M. Conceição Manso

Periodontitis and atherosclerosis: an observational study

BACKGROUND Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort. METHODS Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe. RESULTS The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis (P = 0.007). CONCLUSION This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.

A review of microbiological root canal sampling: updating an emerging picture

Objectives: The significance of microorganisms in root canals with regard to the aetiology of periapical infection and the need for crucial bacteria control during treatment are undeniable. In this study, we re-port and discuss a review of the literature on Microbiological Root Canal Sampling (MRS). The procedure is analyzed in detail, discussing its powers, limitations and the influence of sample collection procedures on the incidence of true and false positive results. Data sources: MEDLINE/PUBMED, B-On and library files of Oporto University were accessed. Selection: Papers were selected using the keywords: “root ca¬nal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. The references were selected under inclusion criteria such as English language, accessibility, rel¬evance to the theme and scientific rigor. Conclusions: This review illustrated the absolute need to adhere to strict methodology procedures if valid samples are to be obtained. A combination of Culture and molecular identification approaches have confirmed the polymicrobial nature of endodontic infections with a pre¬dominance of anaerobic bacteria. Nucleic acid-based techniques provide significant additional information particularly regarding the not-yet-cultivable species of the microbial community, but greatly increase the budget of the procedure. Thus, assessment of the endodontic microflora, in the context of a polymicro¬bial biofilm ecosystem, and its relevance to endodontic treatments must rely in the complementariness of Culture and Metagenomics approaches as they are neither mutually exclusive nor competitive, but strongly complementary.