Luís Otávio Miranda Cota

Prospective study of complier individuals under periodontal maintenance therapy: analysis of clinical periodontal parameters, risk predictors and the progression of periodontitis

AIM This prospective study aimed to evaluate the progression of periodontitis and the influence of risk variables among individuals attending a programme of periodontal maintenance treatment in an academic environment. MATERIAL AND METHODS A total of 150 individuals diagnosed with chronic moderate-advanced periodontitis, and who had finished active periodontal treatment, were incorporated into the periodontal maintenance therapy. Social, demographic and biological variables of interest from subjects were collected at quarterly recalls, over a 12-month period. The effect of variables of interest and confounding on the periodontal status and progression of periodontitis was tested by univariate and multivariate logistic analysis. RESULTS A total of 130 subjects (86.7%) showed stable periodontal status, whereas 20 subjects (13.3%) presented periodontitis progression. Twenty-eight subjects (18.66%) presented tooth loss that resulted in a total of 47 lost teeth (1.38%). Diabetes was not found to be associated with periodontitis progression (p=0.67). Smoking was significantly associated with a greater progression of periodontitis (OR=2.7, 95% CI 1.01-7.22). CONCLUSIONS Periodontal maintenance programmes in academic environment can stabilize the periodontal condition obtained after active periodontal therapy as well as control the action of risk variables for the progression of periodontitis.

Association of functional gene polymorphism IL-1β in patients with external apical root resorption

INTRODUCTION External apical root resorption (EARR) is a frequent complication of orthodontic treatment. Interleukin 1beta (IL-1beta) is a potent stimulus for bone resorption and osteoclastic cell recruitment during orthodontic tooth movement. The purpose of this study was to assess the association between a polymorphism in the IL-1beta genes and EARR during orthodontic treatment. METHODS The sample included 61 Brazilian orthodontic patients, divided into 2 groups according to the presence (affected group, n = 23) or absence (control group, n = 38) of EARR in the central and lateral maxillary incisors in the posttreatment period. DNA was obtained from buccal swab cells. The polymorphism was analyzed by the polymerase chain reaction followed by digestion with restriction enzyme. The polymerase chain reaction products were analyzed in 10% polyacrylamide gel and stained with silver. RESULTS There were significant statistical differences (P <0.05) among the frequencies of the alleles and genotypes of the IL-1beta gene polymorphism between the affected and unaffected groups, suggesting that allele 1 predisposed the subjects to EARR (odds ratio = 4.0). CONCLUSIONS The polymorphism of the IL-1beta gene is associated with root resorption in the studied population.

Periodontal therapy and risk for adverse pregnancy outcomes

Periodontitis has been associated with adverse pregnancy outcomes. Results from intervention studies are few and controversial. The present study assessed the effects of non-surgical periodontal treatment in the occurrence of adverse pregnancy outcomes. Two hundred forty-six eligible women were randomly divided into two groups: periodontitis intervention (n = 122; undergoing non-surgical treatment during gestation) and periodontitis control (n = 124; not treated during gestation). Univariate analysis was performed and estimates of relative risk were reported. Data from 225 women were analyzed. No differences for preterm birth (p = 0.721), low birth weight (p = 0.198), and preterm low birth weight (p = 0.732) rates were observed. Relative risk estimates for preterm birth, low birth weight, and preterm low birth weight in the periodontitis intervention group were 0.915 (95% CI 0.561–1.493), 0.735 (95% CI 0.459–1.179), and 0.927 (0.601–1.431), respectively. Non-surgical periodontal treatment during the second semester of gestation did not reduce the risk for preterm birth, low birth weight, and preterm low birth weight.

Periodontal risk assessment model in a sample of regular and irregular compliers under maintenance therapy: a 3-year prospective study.

