Juliano Cavagni

Dentine hypersensitivity : analysis of self-care products

Dentine hypersensitivity is a condition that is often present in individuals, leading them to seek dental treatment. It has been described as an acute, provoked pain that is not attributable to other dental problems. Its actual prevalence is unknown, but it is interpreted as very unpleasant by individuals. Several therapeutic alternatives are available to manage dentine hypersensitivity, involving both in-office treatment and home-use products. The aim of this literature review was to evaluate self-care products for managing dentine hypersensitivity. Among the products available, dentifrices and fluorides are the most studied self-care products, with positive effects. However, a high percentage of individuals is affected by the placebo effect. Among dentifrices, those containing potassium salts seem to be the most promising. Dental professionals need to understand the advantages and limitations of these therapies and use this knowledge in a positive approach that might help in decreasing dentine hypersensitivity among patients.

Obesity may increase the occurrence of spontaneous periodontal disease in Wistar rats

OBJECTIVE To evaluate the effect of body weight on the occurrence of spontaneous alveolar bone loss in Wistar rats. METHODS Twenty-eight rats were randomly divided in two groups. Control group received standardized rat chow diet and water. Test group received cafeteria (CAF) diet during 17 weeks. Diet was available for both groups ad libitum. Body weight and Lee Index were evaluated. At the end of the experimental period, rats were killed by decapitation and maxillae were defleshed with 9% sodium hypochlorite. Morphometric analysis was performed in digital standard photographs. Presence of spontaneous periodontitis was considered when mean alveolar bone loss was ≥0.51mm (75th percentile). Statistical analysis was performed with chi-square test, Mann-Whitney test and independent samples t-test (significance level P≤0.05). RESULTS After 17 weeks of exposure to standard CAF diet, a statistically significant mean difference in body weight (g±SD) (478±43 vs. 580±60) and Lee Index (3.07±0.05 vs. 3.24±0.07) was observed between control and obesity groups, respectively. Median (interquartile range) of alveolar bone loss in control group was 0.344 (0.313-0.367) and 0.491 (0.427-0.506) for buccal and palatal site, respectively. For obese group was 0.308 (0.289-0.354) and 0.549 (0.482-0.616) for buccal and palatal site, respectively. In animals submitted to CAF diet, 20 sites were classified as spontaneous periodontal disease, whereas in control animals, only 8 sites exhibited periodontal breakdown according cut-off point. A significant difference between groups was detected (P=0.009). CONCLUSIONS It may be concluded that obesity increases the occurrence of spontaneous periodontal disease in Wistar rats.

Obesity and Hyperlipidemia Modulate Alveolar Bone Loss in Wistar Rats

BACKGROUND A positive association between obesity-associated metabolic disorders (e.g., hyperlipidemia and diabetes) and periodontitis has been demonstrated in the literature. This study evaluates the role of cafeteria diet-induced obesity/hyperlipidemia (CAF) on alveolar bone loss (ABL) in rats. METHODS Sixty male Wistar rats were randomly divided in four groups: control, periodontitis (PERIO), obesity/hyperlipidemia (CAF), and obesity/hyperlipidemia plus periodontitis (CAF+PERIO). Groups CAF and CAF+PERIO were exposed to a high-fat, hypercaloric diet. At week 12, periodontal disease was induced in groups PERIO and CAF+PERIO by ligatures in the upper second molar. The contralateral tooth was considered the intragroup control. Body weight and Lee index were evaluated weekly during the experiment. Serum glucose and cholesterol/triglycerides in the liver were evaluated, and percentage of ABL was measured by microcomputed tomography. Serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β were evaluated by enzyme-linked immunosorbent assay at week 17. RESULTS Body weight, Lee index, and cholesterol/triglycerides in the liver increased in groups exposed to the cafeteria diet. Groups PERIO and CAF+PERIO exhibited a significantly higher ABL compared to control and CAF groups. The presence of obesity and hyperlipidemia significantly increased ABL in the CAF+PERIO group compared to the PERIO group (53.60 ± 3.44 versus 42.78 ± 7.27, respectively) in the sides with ligature. Groups exposed to CAF exhibited higher ABL in the sides without ligature. No differences were observed among groups for IL-1β and TNF-α. CONCLUSION Obesity and hyperlipidemia modulate the host response to challenges in the periodontium, increasing the expression of periodontal breakdown.

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

OBJECTIVES To 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). DATA Randomized controlled trials of at least 6 months of follow-up including systemically healthy individuals with gingivitis were included. SOURCES MEDLINE, 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. STUDY SELECTION The 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. CONCLUSIONS EO 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. CLINICAL SIGNIFICANCE Mouthwashes containing essential oils should be considered the first choice for daily use as adjuvants to self-performed mechanical plaque control.

Effects of alcohol and/or tobacco exposure on spontaneous alveolar bone loss in rat.

