Sasa Cakic

The Association Between Periodontal Inflammation and Labor Triggers (Elevated Cytokine Levels) in Preterm Birth: A Cross-Sectional Study

BACKGROUND Periodontitis is considered to be a risk factor for preterm birth. Mechanisms have been proposed for this pathologic relation, but the exact pathologic pattern remains unclear. Therefore, the objective of the present study is to evaluate levels of four major labor triggers, prostaglandin E2 (PGE2), interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, in gingival crevicular fluid (GCF) and serum samples between women with preterm birth (PTB) and full-term birth (FTB) and correlate them with periodontal parameters. METHODS PGE2, IL-1β, IL-6, and TNF-α levels were estimated using enzyme-linked immunosorbent assays in GCF and serum samples collected 24 to 48 hours after labor from 120 women (60 FTB, 60 PTB). RESULTS Women with PTB exhibited significantly more periodontitis, worse periodontal parameters, and increased GCF levels of IL-6 and PGE2 compared with the FTB group; there were no significant differences in serum levels of measured markers. GCF levels of IL-1β, IL-6, and PGE2 and serum levels of TNF-α and PGE2 were significantly higher in women with periodontitis compared with periodontally healthy women. Serum levels of PGE2 were positively correlated with probing depth (PD) and clinical attachment level (CAL) as well as with GCF levels of TNF-α in women with PTB. CONCLUSIONS Women with PTB demonstrated worse periodontal parameters and significantly increased GCF levels of IL-6 and PGE2 compared with those with FTB. Based on significant correlations among serum PGE2 and PD, CAL, and GCF TNF-α in PTB, periodontitis may cause an overall increase of labor triggers and hence contribute to preterm labor onset.

The role of specific cow's milk proteins in the etiology of recurrent aphthous ulcers.

BACKGROUND Recurrent aphthous ulcerations (RAU), or recurrent aphthous stomatitis, is recognized as one of the most common oral mucosal diseases worldwide. It was noted some connection between immunity to cows milk proteins (CMP) and oral diseases. The goal of this study was to determine the prevalence of the increased levels of serum antibodies to specific cows milk proteins (SCMP), constituents of cheese or of whey, by enzyme-linked immunosorbent assay (ELISA) test, in subjects who have RAU. METHODS Fifty subjects with RAU and 50 healthy people, as controls (C), were included in this research. Levels of serum IgA, IgG, and IgE antibodies to SCMP were determined by ELISA. The statistical analysis of data was performed by Wilcoxon rank sum test with continuity correction. RESULTS The levels of serum anti-SCMP IgA, IgG, and IgE antibodies were significantly higher in subjects with RAU in comparison with controls (P < 0.005). CONCLUSIONS These results indicate the strong association between high levels of serum anti-SCMP IgA, IgG, and IgE antibodies, especially to caseins: α-, β-, and κ-casein from cows milk and clinical manifestations of RAU. Serum immunity to the whey proteins in subjects with RAU was not in so high percentage expressed.

Clinical application of autologous fibroblast cell culture in gingival recession treatment

BACKGROUND AND OBJECTIVE Gingival recession is defined as soft and hard tissue displacement resulting in root surface exposure. The optimal outcome of gingival recession treatment is complete, predictable and long-lasting root coverage with a significant level of tissue regeneration. Tissue engineering, which applies active regeneration principles, presents the contemporary treatment approach in the restitution and regeneration of lost tissues. The objective of the present study was to evaluate and compare the clinical results of application of an autologous fibroblast cell culture (AFCC) on a collagen matrix and a connective tissue graft (CTG) placed under a coronally advanced flap (CAF), in the treatment of single and multiple gingival recessions. MATERIAL AND METHODS Eighteen patients from the Department of Periodontology, School of Dentistry, University of Belgrade, were randomly enrolled in this study. Inclusion criteria were the bilateral presence of Miller Class I or II single or multiple maxillary gingival recessions. A split-mouth design was used in the study. The experimental group was treated with AFCC on a collagen scaffold, which was placed under a CAF. The control group received a combination of CTG and CAF. Clinical parameters such as gingival recession coverage, keratinized tissue width, clinical attachment level and gingival index were recorded at baseline and at 12 mo postoperatively. The oral hygiene level was assessed by plaque index evaluation. Postoperative healing was evaluated through the healing index, recorded 1, 2 and 3 wk postoperatively. The final esthetic outcome was assessed using the mean root coverage esthetic score (RES). RESULTS Statistically significant improvement of all parameters assessed was found compared with baseline. A statistically significant difference between groups was observed only in keratinized tissue width. Greater keratinized tissue width is still obtained with the use of CTG. Regarding the tissue-healing results, no statistically significant difference was achieved. The RES results were similar for both groups. CONCLUSIONS Within the limitations of the present study, both procedures proved to be efficient in gingival recession treatment. AFCC, as a novel tissue-engineering concept and living cell-based therapy, proved to be a reliable and successful treatment concept.

