Renata Magalhães Cyrino

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.

Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines

BACKGROUND There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals not or occasionally using alcohol and those with alcohol dependence. The aim of this study is to determine the effect of alcohol consumption on the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) in the gingival fluid among individuals with and without periodontitis. METHODS This observational analytic study includes 88 volunteers allocated in four groups (n = 22): individuals with alcohol dependence and periodontitis (ADP), individuals with alcohol dependence and without periodontitis (ADNP), individuals not or occasionally using alcohol with periodontitis (NAP), and individuals not or occasionally using alcohol without periodontitis (NANP). Levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum were determined by real-time polymerase chain reaction on the basis of the subgingival biofilm, and IL-1β and TNF-α were quantified by enzyme-linked immunosorbent assay in gingival fluid samples. RESULTS Individuals with alcohol dependence showed worse periodontal status and higher levels of P. intermedia, E. corrodens, F. nucleatum, and IL-1β than non-users. No significant correlations between TNF-α and bacterial levels were observed. However, in the ADP group, higher levels of E. corrodens were correlated with higher levels of IL-1β. CONCLUSION A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies.

Very low and low birth weight associated with maternal periodontitis

AIM The aim of this study was to evaluate the association of very low and low birth weight (VLBW and LBW) with maternal periodontitis. MATERIAL AND METHODS Overall, 1206 women were examined at post-partum and two alternative criteria for periodontitis definition were used: (1) four or more teeth with at least one site with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 3 mm; and (2) at least one site with PD and CAL ≥ 4 mm. For each definition, two multivariate analyses were performed: (1) linear regression for birth weight; (2) ordinal logistic regression for birth weight, categorized as adequate (n = 1046), LBW (n = 145) and VLBW (n = 15). RESULTS Linear regression showed that maternal periodontitis was associated with a decrease in mean birth weight (periodontitis definition 1: p = 0.027; periodontitis definition 2: p = 0.003). Ordinal logistic regression showed that maternal periodontitis was associated with LBW and VLBW [odds ratio (OR) = 2.0; 95% confidence interval (CI) 1.39-2.90, when considering periodontitis definition 2]; and with LBW (OR = 1.65; 95% CI 1.15-2.36, when considering periodontitis definition 1). CONCLUSION Maternal periodontitis was associated with a decrease in mean birth weight, as well as with LBW and VLBW.

Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study.

Background and Objective Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. Materials and Methods A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. Results Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. Conclusions Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures.

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

Sense of coherence and periodontal health outcomes

Abstract Objective: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. Materials and methods: The study sample comprised 276 individuals, aged 18–60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24–46); (b) SOC2 = moderate (47–51); (c) SOC3 = strong (52–65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. Results: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). Conclusions: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.