The aim of the present study was to evaluate the effect of alcohol and/or tobacco exposure on spontaneous alveolar bone loss in Wistar rats. Twenty-four, male, 60 day-old, Wistar rats were assigned to 4 groups: Group 1 received 10 mL/kg of glucose solution (5%). Group 2 received 2 g/kg alcohol (20%). Group 3 was exposed to tobacco smoke (6 cigarettes/60 min). Group 4 received both interventions of groups 2 and 3. Alcohol was given by gastric gavage and cigarette exposure was performed using a forced ventilation chamber. After 30 days, animals were sacrificed and the upper maxillae removed and defleshed. Morphometric analysis of alveolar bone loss (ABL) around the second molar was performed in standardized digital photographs. Statistical analysis was conducted using paired t-test, one-way ANOVA and occurrence of spontaneous periodontal disease (ABL ≥ 0.39 mm) was analyzed by Fishers exact test. Significant differences in body weight were observed between all groups. Group 2 presented higher body weight as compared to the 3 other groups at 4 weeks (p≤0.05). Mean ABL values were 0.31 mm (±0.08), 0.29 mm (±0.07), 0.33 mm (±0.10), and 0.33 mm (±0.08) for groups 1, 2, 3, and 4, respectively. No significant differences were found among groups. In the analysis of occurrence of periodontal breakdown, alcohol exposure decreased the occurrence of ABL and cigarette exposure increased ABL. The combination of alcohol and cigarette exposure did not differ from the control group. Alcohol consumption decreased the occurrence of periodontal breakdown, while tobacco increased this rate.

Effect of inhaled corticosteroid on TNF-α production and alveolar bone loss in Wistar rats.

OBJECTIVE To evaluate the effect of different concentrations of inhaled budesonide on secretion of tumoral necrosis factor-alpha (TNF-α) and on ligature-induced alveolar bone loss in Wistar rats. MATERIALS AND METHODS Forty-two animals were randomly divided in four groups. Control group (G1) did not receive any procedure. For the other 3 groups, alveolar bone loss was induced by placement of ligatures around the upper second molar. The contralateral molar was considered intra-group control. Group 2 (G2) was nebulized with saline solution (NaCl 0.9%). Groups 3 and 4 (G3 and G4) were nebulized with 30 μg and 100 μg budesonide, respectively. Administration of drugs was performed daily for 14 days. Blood samples were collected from all animals for analysis of TNF-α. The maxillae from G2, G3 and G4 were removed and defleshed with 9% sodium hypochlorite. Morphometric analysis of bone loss was performed in digital standard photographs. Statistical analysis was performed with one-way ANOVA, followed by Tukey HSD or Scheffé multiple comparisons test (significance level P ≤ 0.05). RESULTS Mean alveolar bone loss values for teeth with ligature were 0.72, 0.70 and 0.77 mm for Groups 2, 3 and 4, respectively. No statistically significant differences were found amongst groups with or without ligature. The production of TNF-α was 60% higher in the presence of ligature (G1 vs. G2/G3/G4). No effect was observed in TNF-α secretion after inhalation of budesonide. CONCLUSION Inhaled budesonide in different concentrations did not alter alveolar bone loss and TNF-α secretion in male Wistar rats.

Correlation analysis of alveolar bone loss in buccal/palatal and proximal surfaces in rats

The aim was to correlate alveolar bone loss in the buccal/palatal and the mesial/distal surfaces of upper molars in rats. Thirty-three, 60-day-old, male Wistar rats were divided in two groups, one treated with alcohol and the other not treated with alcohol. All rats received silk ligatures on the right upper second molars for 4 weeks. The rats were then euthanized and their maxillae were split and defleshed with sodium hypochlorite (9%). The cemento-enamel junction (CEJ) was stained with 1% methylene blue and the alveolar bone loss in the buccal/palatal surfaces was measured linearly in 5 points on standardized digital photographs. Measurement of the proximal sites was performed by sectioning the hemimaxillae, restaining the CEJ and measuring the alveolar bone loss linearly in 3 points. A calibrated and blinded examiner performed all the measurements. Intraclass Correlation Coefficient revealed values of 0.96 and 0.89 for buccal/lingual and proximal surfaces, respectively. The Pearson Correlation Coefficient (r) between measurements in buccal/palatal and proximal surfaces was 0.35 and 0.05 for the group treated with alcohol, with and without ligatures, respectively. The best correlations between buccal/palatal and proximal surfaces were observed in animals not treated with alcohol, in sites both with and without ligatures (r = 0.59 and 0.65, respectively). A positive correlation was found between alveolar bone loss in buccal/palatal and proximal surfaces. The correlation is stronger in animals that were not treated with alcohol, in sites without ligatures. Areas with and without ligature-induced periodontal destruction allow detection of alveolar bone loss in buccal/palatal and proximal surfaces.

