Isaac Suzart Gomes-Filho

Chronic periodontitis and C-reactive protein levels.

BACKGROUND This study aims to analyze the relationship between chronic periodontitis and C-reactive protein (CRP) by considering associated variables in individuals with or without cardiovascular disease. METHODS A sample of 359 individuals of both sexes (aged ≥40 years) was assessed. Among these individuals, 144 subjects were admitted to the hospital because of a first occurrence of acute myocardial infarction; 80 subjects were in the hospital for reasons other than acute myocardial infarction; and 135 subjects were living in the community. A questionnaire was applied to obtain demographic and lifestyle characteristics. Complete clinical periodontal examinations and anthropometric assessments were performed. CRP levels, plasma glucose levels, lipid profiles, and blood tests were performed to investigate any conditions that might have suggested infection and/or inflammation. CRP evaluations were performed using nephelometry. Individuals were considered to have periodontal disease if they simultaneously presented at least four teeth with one or more sites with probing depth ≥4 mm, clinical attachment loss ≥3 mm, and bleeding on probing. Procedures for descriptive analyses and logistic regression were used. RESULTS In the chronic periodontitis group, mean CRP levels were higher than those in the group without chronic periodontitis (2.6 ± 2.6 mg/L versus 1.78 ± 2.7 mg/L, respectively). The final model showed that individuals with chronic periodontitis were more likely to have high CRP levels (adjusted odds ratio: 2.26; 95% confidence interval: 1.30 to 3.93) considering the effects of age, schooling level, sex, smoking, high-density lipoprotein cholesterol, and diabetes. CONCLUSION In this study, chronic periodontitis is associated with elevated plasma CRP levels, even after controlling for several potential confounders.

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

UNLABELLED Starting in the 1990s, several authors sought to investigate the hypothesis that periodontitis during pregnancy may contribute towards the birth of low-weight children. However, this relationship is still not well established. The aim of this study was to evaluate whether this oral infection is associated with this gestational event. METHODS This was a case-control study among 548 puerperae, of whom 164 were the mothers of low-weight live births (case group) and 384 were the mothers of live births of normal gestational weight (control group). They were selected at two public hospital units in two municipalities in the State of Bahia. From interviews and data gathered using live birth cards or birth certificates, information was obtained regarding age, height, previous diseases, marital status, socioeconomic situation, smoking and alcohol use. Mothers who presented at least four teeth on which one or more sites had a probing depth of greater than or equal to 4 mm, clinical attachment loss of greater than or equal to 3 mm and bleeding on probing, at the same site, were deemed to present periodontal disease. The data were analysed by stratification from logistic regression. RESULTS Periodontal disease was diagnosed in 42.7% of the case group and 30% of the control group. A statistically significant association was found between periodontal disease and low birth weight (unadjusted OR = 1.74; 95% CI: 1.19-2.54), particularly among mothers with low schooling levels (adjusted OR = 2.30; 95% CI: 1.14-4.6). CONCLUSION The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels.

Respiratory disease and the role of oral bacteria

Abstract The relationship between oral health and systemic conditions, including the association between poor oral hygiene, periodontal disease, and respiratory disease, has been increasingly debated over recent decades. A considerable number of hypotheses have sought to explain the possible role of oral bacteria in the pathogenesis of respiratory diseases, and some clinical and epidemiological studies have found results favoring such an association. This review discusses the effect of oral bacteria on respiratory disease, briefly introduces the putative biological mechanisms involved, and the main factors that could contribute to this relationship. It also describes the role of oral care for individuals who are vulnerable to respiratory infections.

Genotoxic effects of X-rays on keratinized mucosa cells during panoramic dental radiography

OBJECTIVES The aim of this study was to evaluate the genotoxic effects of X-rays on epithelial gingival cells during panoramic dental radiography using a differentiated protocol for the micronucleus test. METHODS 40 healthy individuals who underwent this procedure for diagnostic purposes on request from their dentists agreed to participate in this study. All of them answered a questionnaire before the examination. Epithelial gingival cells were obtained from the keratinized mucosa of the upper dental arcade by gentle scraping with a cervical brush immediately before exposure and 10 days later. Cytological preparations were stained according to the Feulgen-Rossenbeck reaction, counterstained with fast green 1% for 1 min and analysed under a light microscope. Micronuclei, nuclear projections (broken eggs) and degenerative nuclear alterations (pyknosis, karyolysis, karyorrhexis and condensed chromatin) were scored. RESULTS The frequency of micronuclei was significantly higher after exposure (P < 0.05), as were the frequencies of nuclear alterations indicative of apoptosis (P < 0.001). CONCLUSIONS These results indicate that X-ray radiation emitted during panoramic dental radiography induces a genotoxic effect on epithelial gingival cells that increases the frequency of chromosomal damage and nuclear alterations indicative of apoptosis.