BACKGROUND The purpose of this study is to investigate the association of the periodontal risk assessment (PRA) model with the recurrence of periodontitis and tooth loss during periodontal maintenance therapy (PMT). METHODS In a prospective PMT program, 75 regular complier (RC) and 89 erratic complier (EC) patients were selected. A periodontal examination and PRA were performed after active periodontal therapy and after 3 years of PMT. Risk profiles (low, moderate, or high) of participants were evaluated, and the recurrence of periodontitis and tooth loss were analyzed using univariate and multivariate analyses. RESULTS RCs showed less recurrence of periodontitis and tooth loss than ECs (P <0.05). Rates of periodontitis recurrence in RCs and ECs were 2.7% and 3.4%, respectively, for the moderate-risk profile and 6.7% and 11.2%, respectively, for the high-risk profile. During PMT, 49 teeth (0.65 ± 1.4 teeth per participant) were lost in the RC group, and 70 teeth (0.78 ± 2.1 teeth per participant) were lost in the EC group. High-risk profile participants showed more recurrence of periodontitis and lost significantly more teeth than did participants with moderate- or low-risk profiles in RC and EC groups (P <0.05). CONCLUSION The risk profile influenced the recurrence of periodontitis and tooth loss. RCs had less recurrence of periodontitis and less tooth loss. The PRA model can be useful in particularizing the risk of patients and adjusting recall intervals.

Risk variables in the association between frequency of alcohol consumption and periodontitis

OBJECTIVE Investigate the association between the frequency of alcohol consumption and periodontitis. Moreover, evaluate the influence of biological, behavioural, and social risk variables in this association. METHODS Sample was comprised by 542 subjects of both genders, 35-55 years of age, who underwent a complete periodontal examination, and was divided into four groups according to the frequency of alcohol use, based on alcohol use disorders identification test (AUDIT) and Cut-down, Annoyed, Guilty, Eye-opener (CAGE) instruments: (1) no or occasional alcohol use (NA), (2) moderate alcohol use (MA), (3) intense alcohol use (IA) and (4) alcohol dependence (DA). Associations between the occurrence of periodontitis and potential risk variables were analysed by univariate and multivariate logistic regression stratified by smoking status when appropriate. RESULTS The prevalence of periodontitis in NA, MA, IA and DA groups were 17.2%, 24.0%, 29.6% and 53%, respectively. Alcohol odds ratio (OR) estimates significantly increased with an increase in consumption frequency (DA>IA>MA>NA) and were approximately two times higher in smokers (OR = 3.43 to 7.91) compared to non-smokers (OR = 1.22 to 3.02). CONCLUSION Occurrence of periodontitis among alcohol users were high and the frequency of alcohol consumption increased the odds of periodontitis incrementally mainly in smokers.

Progression of Periodontitis and Tooth Loss Associated with Glycemic Control in Individuals Undergoing Periodontal Maintenance Therapy: A 5-Year Follow-Up Study

BACKGROUND Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. METHODS A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full-mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5-year interval. RESULTS Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). CONCLUSIONS PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.

Progression of Periodontitis in a Sample of Regular and Irregular Compliers Under Maintenance Therapy: A 3-Year Follow-Up Study

BACKGROUND To our knowledge, prospective studies (matched for sex, smoking, and diabetes) that investigated the influence of compliance in the progression of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs were not previously reported. METHODS A total of 58 regular complier (RC) and 58 erratic complier (EC) individuals were recruited from a prospective cohort with 238 patients under PMT and matched by sex, diabetes, and smoking habits. A full-mouth periodontal examination that included bleeding on probing (BOP), probing depths (PDs), clinical attachment levels, and number of teeth were determined at all PMT visits during a 3-year interval. The influence of variables of interest was tested through multivariate logistic regression. RESULTS The progression of periodontitis and tooth loss was significantly lower among RC compared to EC patients. A higher progression of periodontitis was observed among EC patients who smoked. The final logistic model for the progression of periodontitis in the RC group included smoking (odds ratio [OR]: 4.2) and >30% of sites with BOP (OR: 2.8), and the final logistic model for the progression of periodontitis in the EC group included smoking (OR: 7.3), >30% of sites with BOP (OR: 3.2), PDs of 4 to 6 mm in 10% of sites (OR: 3.5), diabetes (OR: 1.9), and number of lost teeth (OR: 3.1). CONCLUSIONS RC patients presented a lower progression of periodontitis and tooth loss compared to EC patients. This result highlighted the influence of the pattern of compliance in maintaining a good periodontal status. Moreover, important risk variables such as smoking and diabetes influenced the periodontal status and should be considered when determining the risk profile and interval time for PMT visits.

