Francisco Wilker Mustafa Gomes Muniz

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.

Essential oils-containing mouthwashes for gingivitis and plaque: Meta-analyses and meta-regression.

OBJECTIVESnTo evaluate the efficacy of EO as adjuncts to mechanical plaque control (MPC) on the reduction of plaque and gingivitis when compared to placebo or cetylpyridium chloride (CPC).nnnDATAnRandomized controlled trials of at least 6 months of follow-up including systemically healthy individuals with gingivitis were included.nnnSOURCESnMEDLINE, EMBASE, Lilacs and SCOPUS were searched up to April 2016. From 3045 citations, 16 studies were included. 14 studies assessed the Quigley-Hein Plaque Index (QHI) and 11 studies assessed the Modified Gingival Index (MGI) and were included in meta-analyses and meta-regression.nnnSTUDY SELECTIONnThe analysis of risk of bias suggested that the quality of the studies ranged from moderate to low. Mean QHI (WMD=-0.86, 95%CI -1.05 to -0.66) and MGI (WMD=-0.52, 95%CI -0.67 to -0.37) were lower for EO+MPC than placebo+MPC. Reductions in plaque and gingivitis were, respectively, 32% and 24% larger for EO+MPC than placebo+MPC. The decreases in QHI (WMD=-0.95, 95%CI -1.26 to -0.63) and in MGI (WMD=-0.34, 95%CI -0.53 to -0.15) observed in the EO+MPC group, compared to placebo+MPC in interproximal areas, were significantly different and in favor to EO+MPC. EO+MPC compared to CPC+MPC resulted in clinically lower levels of plaque and gingivitis. High heterogeneity (I2>95%) was found and explained (MGI-R2=63.6%; QHI-R2=80.1%) by differences between studies in the percentage of males, supervision of the mouthwashes and provision of oral hygiene.nnnCONCLUSIONSnEO seems to be superior to placebo+MPC and CPC+MPC for reduction of plaque and gingival inflammation in patients with gingivitis. Expected benefits may be clinically relevant and may also reach the interproximal area.nnnCLINICAL SIGNIFICANCEnMouthwashes containing essential oils should be considered the first choice for daily use as adjuvants to self-performed mechanical plaque control.

The impact of chewing gum on halitosis parameters: a systematic review

This study aimed to analyze the impact of chewing gum on halitosis parameters. Three databases were searched with the following focused question: Can chewing gum additionally reduce halitosis parameters, such as organoleptic scores and volatile sulfur compounds (VSC), when compared to a control treatment? Controlled clinical trials presenting at least two halitosis measurements (organoleptic scores and/or VSC) were included. Ten studies were included, and different active ingredients were used. One study was performed using a chewing gum without any active ingredient. Chewing gum containing probiotic bacterium was shown to significantly reduce the organoleptic scores. Chewing gums containing zinc acetate and magnolia bark extract as well as allylisothiocyanate (AITC) with zinc lactate significantly reduced the levels of VSC in comparison to a placebo chewing gum. Furthermore, a sodium bicarbonate-containing chewing gum significantly reduced the VSC levels in comparison to rinsing with water. Furthermore, eucalyptus-extract chewing gum showed significant reductions in both organoleptic scores and VSC when compared with a control chewing gum. Chewing gum containing sucrose was able to reduce the VSC levels, in comparison to xylitol and zinc citrate chewing gum, but only for 5 min. It was concluded that chewing gums containing probiotics Lactobaccilus, zinc acetate and magnolia bark extract, eucalyptus-extract, and AITC with zinc lactate may be suitable for halitosis management. However, the low number of included studies and the high heterogeneity among the selected studies may limit the clinical applications of these findings.

The effect of statins on periodontal treatment—a systematic review with meta-analyses and meta-regression