Circulating immune complexes, immunoglobulin G, salivary proteins and salivary immunoglobulin A in patients with Sjögren's syndrome

INTRODUCTION Sjögrens syndrome (SS) is a chronic autoimmune disorder, with its major clinical manifestations resulting from changes in exocrine glands. OBJECTIVE The aim of this study was to evaluate serum concentrations of circulating immune complexes (CIC) and immunoglobulin G (IgG), and salivary proteins (SP) and salivary immunoglobulin A (slgA) in 40 patients with SS, and to correlate these values among themselves, as well as with the unstimulated salivary flow rate (USFR) and the duration of disease. METHODS The total of 40 patients were included in this research. CIC was determined using the solution of polyethylene glycol and IgG with the standard procedure of radial immunodiffusion. SP was investigated by the method of Lowry and slgA was separated from the whole saliva using the method of immune chromatography. RESULTS The values of most of the studied parameters exceeded the normal range in a high degree: CIC 72.5%, IgG 70%, SP 80%. The concentrations of CIC were significantly higher in the patients with the duration of disease less than 10 years. With the decrease of USFR, the concentration of slgA and IgG were increased with statistical significance. CONCLUSION The increased prevalence of abnormal values of CIC, IgG and SP indicate that the patients with SS have developed a higher level of immune reactivity. These results could be useful in diagnosis and disease activity monitoring.

Gingival crevicular fluid in the diagnosis of periodontal and systemic diseases

Gingival crevicular fluid (GCF) can be found in the physiologic space (gingival sulcus), as well as in the pathological space (gingival pocket or periodontal pocket) between the gums and teeth. In the first case it is a transudate, in the second an exudate. The constituents of GCF originate from serum, gingival tissues, and from both bacterial and host response cells present in the aforementioned spaces and the surrounding tissues. The collection and analysis of GCF are the noninvasive methods for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers, such as prostaglandin E2, neutrophil elastase and beta-glucuronidase, and on the marker of cellular necrosis-aspartat aminotransferase. Further, the analysis of inflammatory markers in the GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease, and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases). Major factors which influence the results obtained from the analyses of GCF are not only the methods of these analyses, but the method of GCF collection as well. As saliva collection is less technique-sensitive than GCF collection, some constituents of saliva which originate from the GCF can be analysed as more amenable to chairside utilization.

Assessment of risk factors and preventive measures and their relations to work-related musculoskeletal pain among dentists

BACKGROUND Dentists have a high prevalence of musculoskeletal (MS) pain, which is the most common symptom associated with work-related musculoskeletal disorders (WMSDs). To overcome this problem, identification of the risk factors and preventive measures for MS pain are of paramount importance to dentists in order to improve their quality of life and work. OBJECTIVES The aims of this study were to recognize the risk factors for MS pain and their impact on dental work, as well as to identify preventive measures of MS pain among dentists. METHODS Self-reporting questionnaire consisting of 78 questions was exclusively developed for the study and sent to 500 working active dentists in Serbia. RESULTS Response rate was 71.2% (356 dentists). The prevalence of MS pain was 82.6% among dentists. The main risk factors for MS pain were advanced age, female dentists, presence of chronic diseases, long working hours, and high frequency of treated patients. The most effective preventive measures in preventing MS pain were massage treatments and physical activities. Followed by use of ergonomically designed equipment, correct and dynamic working positions, and an adequate workflow organization. CONCLUSION The risk factors for MS pain and their impact on dental work should widely be disseminated among dentists. Importantly, proper implementation in everyday life of adequate preventive measures is essential for preventing MS pain and development of WMSDs.

Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis

Abstract Objective: The aim of this study was to evaluate clinical efficacy of different chlorhexidine gluconate (CHX) preparations applied subgingivally as an adjunct to scaling and root planing (SRP). Material and methods: A total of 120 periodontal pockets was included in this randomized, controlled, split mouth designed study. According to protocols used in treatment, periodontal pockets were assigned to experimental and control groups as follows: CHX solution as an addition to SRP versus control SRP group; CHX gel as an addition to SRP versus control SRP; CHX chip as an addition to SRP versus control SRP group. Following clinical parameters were recorded at baseline, one and three months after the baseline: plaque index (PI), probing pocket depth (PPD), bleeding index (BI) and clinical attachment level (CAL). Results: The most significant improvements were found concerning PI in CHX solution with SRP and CHX gel with SRP groups over controls at one month recall, as well as concerning BI and PPD in CHX chip with SRP group over SRP alone at three-month recall. Conclusion: Results of this study favour combination therapy using CHX chip as an adjunct to SRP due to greater improvements in BI and PPD compared to those obtained by SRP alone in the treatment of chronic periodontitis.

Clinical study on the influence of hydroxyapatite on apexogenesis in monkeys.

Management of the affected pulp in teeth with incomplete root formation is still an issue. Calcium hydroxide and other materials have been employed for this purpose to a greater or lesser success. Bioceramic materials are in the last decades well established in a number of different medical fields. Having its constituents the same as those of the unorganic portion of bone tissue, hydroxiapatite (HAP), one of the two forms of calcium-phosphate ceramics, is already accepted in endodontic treatment of teeth with completed root formation. The aim of this study was to examine apexogenesis in teeth with immature roots, following the use of HAP on their affected pulp. Examination was performed on eight young monkeys (Cercopithecus Aethiops) with incomplete root development. The 100 _m synthetic HAP material was applied on 32 teeth divided into two groups of 16 teeth each. In one group teeth underwent pulpotomy, in the other high pulpotomy. Evaluation of root growth was recorded from radiographs (pre-treatment, 3 and 12 months following treatment) and by Demjrians scale for dental maturity and tooth age determination. On the basis of radiographic analysis, immature teeth with affected pulp treated with HAP, both with pulpotomy and high pulpotomy, reached the same stage of root development as control teeth in 50% of cases at 3-months radiographic assessment. After 12 months all tested teeth had the same rate of root development as control teeth, except for 1 of 8 with high pulpotomy. Dentinal bridge was radiographically visible in 50% and 87.5% of pulpotomized teeth after 3 and 12 months, respectively. Neither obliteration of the root canal, presence of denticles nor the presence of deformities in the periapical region were found in any of the observed teeth.

Oral Symptoms and Mucosal Lesions in Patients with Diabetes Mellitus Type 2

Summary Background: Good glycoregulation at patients with diabetes mellitus is essential for prevention of many complications, including those in oral cavity. Results of numerous studies indicate that xerostomia and neurosensory oral disorders are present in type 2 diabetics. A review of the literature shows contradictory results about prevalence of oral mucosal lesions in diabetics. The aim of this study was to evaluate the presence of xerostomia, neurosensory disorders and mucosal lesions in oral cavity of type 2 diabetics. Material and Methods: This study involved 90 adults, 60 with type 2 diabetes and 30 healthy subjects, aged 45-65 years. With regard to value of HbA1c level diabetics were divided into two groups: 30 subjects with satisfactory glycoregulation (HbA1c<9%) and 30 subjects with poor glycoregulation (HbA1c≥9%). All patients recruited into the study completed a questionnaire that included their demographic, medical and oral health data. Clinical examination of the oral mucosa was performed by a single examiner. Results: In relation to the presence of xerostomia and dysgeusia between satisfactory controlled diabetics and healthy subjects a significant difference was observed (p<0.05). Compared with healthy subjects, poor controlled diabetics had significantly higher presence of xerostomia (p<0.001) and neurosensory disoders (p<0.05). A higher prevalence of oral mucosal lesions was found in poor controlled diabetics, but significant difference between groups was not observed (p>0.05). A significant positive correlation was revealed between smoking and glossodynia as well as smoking and glossopyrosis (p>0.05). Conclusion: Glycemic control level seems to influence the susceptibility of type 2 diabetics to xerostomia and neurosensory disorders. Less clear is whether diabetes are corellated to oral mucosal lesions.