José Mariano da Rocha

Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight

There is little information about the knowledge and attitudes of physicians regarding oral care. This study aimed to assess the knowledge and attitudes of obstetricians about the relationship between periodontal disease and preterm/low birth weight. A questionnaire was emailed to members of the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO). The questionnaire elicited both personal information and knowledge and attitudes regarding the relationship between periodontal diseases and preterm labor. A total of 875 obstetricians responded to the questionnaire. The majority of respondents were female (54.1%), resided in the Southeast (45.6%), worked in both the public and private sectors (61.4%), and had over 15 years of experience in obstetrics (48.9%). A large proportion of obstetricians (93.4%) stated that bacteria were associated with periodontal disease, and 94% reported that periodontitis was a condition more severe than gingivitis. In total, over 80% of participating obstetricians reported smoking, preeclampsia, bacterial vaginosis and periodontal disease as risk factors or possible risk factors for preterm birth or low birth weight. A correlation between the experience of the obstetricians and referral of their patients for dental examinations (p < 0.001) was observed. Also, obstetricians who had had their own dental visits more recently were more likely to recommend the same for their patients (p < 0.001). It is concluded that, although obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes, the attitudes of these professionals were not in agreement with their apparent knowledge regarding periodontal diseases and their possible repercussions.

Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

The effects of social isolation on wound healing mechanisms in female mice.

Various stressors impair wound healing in humans and rodents. For example, social isolation delays wound closure in rodents, but the healing mechanisms that underlie this delay have yet to be identified. Here, the effects of three weeks of social isolation on hypothalamic-pituitary-adrenal axis responses and healing factors involved in the inflammatory and proliferative phases of wound healing were assessed in adult female hairless mice. Social isolation reduced basal circulating corticosterone concentrations and increased body and thymus weights compared with group-housed controls. Isolation impaired dermal wound closure by up to 30% and reduced initial total wound bacterial load relative to controls. Inflammatory gene expression in the wounds was not affected by the observed differences in wound bacterial load. However, isolation reduced wound gene expression of keratinocyte growth factor and vascular endothelial growth factor, which are involved in keratinocyte proliferation/migration and angiogenesis during the proliferative phase of healing. These data indicate that social isolation induces healing impairments that may be attributed to reductions in growth factors necessary for proper skin cell proliferation and blood vessel growth during healing. This healing impairment occurred in the absence of both high wound bacterial load and elevated circulating glucocorticoids, which have previously been hypothesized to be required for stress-impaired healing in mice.

Contrasting mechanisms by which social isolation and restraint impair healing in male mice

Abstract Stress modulates vital aspects of immune functioning in both human and non-human animals, including tissue repair. For example, dermal wounds heal more slowly and are associated with prolonged inflammation and increased bacterial load in mice that experience chronic physical restraint. Social stressors also negatively affect healing; however, previous studies suggest that the affected healing mechanisms may be stress model-specific. Here, the effects of either social isolation or physical restraint on dermal wound healing (3.5 mm wounds on the dorsum) were compared in hairless male mice. Social isolation beginning 3 weeks prior to wounding delayed healing comparably to physical restraint (12 h/day for eight days), in spite of marked differences in metabolic and hormonal consequences (i.e. body mass) between the two stress models. Additionally, isolated mice exhibited reductions in wound bacterial load and inflammatory gene expression (interleukin-1beta [IL-1β], monocyte chemoattractant protein [MCP]), whereas restraint significantly increased both of these parameters relative to controls. Experimentally augmenting bacterial concentrations in wounds of isolated mice did not ameliorate healing, whereas this treatment accelerated healing in controls. This work indicates that social isolation and restraint stressors comparably impair healing, but do so through disparate mechanisms and at different phases of healing.

Response to a letter to the editor addressing the publication "Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial".

1. The traditional classification based on a distinction between “spontaneous” and “medically indicated” preterm birth proposed by Dr. Lopez has long been debated in obstetrics due to its inherent ambiguity and it is no longer in use. To properly address this issue, the Global Alliance to Prevent Prematurity and Stillbirth task force established a new classification system for the preterm birth syndrome intended for clinical and research use [1]. The 2009 classification was based on the following five components: (1) maternal conditions prior to presentation for birth, (2) fetal conditions prior to presentation for birth, (3) placental pathologies, (4) signs of early labor, and (5) route (pathway) of birth (started spontaneously or by the doctor). Notably, risk factors or the route of delivery (vaginal or cesarean) are explicitly omitted in this new classification [2]. Whereas our original publication did not report results according to the above-mentioned classification, data collected during the study were retrieved and the results are presented below for the reader’s sake. As reported previously, 14 and 17 preterm births occurred in the control and test groups, respectively. Four out of the 14 preterm births in the control group had significant maternal conditions as defined by the new classification, namely one case of chronic hypertension, one case of preeclampsia, and two cases of urinary tract infection. The remaining ten women had no maternal, fetal, or placental factors for preterm birth that could be identified. In the test group, 6 out of the 17 preterm births showed significant pathological conditions: one case of preeclampsia, one case of depressed mood, two cases of gestational diabetes, and two cases of urinary tract infection. Eleven cases of preterm birth in the test group did not have any maternal, fetal, or placental factors that could be identified. No cases of fetal or placental pathological conditions were identified in any of the participants. Spontaneous delivery occurred in 10 out of 14 women in the control group and in 11 out of 17 women in the intervention group (71.4 vs. 64.7 %, p=0.70). Thus, no significant differences could be observed between groups when the most current classification system is used, corroborating our initial findings and conclusions. P. Weidlich (*) : T. Fiorini :M. L. Musskopf : J. M. da Rocha : M. L. R. Oppermann : C. K. Rösing : R. V. Oppermann Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil e-mail: patricia.weidlich@ufrgs.br

Effect of 15% Alcohol Dependence on Alveolar Bone Loss and TNF-α Secretion in Wistar Rats

The aim of the present study was to evaluate the effect of 15% alcohol dependence on ligature-induced alveolar bone loss and TNF-α secretion in Wistar rats. Thirty-three male Wistar rats aged 45-60 days (mean weight=253 g) were randomly allocated test or control groups. Test group (n=18) received 15% alcohol as liquid intake and control group (n=15) received water during the experimental period. TNF-α was analyzed by ELISA assay in 11 animals per group. After 14 days of alcohol/water intake, alcohol dependency was assessed and silk ligatures were placed around the left second upper molars. Ligature presence and body weight were checked weekly. After 40 days, animals were sacrificed and the maxillae were defleshed for morphometric analysis using standardized images. All animals in the test group displayed signs of alcohol dependency at day 14. No statistically significant differences in final body weight (334.83±21.38 vs. 322.48±30.65 g, p=0.20) were observed between groups. In relation to alveolar bone loss, no statistically significant difference was observed among test and control groups both for ligated teeth (0.76±0.06 vs. 0.74±0.10 mm, p=0.60) and unligated teeth (0.41±0.16 vs. 0.35±0.05 mm, p=0.22). The TNF-α secretion also did not display statistically significant differences between test and control groups (10.78±1.84 vs. 12.13±2.11 pg/mL, p=0.12). It may be concluded that 15% alcohol dependency was not capable to alter alveolar bone loss and TNF-α secretion in Wistar rats.