ObjectiveThis study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical attachment level, and intrabony defects, in comparison to mechanical periodontal therapy alone or in association with placebo.Material and methodsThree databases were searched for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment. Weighted mean differences between baseline and 6xa0months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated. A high heterogeneity was detected. Therefore, a meta-regression adjusted for type of statin and year of publication was performed.ResultsFifteen studies were included in the systematic review, and ten studies were included in the meta-analysis. In the meta-regression, the adjunct use of simvastatin, rosuvastatin, and atorvastatin additionally reduced PPD in comparison to mechanical periodontal therapy and a placebo gel (2.90u2009±u20090.35, 3.90u2009±u20090.77, 3.06u2009±u20090.71xa0mm, respectively; pu2009<u20090.05). Regarding the resolution of IBD, simvastatin and rosuvastatin significantly improved in comparison to control group (0.89u2009±u20090.35 and 1.93u2009±u20090.77xa0mm, respectively; pu2009<u20090.05). No statistically significant difference was found between the statins for both PPD and IBD (pu2009<u20090.05). Regarding CAL gain, simvastatin provided a statistically significant improvement as compared to the control group (2.02u2009±u20090.79xa0mm; pu2009=u20090.043).ConclusionsThe use of statins, used as sole adjuncts to mechanical periodontal treatment, improved the periodontal parameters. In the quantitative analyses, simvastatin was the only drug that showed additional benefits in all evaluated parameters.Clinical relevanceStatins promote significantly clinical periodontal improvements when administered in association with non-surgical scaling and root planning (SRP), when compared to SRP alone or in association with a placebo.

Efficacy of an unwaxed dental floss impregnated with 2% chlorhexidine on control of supragingival biofilm: A randomized, clinical trial

AIMnIn the present study, we evaluated the antiplaque and antigingivitis efficacy of a dental floss impregnated with 2% chlorhexidine digluconate.nnnMETHODSnThirty dental students were randomly divided into three groups (n=10): (a) negative control (NC) group, in which no interproximal cleaning was performed; (b) the positive control (PC) group, which used a standard unwaxed dental floss twice daily; and (c) and the test group, which used a unwaxed dental floss impregnated with 2% chlorhexidine twice daily. Six surfaces per tooth were evaluated by the Quigley-Hein plaque index (Turesky modification) at the last appointment (day 15), and testing for the presence of marginal bleeding was performed using the marginal bleeding index (MBI) at both the baseline and last appointments.nnnRESULTSnAt day 15, the test group had the lowest mean plaque index (1.04±0.67), showing a statistically-significant difference compared to the NC group (1.40±0.65, P<.001) and PC group (2.30±0.73, P<.001). The PC and test groups showed a mean reduction of 70.2% and 87.26%, respectively, with significant reduction compared to baseline (P<.05) for the MBI. No statistically-significant difference was found between the PC and test groups (P=.126).nnnCONCLUSIONnUnwaxed dental floss impregnated with 2% chlorhexidine showed additional reductions in supragingival interproximal biofilm compared with a conventional unwaxed dental floss, without additional improvement in marginal bleeding.

Citation Analysis and Trends in review articles in dentistry

Objective This study aimed to describe the trends in dentistry article reviews as well as to compare citation patterns between systematic and narrative reviews. Methods A search strategy was developed, in Scopus database, in order to identify all narrative and systematic reviews published between 2000 and 2015. Original research studies, letters to the editor, editorials, book chapters, and case reports were excluded. From the list of studies available, 30 reviews per year were randomly chosen. The review type, year of publication, number of authors, country of the first author, open access, language, main topic of interest, journals H index, number of references, and number of citations were extracted by 2 researchers. The number of citations was extracted from the Scopus database. Multivariable regression analysis was used in order to detect the association between citation rate and the independent variables. Results Overall, 118 and 362 systematic and narrative reviews were included in this study. Throughout the years, the number of systematic reviews has increased from 5.8% to 53.3%. However, the mean number of citations has significantly decreased, and this is affected by the reviews year of publication. A trend for lower citation in systematic reviews (Relative risk [RR]: 0.79; 95% confidence interval: 0.75–0.84) has been demonstrated; however, the number of citations of narrative reviews has been increasing over the years (RR: 1.14; 95% confidence interval: 1.08–1.21). Conclusion From 2000 to 2015, the number of systematic reviews increased substantially. On the other hand, a trend for lower citations of these studies has been observed that is affected over time.

Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis

This systematic review aimed to compare the nutritional status and oral health in older adults individuals. Three databases (Medline-Pubmed, Scopus and EMBASE) were searched up to October 28th 2016 for studies that performed the Subjective Global Assessment (SGA) or the Mini Nutritional Assessment (MNA) and an oral examination performed by a dental professional, either dental hygienist or a dentist. Both observational and interventional studies were screened for eligibility. Meta-analyses were performed comparing the malnourished/at risk of malnutrition and the normal nutrition subjects with three oral health parameters (edentulism, use of prosthesis and mean number of present teeth). Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was showed that well-nourished subjects had a significantly higher number of pairs of teeth/Functional Teeth Units (FTU) in comparison to individuals with risk of malnutrition or malnutrition. The meta-analyses showed no statistically significant association between edentulism and use of prosthesis, as the pooled Relative Risk were, respectively, 1.072 (95% CI 0.957-1.200, pxa0=xa00.230) and 0.874 (95% CI 0.710-1.075, pxa0=xa00.202). On the other hand, the pooled Standard Mean Difference of mean number of present teeth werexa0-0.141 (95% CIxa0-0.278 toxa0-0.005, pxa0=xa00.042) in subjects with at risk of malnutrition/malnourished. FTU and mean number of teeth present were significantly associated with nutritional status. Furthermore, more longitudinal studies in this field are needed.

