Juliane Avansini Marsicano

Obesity and periodontitis: systematic review and meta-analysis

The scope of this study was to conduct a systematic review of the studies on the association between obesity and periodontitis. The methods applied included a literature search strategy and selection of studies using inclusion and exclusion in accordance with the criteria for characteristics of the studies and meta-analysis. The research was conducted in the PubMed, Embase and Lilacs databases through 2010. Selected papers were on studies on humans investigating whether or not obesity is a risk factor for periodontitis. Of the 822 studies identified, 31 studies met the inclusion criteria and were included in this meta-analysis. The risk of periodontitis was associated with obesity (or had a tendency for this) in 25 studies, though it was not associated in 6 studies. The meta-analysis showed a significant association with obesity and periodontitis (OR = 1.30 [95% Confidence Interval (CI), 1.25 - 1.35]) and with mean Body Mass Index (BMI) and periodontal disease (mean difference = 2.75). Obesity was associated with periodontitis, however the risk factors that aggravate these diseases should be better clarified to elucidate the direction of this association. Working with paired samples and avoiding confusion factors may contribute to homogeneity between the studies.

Effectiveness of 0.50% and 0.75% chlorhexidine dentifrices in orthodontic patients: A double-blind and randomized controlled trial

INTRODUCTION In this double-blind and randomized controlled trial, we analyzed whether a lower concentration of chlorhexidine in dentifrices could reduce the risk of tooth staining without compromising its effectiveness in controlling gingivitis, bleeding, and dental plaque. METHODS Volunteers with fixed orthodontic appliances were randomly divided into 3 groups: control, 1100 ppm F, NaF (n = 27); experimental, chlorhexidine 0.50% (n = 27); and experimental, chlorhexidine 0.75% (n = 27). At baseline, and after 6 and 12 weeks, clinical examinations were carried out. Staining, calculus, gingivitis, bleeding, and dental plaque data were analyzed with Friedman tests to evaluate intragroup changes over time. To detect intergroup differences after 12 months, the data were evaluated with Kruskal-Wallis tests. Dunn tests were used in both situations for necessary post-hoc analyses. RESULTS The groups were statistically similar for the stain, calculus, and plaque indexes, but there were statistically significant differences for the gingival and bleeding indexes. During the experimental periods, gingivitis and bleeding scores improved in all 3 groups. Only the 0.75% chlorhexidine dentifrice significantly increased the stain index, although most patients did not notice the stains. The intergroup comparison showed a statistically significant better performance of the experimental groups regarding the gingival and bleeding indexes. CONCLUSIONS This study suggests that the use of dentifrices with lower concentration of chlorhexidine can reduce the risk of tooth staining without compromising its effectiveness in controlling gingivitis and bleeding in orthodontic patients.

Effect of propolis gel on the in vitro reduction of dentin permeability

Objective The aim of this study was to evaluate the capacity of potassium oxalate, fluoride gel and two kinds of propolis gel to reduce the hydraulic conductance of dentin, in vitro. Material and Methods The methodology used for the measurement of hydraulic conductance of dentin in the present study was based on a model proposed in literature. Thirty-six 1-mm-thick dentin discs, obtained from extracted human third molars were divided into 4 groups (n=9). The groups corresponded to the following experimental materials: GI-10% propolis gel, pH 4.1; GII-30% propolis gel; GIII-3% potassium oxalate gel, pH 4,1; and GIV-1.23% fluoride gel, pH 4.1, applied to the dentin under the following surface conditions: after 37% phosphoric acid and before 6% citric acid application. The occluding capacity of the dentin tubules was evaluated using scanning electron microscopy (SEM) at ×500, ×1,000 and ×2,000 magnifications. Data were analyzed statistically by two-way ANOVA and Tukeys test at 5% significance level. Results Groups I, II, III, IV did not differ significantly from the others in any conditions by reducing in hydraulic conductance. The active agents reduced dentin permeability; however they produced the smallest reduction in hydraulic conductance when compared to the presence of smear layer (P<0.05). The effectiveness in reducing dentin permeability did not differ significantly from 10% or 30% propolis gels. SEM micrographs revealed that dentin tubules were partially occluded after treatment with propolis. Conclusions Under the conditions of this study, the application of 10% and 30% propolis gels did not seem to reduce the hydraulic conductance of dentin in vitro, but it showed capacity of partially obliterating the dentin tubules. Propolis is used in the treatment of different oral problems without causing significant great collateral effects, and can be a good option in the treatment of patients with dentin sensitivity.