The effect of inflammatory response modulator agents on gingivitis and periodontitis

Periodontal diseases are infecto-inflammatory diseases. Literature, has tried to elucidate the infections component of gingivitis and periodontitis, for several years. In recent years, much has been discussed about the role of the host response modulators to periodontal therapeutic procedures. The aim of the present literature review was to evaluate the effect of host response modulating agents (anti-inflammatories) on the pathogenesis of gingivitis and periodontitis. A search in the main databases was performed and human and animal studies were selected. The majority of studies was performed in humans and non-steroidal anti-inflammatory drugs in different dosages were used. The results have shown a potential benefit of the non-steroidal anti-inflammatory drugs concerning the microbial challenge. However, this benefit seems not to occur in the long term, thus not supporting it as a periodontal therapeutic approach. Few studies evaluated the effect of steroidal antiinflammatory drugs on the pathogenesis of periodontal diseases. Moreover, the results in humans and animals are controversial, pointing to a possible deleterious effect of steroidal anti-inflammatory drugs on periodontal structures. Indexing terms: Anti-inflammatory agents. Gingivitis. Periodontal diseases. Periodontitis.Doencas periodontais sao doencas de natureza infecto-inflamatoria. A literatura, por muitos anos, preocupou-se em elucidar somente o aspecto infeccioso de gengivites e periodontites. Nos ultimos anos, muito tem-se debatido quanto ao papel da modulacao da resposta do organismo como medida terapeutica periodontal. Nesse sentido, o objetivo da presente revisao de literatura foi avaliar o efeito de agentes moduladores da resposta inflamatoria (antiinflamatorios) na patogenese de gengivites e periodontites. Foi realizada uma busca nas principais bases de dados sendo selecionados estudos em humanos e em modelo animal. Observou-se que a maioria dos estudos foi realizada em humanos e utilizou antiinflamatorios nao-esteroides) em diferentes posologias. Os resultados dos estudos apontam para um potencial efeito benefico dos antiinflamatorios nao-esteroides frente ao desafio microbiano. Entretanto, esse beneficio parece nao ocorrer a longo prazo nao sendo justificado seu uso como medida terapeutica periodontal. Poucos estudos avaliaram o efeito dos antiinflamatorios esteroides na patogenese das doencas periodontais. Alem disso, os resultados dos estudos tanto em humanos quanto em animais sao controversos, mas apontam para um possivel efeito deleterio dos antiinflamatorios esteroides sobre as estruturas periodontais.

Response to Proximal Restorations Placed Either Subgingivally or Following Crown Lengthening in Patients with No History of Periodontal Disease.

The purpose of this study was to compare the impact of resin restorations placed supragingivally or impinging periodontal biologic width (PBW). Ten patients (aged 19 to 35 years) with at least two contralateral teeth (premolars and molars) in need of proximal subgingival restorations participated. Test group (TG) (impingement of PBW with transsurgical restorations) and control croup (CG) (supragingival restorations after crown lengthening) were randomly assigned. Visible plaque (VP), bleeding on probing (BOP), periodontal probing depth (PPD), and clinical attachment loss (CAL) were evaluated at baseline and at 45, 90, and 180 days, and by transperiodontal probing at baseline and 180 days. Generalized estimating equations, Wald test, and t test were used (P ≤ .05). VP and BOP were reduced and maintained at low levels (less than 10% from day 45 on). PPD initially reduced in the TG. At day 180, no intra- or intergroup differences were observed (P > .05). CAL was higher in the CG after surgery (P < .05) and remained stable for both groups throughout the study. In conclusion, proximal bonded restorations infringing on the PBW may not require clinical crown lengthening.

Efficacy of two soft-bristle toothbrushes in plaque removal: a randomized controlled trial

The aim of this study was to compare the efficacy in supragingival plaque removal of two soft-bristle toothbrushes. Seventy volunteers were allocated randomly to the Colgate Slim Soft or Curaprox CS5460 toothbrush grourps. At baseline appointment, volunteers underwent plaque examination using the Rustogi Modification of the Navy Plaque Index. Under supervision, they then brushed their teeth for 1minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers performed daily oral hygiene with their assigned toothbrush and a regular dentifrice provided by the researchers for 7 days. The baseline experimental procedures were then repeated. Separate analyses of variance were performed for the whole-mouth, interproximal, and gumline plaque scores (p < 0.05). No difference in baseline pre-brushing scores was found between groups. After a single toothbrushing, the mean plaque score was significantly reduced in both groups (p < 0.05), with greater reduction of whole-mouth and interproximal plaque scores observed in the SlimSoft group compared with the Curaprox group (p < 0.05). After 7 days, the SlimSoft group showed greater reduction of the whole-mouth and interproximal plaque scores compared with the Curaprox group (p < 0.05). In conclusion, the SlimSoft toothbrush presented greater efficacy in supragingival plaque removal than did the Curaprox CS5460 toothbrush, as reflected by whole-mouth and interproximal plaque scores.