Márlon Munhoz Montenegro

Análise quantitativa do palato duro em diferentes tipologias faciais de respiradores nasais e orais

PURPOSE: to compare the hard palate dimensions in nasal and mouth breathing children of different facial typologies. METHOD: the sample comprised 54 children between seven and 11 year old, divided in two groups according to the facial type and breathing mode. The facial type was obtained through the Ricketts cephalometric analysis, and the breathing mode was determined from speech-language evaluation and otorhynolaryngologic diagnosis. In order to measure the transverse, vertical and anteroposterior length of the hard palate, plaster cast models of the children superior dental arch were obtained. To get the hard palate dimensions among the groups, parametric and nonparametric tests were used under a significance level of 5%. RESULTS: no statistically significant difference was found in hard palate measures among brachyfacial, mesofacial and dolichofacial children. A significant statistical difference in the distance among the second premolars was identified when compared with the different facial types of nasal and mouth breathing children, and such a difference was not detected in multiple comparisons. CONCLUSION: the dimensions of the hard palate did not show any difference when analyzed in different facial types regardless of the breathing mode. However, when analyzing the facial type in nasal and mouth breathers, we found a difference in the distance among the second premolars.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Periodontal Status Affects C-Reactive Protein and Lipids in Patients With Stable Heart Disease From a Tertiary Care Cardiovascular Clinic

BACKGROUND There are scarce data on the impact of the periodontal condition in the control of biomarkers in patients with cardiovascular disease (CVD). The aim of this study is to assess whether periodontal inflammation and tissue breakdown are associated with C-reactive protein (CRP) and lipids in patients with stable heart disease. METHODS This cross-sectional study included 93 patients with stable coronary artery disease (57 males; mean age: 63.5 ± 9.8 years) who were in outpatient care for at least 6 months. After applying a structured questionnaire, periodontal examinations were performed by two calibrated periodontists in six sites per tooth at all teeth. Blood samples were collected from patients on the day of periodontal examination to determine levels of CRP, lipids, and glycated hemoglobin. Multiple linear regression models were fitted to evaluate the association among different periodontal and blood parameters controlling for sex, body mass index, glycated hemoglobin, use of oral hypoglycemic drugs, and smoking. RESULTS Overall, the sample presented high levels of periodontal inflammation and tissue breakdown. Unadjusted mean concentrations of triglycerides (TGs), very-low-density lipoprotein cholesterol, and glucose were significantly higher in individuals with severe periodontitis. When multiple linear regression models were applied, number of teeth with clinical attachment loss ≥6 mm and presence of severe periodontitis were significantly associated with higher CRP concentrations. Bleeding on probing was significantly associated with TGs, total cholesterol, and non-high-density lipoprotein cholesterol. CONCLUSION In this sample of patients with stable CVD, current periodontal inflammation and tissue breakdown are associated with cardiovascular inflammatory markers, such as CRP and lipid profile.

The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial

BackgroundScarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months.Methods/designThis is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1β, IL-6, TNFα, fibrinogen, ICAM-1, VCAM-1 and E-selectin. These outcomes will be assessed at all time points over 12 months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6 months after periodontal therapy.DiscussionThis trial will provide new evidence regarding the effect of periodontal treatment on risk markers for recurrence of cardiovascular events in stable coronary artery disease patients.Trial registration numberClinicalTrials.gov Identifier, NCT01609725

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

O gênero e a idade influenciam as dimensões do palato duro? Revisão sistemática da literatura

PURPOSE Analyze the influence of gender and age on hard palate dimensions and verify the reference parameters available in the literature. RESEARCH STRATEGIES Two reviewers independently performed a search at the Cochrane Library, PubMed-Medline and Web of Knowledge databases using descriptors according to the syntax rules of each database. SELECTION CRITERIA Observational or experimental human studies evaluating the dimensions of the hard palate or maxillary dental arch, with at least one transverse, vertical or sagittal plane measurement, in normal occlusions or class I malocclusions, and comparisons of the dimensions between genders and/or ages. DATA ANALYSIS Descriptive analysis with the following subdivisions: design, sample, evaluation instruments, measurements in millimeters, and statistical analysis. Quality of the included studies was verified by the Newcastle - Ottawa Quality scale. RESULTS Eighteen studies were selected and 11 presented results for hard palate or maxillary dental arch dimensions according to gender, six in age and gender and one in age only. CONCLUSION The dimensions were larger in males and progressive increase in the measurements was observed from birth to the permanent dentition period.

Impact of Periodontal Disease in the Lipid Profile of Patients With Chronic Coronary Artery Disease: a 3-Year, Retrospective Cohort

Mailing Address: Cassio Kampits Frederico Kops, 75. Postal Code: 96890-000, Centro, Sinimbu, Rio Grande do Sul, RS – Brazil E-mail: cassiokampits@gmail.com Impact of Periodontal Disease in the Lipid Profile of Patients With Chronic Coronary Artery Disease: a 3-Year, Retrospective Cohort Cassio Kampits, Cassiano K. Rösing, Marlon Munhoz Montenegro, Ingrid W. J. Ribeiro, Marco Aurelio Lumerts Saffi, Carisi A. Polanczyk, Mariana V. Furtado, Alex N. Haas Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS – Brazil