Interfaces between bariatric surgery and oral health: a longitudinal survey.

PURPOSE To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p<0.05). RESULTS DMFT was 17.6 ± 5.7, 18.4 ± 4.1 and 18.3 ± 5.5 (P>0.05), presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05), tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012). Salivary flow was 0.8 ± 0.5 ml/min before surgery, 0.9 ± 0.5 ml/min for 3 months and 1.1 ± 0.5m/min for 6 months (p>0.05). The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029). CONCLUSION The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.

Impact of bariatric surgery on oral health conditions: 6-months cohort study

OBJECTIVES We evaluate oral health conditions before and after bariatric surgery. METHODS The sample was composed of 59 patients who had undergone Roux-en-Y gastric bypass (RYGB). Salivary flow, periodontal pocket depth and dental wear were evaluated before and after 6 months of surgery. Body mass index (BMI), C-reactive protein (CRP) and glucose levels were obtained from the patients medical files. A t-test was used for dependent samples. RESULTS The mean BMI decreased from 49.31 ± 8.76 to 35.52 ± 8.12 kg/m(2) in 6 months after surgery (P < 0.000). Before surgery, 67% of patients had high levels of CRP and 38% higher blood glucose levels and after surgery there were significant reductions in these levels (P < 0.001). Salivary flow ranged from 0.84 to 0.95 ml/min. There was increased prevalence of periodontal pockets (P = 0.022) and mean pocket depth increased to about 0.5 mm (P < 0.001). The percentage of surfaces with dental wear in dentine was significantly higher after bariatric surgery (P = 0.002), while dental wear in enamel decreased (P = 0.019). CONCLUSIONS Bariatric surgery may improve systemic conditions. However, it had a negative impact on oral health conditions because of an increase in periodontal disease and dental wear.

Evaluation of an Experimental Gel Containing Euclea natalensis: An In Vitro Study

Objective. To evaluate the effect of an experimental gel containing Euclea natalensis extract on dentin permeability. Methods. Thirty-six dentin discs, 1-mm-thick. The discs were prepared from the coronal dentin of extracted human third molars that were divided into 3 groups (n = 10). The dentin discs in each group were treated with the groups following experimental materials: (FG): 1.23% fluoride gel, pH 4.1; (EG): Euclea natalensis extract gel, pH 4.1; (CG): control gel, pH 4.1. The gels were applied to the occlusal slide of the dentin under the following conditions: after 37% phosphoric acid and before 6% citric acid. The hydraulic conductance (HC) of each condition was determined four times using a fluid flow apparatus (Flodec). The data were analyzed using Two-way ANOVA and Tukeys test (P < 0.05). Results. The greatest mean reduction in HC was produced in group EG dentin discs (61.2%; P < 0.05). Even after acid challenge with 6% citric acid the great reduction occurred in group EG (66.0%; P < 0.05) than other groups (CG-77.1%, FG-90.8%). Conclusion. E. natalensis gel not only reduced dentin permeability, but also resisted posttreatment citric acid challenge without changing its permeability. Further research has to confirm this promising result in the clinical situation.

An epidemiological scoring system for tooth wear and dental erosive wear

BACKGROUND The prevalence and severity of tooth wear and dental erosion is rising in children and there is no consensus about an index to be employed. AIM To assess the reliability of an epidemiological scoring system dental wear index (DWI) to measure tooth wear and dental erosive wear. DESIGN An epidemiological cross-sectional survey was conducted to evaluate and compare tooth wear and dental erosion using the dental wear index and erosion wear index (EWI). The study was conducted with randomised samples of 2,371 children aged between 4 years and 12 years selected from the State of São Paulo, Brazil. Records were used for calculating tooth wear and dental erosion; the incisal edge and canine cusp were excluded. RESULTS As the schoolchildrens ages increased the severity of primary tooth wear increased in canines (P = 0.0001, OR = 0.34) and molars (P = 0.0001, OR = 2.47) and erosion wear increased in incisal/occlusal (P = 0.0001, OR = 5.18) and molars (P = 0.0001, OR = 2.47). There was an increased prevalence of wear in the permanent teeth of older schoolchildren, particularly on the incisal/occlusal surfaces (P = 0.0001, OR = 7.03). CONCLUSION The prevalence of tooth wear and dental erosion increased as age increased in children. The epidemiological scoring system Dental Wear Index is able to measure both tooth wear and dental erosive wear. This index should be used to monitor the progression of non-carious lesions and to evaluate the levels of disease in the population.