Outcome measurements in studies on the association between osteoporosis and periodontal disease.

BACKGROUND The present study aims to compare different diagnostic criteria for periodontal disease that were used to study the association between periodontal disease and osteoporosis. METHODS A database from a case-control study was used. The present study included sociodemographic, lifestyle, and health-condition data; panoramic radiographs; and clinical measurements on periodontal conditions from 139 postmenopausal women. Each participant was classified with regard to the diagnosis of periodontal disease using five different criteria for the outcome measurement (OM) found in the literature in studies on the association between osteoporosis and periodontal disease (OM1 through OM5). The frequency of periodontal disease and diagnostic values were calculated taking OM5 as the gold standard and the main association measurement for all criteria using odds ratios. RESULTS The frequency of periodontal disease varied from 24.5% to 98.6% depending on the OM used. OM4 and OM3 presented the highest specificity (98.9% and 94.5%, respectively), whereas OM2 and OM1 presented the highest sensitivity (100% and 77.1%, respectively). The association measurements with adjustments for age and smoking varied significantly according to the OM over a range from 1.87 to 3.75, and there were also variations in the statistical significance of the associations found. CONCLUSIONS The results of this study emphasize that the frequency of periodontal disease may be influenced by different OMs and indicated variations outside of the association between osteoporosis and periodontal disease. Therefore, there is a need for prior selection of a precise measurement of periodontal disease in investigations on this topic.

Factors related to periodontal disease in a rural population

To estimate the prevalence and related aspects of periodontitis in a rural area of the State of Bahia, Brazil, this cross-sectional study was carried out in the village of Matinha dos Pretos, Feira de Santana County, Bahia, among 172 subjects ranging from 20 to 60 years of age. During household visits, a full-mouth periodontal exam was performed on each subject, who also answered a questionnaire about socio-demographic, economic and health-related issues. The factors assessed were plaque index, bleeding on probing index, probing depth, gingival recession or hyperplasia measurements. Clinical attachment loss was also calculated. The multivariate logistic regression method was used to evaluate the relative contribution of these factors to the periodontitis condition. The prevalence of periodontitis was 24.4%. The following factors were all positively associated with the presence of periodontitis: being male (OR = 1.58; 1.00 - 2.53), being 30 years of age or older (OR = 2.80; 1.00 - 7.39), living in a house where there was more than one person per room (OR = 1.53; 0.96 - 2.45), being a cigarette or pipe smoker or ex-smoker (OR = 1.49; 0.92 - 2.39), having a plaque index of over 65% (OR = 2.97; 2.72 - 7.39) and more than four missing teeth (OR = 1.51; 0.82 - 2.78). The authors concluded that socioeconomic and biological factors, especially poor oral hygiene and older age, are positively associated with periodontitis in the rural population of a small village in the county of Feira de Santana, State of Bahia, Brazil.

Does Periodontal Infection Have an Effect on Severe Asthma in Adults

BACKGROUND The effect of periodontal infection on systemic diseases and conditions has been the subject of numerous studies worldwide. It is considered that periodontitis may influence the hyperinflammatory response in patients with severe asthma as a result of immuno-inflammatory changes. This study aims to evaluate the influence of periodontitis on severe asthma in adults. METHODS A case-control study was carried out, comprising 220 adult individuals: 113 diagnosed with asthma (case group) and 107 without asthma diagnosis (control group). The diagnosis of periodontitis was established after a full clinical examination using probing depth, clinical attachment level, and bleeding on probing. The diagnosis of severe asthma was based on the criteria recommended by the Global Initiative of Asthma (2012). Descriptive analyses of the variables were performed, followed by bivariate analyses, using the χ(2) test. Association measurements (odds ratio [OR]), with and without adjustment for potential confounders, were obtained. A significance level of 5% was used. RESULTS The ORunadjusted for the main association was 4.38 (95% confidence interval [CI] = 2.47 to 7.75). In the logistic regression model, after adjusting for age, education level, osteoporosis, smoking habit, and body mass index, the ORadjusted was 4.82 (95% CI = 2.66 to 8.76), which was statistically significant. Individuals with periodontal infection showed, approximately, five times more likelihood to have bronchial inflammation than those without such periodontal tissue infection. CONCLUSION The findings demonstrate the influence of periodontitis on severe asthma, given that the frequency of periodontitis is higher in individuals with severe asthma than in those without a diagnosis of bronchial inflammation.

