Patrícia Garcia de Moura-Grec

Intraoral distalizer effects with conventional and skeletal anchorage: a meta-analysis.

INTRODUCTION The aims of this meta-analysis were to quantify and to compare the amounts of distalization and anchorage loss of conventional and skeletal anchorage methods in the correction of Class II malocclusion with intraoral distalizers. METHODS The literature was searched through 5 electronic databases, and inclusion criteria were applied. Articles that presented pretreatment and posttreatment cephalometric values were preferred. Quality assessments of the studies were performed. The averages and standard deviations of molar and premolar effects were extracted from the studies to perform a meta-analysis. RESULTS After applying the inclusion and exclusion criteria, 40 studies were included in the systematic review. After the quality analysis, 2 articles were classified as high quality, 27 as medium quality, and 11 as low quality. For the meta-analysis, 6 studies were included, and they showed average molar distalization amounts of 3.34 mm with conventional anchorage and 5.10 mm with skeletal anchorage. The meta-analysis of premolar movement showed estimates of combined effects of 2.30 mm (mesialization) in studies with conventional anchorage and -4.01 mm (distalization) in studies with skeletal anchorage. CONCLUSIONS There was scientific evidence that both anchorage systems are effective for distalization; however, with skeletal anchorage, there was no anchorage loss when direct anchorage was used.

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.

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.

Oral manifestations in HIV+ children in Mozambique

The scope of this study was to identify the prevalence of oral manifestations in HIV+/AIDS patients at the DIA Pediatric Hospital of Maputo. All 90 patients were included in the research. Data on dental caries (dmft/DMFT index), soft tissues and saliva flow were analyzed. Information on diet and hygienic habits was obtained in a semi-structured questionnaire. The t- student and chi-square tests were used for statistical assessment. The most frequent oral lesion was candidiasis (5.5%) and upon further oral examination the prevalence of parotid enlargement was 23.0%. The mean dmft 2.6 (SD 3.6) was considerably higher in relation to DMFT of 0.6 (SD 1.6), and the differences between them were statistically significant (P<0.05). The occurrence of mucosal lesions was higher in children who did not take antiretroviral therapy (ART) (p = 0.026). The use of ART is associated with reduced prevalence of oral lesions in HIV+ patients; however, rampant caries were highest in this group. Primary dentition of HIV+ patients should be considered high risk for caries.O objetivo deste estudo foi identificar a prevalencia das manifestacoes bucais em pacientes HIV+/SIDA do Hospital Pediatrico DIA de Maputo. Foram incluidos 90 pacientes na pesquisa. Carie dentaria (indice ceod/CPOD), mucosa e fluxo salivar foram avaliados. Informacoes sobre alimentacao e habitos de higiene bucal foram obtidas por meio de um questionario. Para a analise estatistica foram utilizados os testes t-student e qui-quadrado. A lesao oral mais frequente foi a candidiase (5,5%) e no exame extra-oral foi observada uma prevalencia de alargamento da parotida de 23%. A media do ceod foi 2,6 (± 3,6) dentes, consideravelmente alta em relacao ao CPOD que foi de 0,6 (±1,6) dentes, sendo esta diferenca estatisticamente significante (p<0,05). A ocorrencia de lesoes na mucosa bucal foi maior em criancas que nao faziam uso da terapia antiretroviral (TRA). O uso da TRA esteve associado com a reducao da prevalencia de lesoes bucais em pacientes HIV+, contudo caries rampantes foram maiores neste grupo. Pacientes HIV+ mostraram maior risco de caries na dentadura decidua.

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

INTRODUCAO: O controle da obesidade morbida pode ser realizado atraves da cirurgia bariatrica que leva a restricao e/ou a ma-absorcao de alimentos. O objetivo dessa revisao foi identificar consequencias desse procedimento e suas repercussoes na saude bucal. METODO: Foi realizada busca na Biblioteca Virtual em Saude, sendo incluidos artigos com relacao direta ou indireta entre cirurgia bariatrica e saude bucal e publicados nos ultimos dez anos. RESULTADOS: Verificaram-se algumas complicacoes decorrentes dessa operacao, como regurgitacao cronica e deficiencias nutricionais, que podem trazer repercussoes na cavidade bucal como erosao dentaria, perda ossea e carie dentaria. Por outro lado, existem consequencias positivas como controle da diabetes, da apneia e melhora da auto-estima, que tornam os pacientes menos susceptiveis a complicacoes na cavidade oral, como xerostomia e doenca periodontal. CONCLUSAO: A manutencao da saude bucal adequada em pacientes submetidos a cirurgia bariatrica contribui para o sucesso apos a operacao, resguardando os beneficios e minimizando os efeitos colaterais.