Antimicrobial activity of copaiba oil (Copaifera ssp.) on oral pathogens: Systematic review

Copaifera ssp. produces an oil‐resin that presents antiinflammatory, antitumor, antiseptic, germicidal, antifungal, and antibacterial activity. This systematic review aimed to analyze the antimicrobial action of Copaiba oil against oral pathogens, when compared to that of control substances. A search on Medline/PubMed, LILACS, SciELO, EMBASE, and SCOPUS databases were performed up to March 2017. To be included, the studies needed to perform any antimicrobial activity essay, using copaiba oil and a control substance. The antimicrobial effect of each substance, in each study, was extracted. Eleven studies were included, and several copaiba species were used. All studies showed that copaiba oil, regardless of its species, presented a bactericidal and/or bacteriostatic effect in in vitro analyzes. Only one study showed that the antimicrobial effect of the Copaifera officinalis was similar to the one found in chlorhexidine. A higher risk of bias was detected in most of the included studies. The studies demonstrated that the antimicrobial activity of copaiba oil, in most cases, is lower than chlorhexidine, which is considered the gold standard. However, there is great potential against oral bacteria. Further high quality studies are warranted in order to assess the efficacy of copaiba oil on oral pathogens.

Nutritional assessment and associated factors in the elderly: apopulation-based cross-sectional study

OBJECTIVEnThe aim of this study was to assess nutritional status and associated factors in elderly individuals.nnnMETHODSnThis cross-sectional study was conducted in residential homes with a probabilistic cluster sample. Two-hundred eighty-seven individuals 65-74 y of age were interviewed and examined in the city of Cruz Alta, state of Rio Grande do Sul, Brazil. A structured questionnaire was used to assess the socioeconomic, behavioral, and general health conditions; the number of present teeth were counted. Nutrition was assessed with a validated instrument-the Mini Nutritional Assessment-which classifies the patient as normal (eutrophic), at nutritional risk, or malnourished. For data analysis, the participants were categorized in eutrophic or at nutritional risk (at risk of malnutritionu2009+u2009malnourished). The associations were assessed by either the χ2 or Mann-Whitney tests. Uni- and multivariate Poisson regression analyses verified the associations. The significance level was set at 5%.nnnRESULTSnThe prevalence of nutritional risk was 48.4%. In the multivariate model, edentulous individuals with no complete denture or with only one complete denture (prevalence ratio PR, 1.59; 95% confidence interval [CI], 1.18-2.13) and elderly individuals with no access to the dentist (PR, 1.48; 95% CI, 1.11-1.88) presented higher potential for nutritional risk than their respective controls.nnnCONCLUSIONSnThe results showed that approximately half of the participants (48.4%) were at nutritional risk. The lack of complete or partial rehabilitation of edentulous patients and the lack of access to the dentist were associated with higher nutrition risk.

Use of antidepressive agents as a possibility in the management of periodontal diseases: A systematic review of experimental studies.

Antidepressant agents have anti-inflammatory functions that could be interesting as adjuvants in periodontal therapy. The aim of the present study was to analyze the effect of antidepressive drugs in the management of periodontal disease. The MEDLINE, Scopus, Embase, LILACS, and SciELO databases were searched. To be included, the studies had to be experimental studies; randomized, controlled; double-blinded; or blinded studies. A total of 565 articles were initially searched, of which five were selected for the systematic review. All studies used rats, and three different drugs were evaluated: tianeptine, venlafaxine, and fluoxetine. Two of these studies evaluated the effect of antidepressive agents in rats submitted to both ligature-induced periodontitis and depression models, showing that depressive rats had greater alveolar bone loss (ABL). Only the venlafaxine study was not able to find any significant ABL reduction in the group that used this antidepressive drug. The other four studies showed statistically-significant differences, favoring the group with the antidepressant agent. Treatments that are able to modulate the brain-neuroendocrine-immune system could be used as an adjuvant to periodontal disease management. However, studies on humans and animals are scarce, limiting the conclusion of a positive effect in the present systematic review.