Guillermo Machuca

Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol. Key words: Apical periodontitis, diabetes mellitus, endodontics, root canal treatment.

Clinical assessment of gingival size among patients treated with diltiazem

Gingival overgrowth induced by nifedipine has been extensively reported. This finding, however, does not apply to gingival size changes caused by other calcium antagonists such as diltiazem. We studied the gingiva of 13 subjects with ischemic cardiopathy who had been treated with diltiazem and established two control groups: (1) a healthy group of 12 patients and (2) a group of 10 patients with ischemic cardiopathy and concomitant treatment similar to that applied to the diltiazem group except that they had not been administered any type of calcium antagonists. The size of the gingiva around the six anterior teeth was measured on plaster models of the upper and lower jaws. Significantly higher scores of the size of the gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) and also when interproximal (p < 0.05) and vestibular (p < 0.05) sites were considered. We did not observe any significant difference in the plaque index of each group (p < 0.05); only bleeding after probing was found statistically different between the diltiazem and the nondiltiazem groups.

Relationship between Smoking and Endodontic Variables in Hypertensive Patients

INTRODUCTION The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients. METHODS In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score. RESULTS Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P=.000; odds ratio [OR], 16.8; 95% confidence interval [CI], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P < .01; OR, 5.5; 95% CI, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P < .01; OR, 3.3; 95% CI, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P < .01; OR, 2.9; 95% CI, 1.6-5.5). CONCLUSIONS The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects.

Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study.

Objectives: There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease. Study Design: The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years. Statistical method: A one way-ANOVA and a MR-ANOVA were established; significance p<0.05. Results: No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001). Conclusion: Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index. Key words:Attachment loss, coronary heart disease, periodontal disease, risk factors.

Craniofacial and oral manifestations of trichorhinophalangeal syndrome type I (Giedion's syndrome): A case report

A case of trichorhinophalangeal syndrome type I (Giedions syndrome) is presented and discussed. Pathologic alterations, including oral and facial manifestations, and the clinical history of this unusual condition are described. The case is compared with others reported in the literature.

Panoramic radiomorphometry and vertebral fractures in Spanish postmenopausal women

OBJECTIVE To evaluate the relationship between panoramic radiomorphometric indexes, and the presence of osteoporotic fractures in a Spanish postmenopausal women. METHODS A sample of 120 women (60 with fragility spine fractures and 60 healthy), aged 55-70 years, with fragility spine fractures, were included in this cross-sectional study that was conducted from 2008 to 2011. All the women were referred to undergo a radiological spine examination, spinal densitometry and a panoramic radiograph for assessing osteoporosis using 3 radiomorphometric indexes: Panoramic Mandibular Index (PMI), Mental Index (MI) and Mandibular Cortical Index (MCI). According to mandibular cortical shape, in MCI, three groups were defined: C3 (osteoporosis), C2 (osteopenia), C1 (health). RESULTS Significant differences were found between all the MCI groups due to their composition between fractures and non-fractures. C1 group (healthy) has less fractures women than C2 (Bonferroni p<0.001), C1 has less fractures than C3 (Bonferroni p<0.001) and finally, C2 has less fractures than C3 (Bonferroni p<0.006). PMI and MI values were significantly lower in cases than in controls (U Mann-Whitney p<0.001). CONCLUSIONS Panoramic radiomorphometrics mandibular indexes such as MCI, PMI, and MI, may be useful for identifying the population at higher risk for fracture. The relationship between panoramic index and osteoporosis remains unclear and further studies using fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.

Manifestaciones periodontales en la menopausia

Hormonal changes in menopausal women frecquently develops many systemic alterations such as osteoporosis. In the present paper, menopause and its role in the development of periodontal disease and periodontal attachment loss is reviewed. Looking at the particular role of osteoporosis and calcium, hormonal, and interleukines levels in menopausal women, the relationship between periodontal disease and these factors seems to be stablished, but to improve the knowledge about this important situation, more studies should be developed in the future.