Effect of iron gel on dentin permeability.

This study evaluated in vitro the effect of an experimental gel containing iron on the reduction of hydraulic conductance of dentin. Thirty-six 1-mm-thick dentin discs obtained from extracted human third molars were divided into 3 groups of 10 specimens each. The groups corresponded to the following experimental materials: 1.23% acidulated phosphate fluoride gel, pH 4.1; 3% potassium oxalate gel, pH 4.1 (Oxa-Gel®); and iron sulfate gel (10 mmol/L FeSO4), pH 4.1. The gels were applied to dentin under the following conditions: after 37% phosphoric acid and before 6% citric acid. Data were analyzed statistically by ANOVA and Tukeys test at 5% significance level. There was no significant differences (p<0.05) among the groups in any of the conditions for hydraulic conductance reduction, except for smear layer presence. The active agents reduced dentin permeability, but they produced significantly lower (p<0.05) reduction in hydraulic conductance when compared to presence of smear layer. The effectiveness in reducing dentin permeability was not significantly different (p>0.05) among the gels. This study suggests that the iron gel promoted reduction in dentin permeability comparable to that of the other agents and thus may be considered a good clinical alternative for the treatment of dentin hypersensitivity.

Prevalence, severity and etiology of dental wear in patients with eating disorders

Objective: The purpose of this study was to evaluate the prevalence, distribution and associated factors of dental wear among patients with eating disorders (EDs). Materials and Methods: An epidemiological cross-sectional survey was conducted by trained, calibrated examiners, using the dental wear index. The sample was composed of 30 patients with EDs (experimental group - G1) and 30 control patients without current or previous history of EDs (G2). A questionnaire was used to assess the etiological factors of dental wear. The univariate analyses using the Chi-square (χ2 ) test were used to compare the tooth wear prevalence between groups according to the surface and tooth (P > 0.05). Results: The dental wear was similar for both group; however, the G1 presented more moderate wear in molars when compared with G2 (P = 0.048). The majority of EDs patients related have one or more oral habits (n = 26; 86.6%) and only 13.4% (n = 4) affirmed did not have oral habits. The etiological factors of tooth wear related with dental wear were biting objects (P = 0.04) and pain in temporomandibular disorders (P = 0.03). Conclusion: The highest prevalence of dental wear was observed in the molars teeth. Differences in the extent and pattern of dental wear were found in an individual, emphasized the relevance of clinical parameter.

Effect of natural gel product on bovine dentin erosion in vitro

Objective To evaluate the efficacy of Neem (Azadirachta indica) experimental gel for the prevention of erosive wear on bovine dentin, in vitro. Material and Methods One hundred dentin blocks were allocated into 5 experimental groups (20 samples each): C (control group, without gel); CG (control group, only base gel); F (fluoride gel, 1.23% NaF; pH 4.1, Dentsply; Brazil); N (Neem gel, 10% neem extract; pH 4.1, manipulation); NF (Neem+fluoride gel, 10% Neem extract and 1.23% NaF; pH 4.1, manipulation). The blocks were stored in artificial saliva for 24 hours. After this, they were submitted to six alternating re- and demineralization cycles. The blocks were analyzed for wear (profilometry). The results were submitted to statistical analysis by ANOVA and Tukey tests (P<0.05). Results The mean wear (±SD, µm) was shown as follows in groups: C (13.09±0.99), CG (10.60±1.99), F (10.90±1.44), N (12.68±1.13) and NF (10.84±1.65). All gels showed some preventive action when compared with control group. However, significant differences were found only between Neem+fluoride gel and fluoride gel. Conclusion A single application of a neem-containing fluoride gel reduced dentin erosion, thus it is a possible alternative in reducing dental wear. Further research should investigate the action mechanism and the synergism between them.