependent or independent samples (alpha = 0.05%). Distances from cementoenamel junction to bone crest were 0.95 +/- 0.25 and 1.07 +/- 0.30 mm for H and M, respectively. Buccal measurements were 0.92 +/- 0.16 and 1.08 +/- 0.35 mm for H and M. The values obtained using H and M for areas without ligatures were 0.44 +/- 0.15 and 0.47 +/- 0.11 mm for lingual measurements and 0.23 +/- 0.08 and 0.41 +/- 0.10 mm for buccal measurements. No significant differences were found between the two methods in the detection of bone height associated with the placement of ligatures in rats.

Halitosis: an overview of epidemiology, etiology and clinical management

Halitosis is an unpleasant condition that causes social restraint. Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the populations. The etiological chain of halitosis relates to the presence of odoriferous substances in exhaled air, especially the volatile sulphur compounds (VSC) produced by bacteria. The organoleptic diagnosis is the gold standard and clinical management includes oral approaches, especially periodontal treatment and oral hygiene instructions, including the tongue. When oral strategies are not successful, referral to physicians is warranted.

The effect of dexamethasone in the pathogenesis of ligature-induced periodontal disease in Wistar rats

The aim of this study was to evaluate, in rats, the role of the systemic use of dexamethasone in the pathogenesis of induced alveolar bone loss. In 26 female Wistar rats, ligatures were placed around the second upper molars, and the contralateral ones served as intra-group controls. Two groups were formed. The test group received 0.5 mg/kg of dexamethasone subcutaneously every third day during thirty days. The control group received the same amount of saline solution. After thirty days, the animals were sacrificed and their maxillae were removed. Sodium hypochlorite was used to prepare the specimens, and the cementum-enamel junction was stained with 1% methylene blue. Morphometric analysis of the alveolar bone loss was performed with standardized digital photographs, and the distance between the cementum-enamel junction and the alveolar bone crest was measured with the software ImageTool 3.0. Intra-examiner calibration revealed a Pearson correlation coefficient of 0.99. Statistical analysis was performed by paired or independent samplet tests, as appropriate (alpha = 0.05). Dexamethasone increased the mean alveolar bone loss in ligature-induced periodontitis in relation to the control group (0.77 and 0.61 buccally, and 0.65 and 0.56 palatally, respectively). No significant differences were observed intergroups in the teeth without ligatures. In the animal model used here, the use of dexamethasone increased the progression of ligature-induced alveolar bone loss.

Dentine hypersensitivity : analysis of self-care products

Dentine hypersensitivity is a condition that is often present in individuals, leading them to seek dental treatment. It has been described as an acute, provoked pain that is not attributable to other dental problems. Its actual prevalence is unknown, but it is interpreted as very unpleasant by individuals. Several therapeutic alternatives are available to manage dentine hypersensitivity, involving both in-office treatment and home-use products. The aim of this literature review was to evaluate self-care products for managing dentine hypersensitivity. Among the products available, dentifrices and fluorides are the most studied self-care products, with positive effects. However, a high percentage of individuals is affected by the placebo effect. Among dentifrices, those containing potassium salts seem to be the most promising. Dental professionals need to understand the advantages and limitations of these therapies and use this knowledge in a positive approach that might help in decreasing dentine hypersensitivity among patients.

Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding

The aim of the present study was to evaluate the effect of two chlorhexidine rinsing solutions (0.12% and 0.2%) on plaque and gingival bleeding. Ten dental students participated in this double-blind, cross-over study, rinsing twice a day, for one minute, with each one of the tested solutions for fourteen days. A wash-out period of one week between treatments was observed. In order to assess gingival bleeding, the van der Weijden et al.(1) (1994) index was used. The plaque indexes used were those of Quigley, Hein(2) (1962) and Silness, Löe(3) (1964). In the pre-experimental period, subjects received oral hygiene instructions and dental prophylaxis. The results revealed no significant differences between both concentrations in relation to plaque and gingival bleeding. Mean values (+/- standard deviation) of the Quigley & Hein index were 0.25 +/- 0.16 for the 0.12% solution and 0.23 +/- 0.26 for the 0.2% solution (p = 0.4838). Mean values (+/- standard deviation) of the Silness-Löe index were 0.12 +/- 0.10 for the 0.12% solution and 0.11 +/- 0.11 for the 0.2% solution (p = 0.7592). The bleeding index mean values at the end of the study were not different for both concentrations with mean values (+/- standard deviation) of 14.93% +/- 6.68% and 13.95 +/- 9.24% for the 0.12% and 0.2% solutions, respectively. Although an increase in gingival bleeding was observed, both concentrations were able to control dental plaque.