Influence of Periodontitis in the Development of Nosocomial Pneumonia: A Case Control Study

BACKGROUND Although a number of studies on the role of periodontitis in the development of nosocomial pneumonia (NP) have been published, the debate surrounding the existence and nature of this association continues. The present study investigates the influence of periodontitis in NP. METHODS This case-control study involved 315 individuals: 85 cases (with NP) and 230 controls (without NP), at a general hospital in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions, and lifestyle habits were recorded. A full-mouth periodontal examination was performed and periodontal condition assessed. The diagnosis of NP was made in accordance with established medical criteria, after physical, microbiologic, and/or radiographic examination. Logistic regression was used to calculate the strength of the association between periodontitis and NP. RESULTS Individuals with periodontitis were three times as likely to present with NP (unadjusted odds ratio [OR unadjusted] = 3.06, 95% confidence interval [95% CI]: 1.82 to 5.15) as those without periodontal disease. After adjusting for age, time between hospitalization and data collection, last visit to dentist, smoking habit, and present occupation, the association measurement had a slight decrease (OR adjusted = 2.88, 95% CI: 1.59 to 5.19), but the results continued to be statistically significant. CONCLUSION These findings suggest that periodontal infection may influence the development of NP, highlighting that periodontitis is a factor positively associated with this respiratory tract infection.

Porphyromonas gingivalis HmuY-induced production of interleukin-6 and IL-6 polymorphism in chronic periodontitis.

BACKGROUND In chronic periodontitis (CP), the gene polymorphism of interleukin-6 (IL-6) to 174C/G has been associated with the altered production of this cytokine. The aim of this pilot study is to compare the allelic and genotypic frequencies in patients with CP with control individuals without periodontitis (NP) and to measure the production of IL-6 by whole blood cells stimulated with Porphyromonas gingivalis HmuY protein. METHODS DNA was isolated from peripheral blood cells of 49 patients with CP and 60 control individuals classified as NP, and genotyping was performed by polymerase chain reaction using sequence-specific primers. Whole blood cells from 29 patients with CP and 30 control individuals were stimulated for 48 hours with HmuY, and IL-6 levels were measured using enzyme-linked immunosorbent assay. RESULTS The proportion of individuals carrying the G allele at position -174 of the IL-6 gene was higher in the group with CP (85.7%) than in the normal control group (73.3%; P <0.03). P. gingivalis HmuY-induced production of IL-6 was higher in the group with CP (P <0.05). CONCLUSIONS Our findings suggest that P. gingivalis HmuY may be associated with increased IL-6 production during CP. Furthermore, patients with periodontitis and individuals with higher HmuY-induced production of IL-6 show a high frequency of the G allele at position -174.

Periodontitis and nosocomial lower respiratory tract infection: preliminary findings.

AIM To evaluate the possible association between periodontitis and nosocomial lower respiratory tract infection (LRTI). MATERIAL AND METHODS A case-control study was conducted at a General Hospital in Feira de Santana, Bahia, Brazil. The sample consisted of 103 individuals: 22 cases (presence of nosocomial LRTI) and 81 controls (absence of nosocomial LRTI). The diagnosis of periodontitis was based on probing depth, gingival recession, clinical attachment loss and bleeding on probing. The diagnosis of nosocomial LRTI was made in accordance with established medical criteria. RESULTS Invasive ventilation was much more frequent in cases (95.5%) than in controls (7.4%). An orotracheal tube was used in 81.8% of cases and in 7.4% of controls; bronchoaspiration was suspected in 81.8% of cases and in 6.2% of controls. There was no statistically significant difference in any of the clinical periodontal parameters between cases and controls. The crude odds ratio (OR) value for individuals with periodontitis having LRTI was not statistically significant [OR(crude)=1.70; 95% confidence interval:(0.60-4.87)]. After including age, smoking and duration of hospitalization in the logistic regression, the adjusted OR for individuals with periodontitis having LRTI was statistically significant [OR(adjusted)=3.67 (1.01-13.53); p=0.049]. CONCLUSIONS A marginal association between periodontitis and LRTI was found when smoking, age and length of hospitalization were included as covariates. Patients with LRTI had a high frequency of suspected bronchoaspiration and this could explain the possible association of periodontal disease and LRTI found in this and other studies. Additional studies are needed to further clarify the possible relationship between periodontal disease and LRTI.