Periodontal status and pathogenic bacteria after gastric bypass: a cohort study

AIM The aim this study was to evaluate the influence of gastric bypass surgery (GBS) on periodontal disease and quantify the periodontopathogenic bacteria in patients undergoing this surgery. MATERIAL AND METHODS This prospective study was composed of 50 patients who underwent bariatric surgery and the data collection was performed in three periods pre-operative, 6 (6M) and 12 months (12 M) postoperative. The oral clinical examination to assess periodontal disease; gingival fluid sample collection for quantification of the periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia using q-PCR; body mass index (BMI) and for collection of the individuals health-related data from medical files. RESULTS There was a significant reduction in serum C-reactive protein (CRP) and glucose levels after surgery. The mean probing pocket depth (PPD) and clinical attachment level (CAL) increased significantly in the postoperative period of 6 months (p = 0.001). In the same period, the amount of P. gingivalis increased (p = 0.028) and the other bacteria decreased slightly (p > 0.050). In the presence of P. gingivalis, T. forsythia, T. denticola and P. intermedia, a poor periodontal condition was observed. CONCLUSION The periodontal disease increased in severity and P. gingivalis increased after GBS. A systemic inflammation resolution due to bariatric surgery in obese subjects does not seem to affect the course of periodontal disease.

Assessment of Oral Conditions and Quality of Life in Morbid Obese and Normal Weight Individuals: A Cross-Sectional Study

The aim of this study was to identify the impact of oral disease on the quality of life of morbid obese and normal weight individuals. Cohort was composed of 100 morbid-obese and 50 normal-weight subjects. Dental caries, community periodontal index, gingival bleeding on probing (BOP), calculus, probing pocket depth, clinical attachment level, dental wear, stimulated salivary flow, and salivary pH were used to evaluate oral diseases. Socioeconomic and the oral impacts on daily performances (OIDP) questionnaires showed the quality of life in both groups. Unpaired Student, Fisher’s Exact, Chi-Square, Mann-Whitney, and Multiple Regression tests were used (p<0.05). Obese showed lower socio-economic level than control group, but no differences were found considering OIDP. No significant differences were observed between groups considering the number of absent teeth, bruxism, difficult mastication, calculus, initial caries lesion, and caries. However, saliva flow was low, and the salivary pH was changed in the obese group. Enamel wear was lower and dentine wear was higher in obese. More BOP, insertion loss, and periodontal pocket, especially the deeper ones, were found in obese subjects. The regression model showed gender, smoking, salivary pH, socio-economic level, periodontal pocket, and periodontal insertion loss significantly associated to obesity. However, both OIDP and BOP did not show significant contribution to the model. The quality of life of morbid obese was more negatively influenced by oral disease and socio-economic factors than in normal weight subjects.

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.

Manifestações bucais em pacientes portadores de Diabetes Mellitus: uma revisão sistemática

PURPOSE: The aim of this study was to systematically review studies on the association between diabetes mellitus and oral manifestations. METHOD: The methods applied include a literature search strategy, inclusion and exclusion criteria for selecting the studies, characteristics of the studies were adopted. Data bases included PubMed, SciElo, BBO and LILACS until September 2011. Selected articles were related to clinical studies investigating whether or not there is an association between diabetes mellitus and oral manifestations, excluding periodontal disease. RESULT: Of the 1164 studies identified, 30 of them remained in the study due the inclusion criteria. The oral manifestations were associated with diabetes mellitus in 20 studies. The diseases candidiasis, hypossalivation, oral lichen planus, dentadure stomatitis and tongue lesions were related. CONCLUSION: Patients with diabetes mellitus are more susceptible to the candidiasis and hypossalivation, which in turn may exacerbate other oral health conditions.

Nutritional status, tooth wear and quality of life in Brazilian schoolchildren

OBJECTIVE To evaluate the correlation among nutritional status, tooth wear and quality of life in Brazilian schoolchildren. DESIGN The study followed a cross-sectional design. Nutritional status was measured via anthropometry using BMI and tooth wear was measured using the Dental Wear Index; both these assessments were carried out by a trained recorder according to standard criteria. A modified version of the Child Oral Impacts on Daily Performances was used to assess quality of life. SETTING City of Bauru, in Brazil. SUBJECTS A cluster sample of 396 schoolchildren (194 boys and 202 girls) aged 7-10 years. RESULTS The anthropometric assessment showed similar situations for both sexes regarding underweight (31·40 % in boys and 30·20 % in girls) and overweight/obesity (33·96 % in boys and 33·17 % in girls). The underweight children showed a greater severity of tooth wear in the primary teeth (OR=0·72; CI 0·36, 1·42), although in the permanent dentition the obese children had a greater severity of tooth wear (OR=1·42; 95 % CI 0·31, 6·55). The tooth wear was correlated with age for both dentitions. CONCLUSIONS Tooth wear in the primary and permanent dentition may be related to nutritional status. Tooth wear and obesity did not have a significant impact on the schoolchildrens perception of quality of life.