The impact of antioxidant agents complimentary to periodontal therapy on oxidative stress and periodontal outcomes: A systematic review

There is significant evidence linking chronic periodontitis (CP) and oxidative stress (OS). CP is a multifactorial infecto-inflammatory disease caused by the interaction of microbial agents present in the biofilm associated with host susceptibility and environmental factors. OS is a condition that arises when there is an imbalance between the levels of free radicals (FR) and its antioxidant defences. Antioxidants, defined as substances that are able to delay or prevent the oxidation of a substrate, exist in all bodily tissues and fluids, and their function is to protect against FR. This systematic review assessed the effects of the complimentary use of antioxidant agents to periodontal therapy in terms of oxidative stress/antioxidants. Only randomised, controlled, double-blind or blind studies were included. The majority of the included studies were performed in chronic periodontitis patients. Lycopene, vitamin C, vitamin E, capsules with fruits/vegetables/berry and dietary interventions were the antioxidant approaches employed. Only the studies that used lycopene and vitamin E demonstrated statistically significant improvement when compared to a control group in terms of periodontal parameters. However, oxidative stress outcomes did not follow the same pattern throughout the studies. It may be concluded that the use of some antioxidants has the potential to improve periodontal clinical parameters. The role of antioxidant/oxidative stress parameters needs further investigations.

Obesity may increase the occurrence of spontaneous periodontal disease in Wistar rats

OBJECTIVE To evaluate the effect of body weight on the occurrence of spontaneous alveolar bone loss in Wistar rats. METHODS Twenty-eight rats were randomly divided in two groups. Control group received standardized rat chow diet and water. Test group received cafeteria (CAF) diet during 17 weeks. Diet was available for both groups ad libitum. Body weight and Lee Index were evaluated. At the end of the experimental period, rats were killed by decapitation and maxillae were defleshed with 9% sodium hypochlorite. Morphometric analysis was performed in digital standard photographs. Presence of spontaneous periodontitis was considered when mean alveolar bone loss was ≥0.51mm (75th percentile). Statistical analysis was performed with chi-square test, Mann-Whitney test and independent samples t-test (significance level P≤0.05). RESULTS After 17 weeks of exposure to standard CAF diet, a statistically significant mean difference in body weight (g±SD) (478±43 vs. 580±60) and Lee Index (3.07±0.05 vs. 3.24±0.07) was observed between control and obesity groups, respectively. Median (interquartile range) of alveolar bone loss in control group was 0.344 (0.313-0.367) and 0.491 (0.427-0.506) for buccal and palatal site, respectively. For obese group was 0.308 (0.289-0.354) and 0.549 (0.482-0.616) for buccal and palatal site, respectively. In animals submitted to CAF diet, 20 sites were classified as spontaneous periodontal disease, whereas in control animals, only 8 sites exhibited periodontal breakdown according cut-off point. A significant difference between groups was detected (P=0.009). CONCLUSIONS It may be concluded that obesity increases the occurrence of spontaneous periodontal disease in Wistar rats.

Epidemiology of periodontal diseases in adults from Latin America

A decade has passed since we first reviewed the epidemiology of periodontal diseases in Latin America. At that time, lack of population-based studies was the norm and our conclusions were based on very limited evidence. The aim of the present comprehensive review was to update and expand our previous work by providing a broad overview of Latin America and its current social, economic and demographic status and by focusing on the epidemiology of periodontal diseases in Latin American adults published in the last 15 years. The amount of periodontal epidemiological data available has increased but is still restricted to a few countries only. The scope of the literature available has also broadened to include oral health-related quality of life and systemic interactions; however, most studies had methodological limitations that might have biased their results. In general, periodontitis was very prevalent, but severe periodontal destruction was localized. Besides being associated with well-established risk factors, periodontitis was associated with demographics and socio-economic factors in Latin American populations. To advance epidemiological knowledge, population-based cross-sectional and longitudinal studies, using appropriate methodologies, should be the future focus of the research agenda of researchers and public health planners in Latin American countries.