Gingival overgrowth in subjects under immunosuppressive regimens based on cyclosporine, tacrolimus, or sirolimus

AIM To assess the prevalence and variables associated with gingival overgrowth (GO) in renal transplant recipients medicated with cyclosporine (CsA), tacrolimus (Tcr), or sirolimus (Sir). MATERIALS AND METHODS One hundred and thirty-five eligible subjects were divided in CsA, Tcr, and Sir groups comprising 45 subjects each. GO was visually assessed and subjects were assigned as GO+ or GO- in a post hoc definition. Saliva samples were collected and the presence of periodontal pathogens was assessed through polymerase chain reaction. Variables of interest were compared between GO+ and GO- subjects through univariate and multivariate analysis. RESULTS Prevalence of GO was of 60.0% for CsA, 28.9% for Tcr, and 15.6% for Sir groups. Within the CsA group, GO was associated with papillary bleeding index (p=0.001); within the Tcr group, GO was associated with CsA previous use (p=0.013), and calcium channel blockers (CCB) use (p=0.003); within the Sir group, GO was associated with papillary bleeding index (p=0.018), and CCB use (p=0.020). A higher frequency of Tannerella forsythia was observed among GO+ subjects medicated with Tcr. CONCLUSION Pharmacological and periodontal variables were associated with GO in different immunosuppressive regimens. Integration between the medical and the dental team may be an important approach in the post-transplant maintenance routine.

Association between periodontal condition and use of tongue piercing: a case-control study.

OBJECTIVE This cross-sectional study aimed to evaluate the periodontal status and risk factors for gingival recession in individuals with tongue piercings. METHODS Sixty cases (individuals with tongue piercings) and 120 controls (non-users) in Brazil, between 13 and 28 years of age, from both genders and a mix of races were selected. The clinical evaluation of patient oral health records included periodontal parameters and the presence of tooth fracture. Cases and controls were compared with demographic, behavioural and clinical variables of interest. Risk variables for the occurrence of gingival recession were identified in multivariate regression models, with linear and logistic regressions. RESULTS The case group presented a higher prevalence and severity of gingival recession when compared with the control group. Individuals with tongue piercings presented an 11 times greater chance for the occurrence of gingival recession in the anterior lingual mandibular region as compared with controls (OR=11.0, 95% CI 5.02-24.09). The presence of gingival recession in the anterior lingual mandibular region was associated with the use of piercings, age, male gender and bleeding on probing. CONCLUSIONS The use of tongue piercings was strongly associated with the occurrence of gingival recession in the anterior lingual mandibular region.

Tooth loss in individuals under periodontal maintenance therapy: prospective study

This prospective study aimed to evaluate the incidence, the underlying reasons, and the influence of predictors of risk for the occurrence of tooth loss (TL) in a program of Periodontal Maintenance Therapy (PMT). The sample was composed of 150 complier individuals diagnosed with chronic moderate-severe periodontitis who had finished active periodontal treatment and were incorporated in a program of PMT. Social, demographic, behavioral and biological variables were collected at quarterly recalls, over a 12-month period. The effect of predictors of risk of and confounding for the dependent variable TL was tested by univariate and multivariate analysis, as well as the underlying reasons and the types of teeth lost. During the monitoring period, there was a considerable improvement in periodontal clinical parameters, with a stability of periodontal status in the majority of individuals. Twenty-eight subjects (18.66%) had TL, totaling 47 lost teeth (1.4%). The underlying reasons for TL were: periodontal disease (n = 34, 72.3%), caries (n = 3, 6.4%), prosthetic reasons (n = 9, 19.2%), and endodontic reasons (n = 1, 2.1%). Additionally, subjects with 10% of sites with probing depth between 4 and 6 mm were 5 times more likely to present TL (OR = 5.13, 95% CI 2.04-12.09). In this study, the incidence of TL was small and limited to few individuals. Additionally, gender and severity of periodontitis were significantly associated with TL during the monitoring period.