Valeria Ramírez

Increased inflammatory biomarkers in early pregnancy is associated with the development of pre-eclampsia in patients with periodontitis: a case control study

AIM(S) To explore the relationship between biomarkers of systemic inflammation in plasma and gingival crevicular fluid in early pregnancy and the subsequent development of pre-eclampsia in patients with periodontitis. MATERIALS AND METHODS A case-control study was performed. From a cohort composed of 126 pregnant women, 43 normotensive healthy pregnant women were randomly selected, and 11 cases of preeclampsia were identified. Plasmatic and gingival crevicular fluid (GCF) samples were collected in early pregnancy (11-14 wk gestation). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were measured in the plasma and GCF samples, whereas the level of C-reactive protein (CRP) was measured in plasma samples. Biomarkers were determined by ELISA assays. The data were analysed using descriptive statistics, and the association between variables was estimated through logistic regression models. RESULTS There was observed an association between pre-eclampsia and plasmatic levels of CRP (OR: 1.07; p = 0.003). Additionally, pre-eclampsia also was associated with IL-6 levels in GCF samples in early pregnancy (OR: 1.05; p = 0.039). A multiple logistic regression model suggests that increased levels of IL-6 in GCF (OR = 1.06; p = 0.02; CI 95% 1.007-1.117) in early pregnancy increase the risk of developing pre-eclampsia. CONCLUSION(S) Pregnant women with periodontitis who later development pre-eclampsia, shows increased levels of IL-6 in GCF and CRP in plasma during early pregnancy. Periodontal disease could contribute to systemic inflammation in early pregnancy via a local increase of IL-6 and the systemic elevation of CRP. Therefore, both inflammatory markers could be involved in the relationship between periodontal disease and pre-eclampsia.

Short-term effects of 2% atorvastatin dentifrice as an adjunct to periodontal therapy: a randomized double-masked clinical trial.

BACKGROUND The pleiotropic effects of statins, such as immunomodulation and anti-inflammatory effects, may also improve periodontal conditions. The aim of the present study is to assess the effectiveness of a dentifrice medicated with 2% atorvastatin in improving clinical periodontal parameters as a complement to non-surgical periodontal treatment (NSPT). METHODS A randomized, double-masked clinical trial was performed with two parallel groups: 1) atorvastatin group (NSPT plus medicated 2% atorvastatin dentifrice) and 2) placebo group (NSPT plus placebo dentifrice). The effectiveness of these treatments was assessed using periodontal measurements obtained at baseline and 1 month later. The measurements were probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and periodontal inflamed surface area (PISA). Multiple linear regression models were used to compare outcome variables after adjusting for sex, diabetes, and tobacco use. RESULTS A total of 36 individuals participated in this study (atorvastatin group, n = 18; placebo group, n = 18). Both groups showed improvements in periodontal parameters. The atorvastatin group showed a decrease of 297.63 mm(2) in PISA (95% confidence interval = 76.04 to 519.23; P = 0.01), which was significantly greater than the reduction observed in the placebo group. There was also a significantly greater reduction in mean PD, percentage of sites with PD ≥5 mm, mean CAL, percentage of sites with CAL ≥5 mm, BOP, and GI in the atorvastatin group compared with the placebo group. CONCLUSION NSPT plus 2% atorvastatin medicated dentifrice was more effective in improving clinical periodontal parameters than NSPT plus a placebo dentifrice.

Direct Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate, and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial

Introduction Direct pulp capping treatment is intended to preserve pulp vitality, to avoid or retard root canal treatment, and, in cases with an open apex, to allow continued root development. Historically, calcium hydroxide (CH) was the gold standard material, but nowadays calcium silicate materials (CSMs) are displacing CH because of their high bioactivity, biocompatibility, sealing ability, and mechanical properties. However, more randomized clinical trials are needed to confirm the appropriateness of CSMs as replacement materials for CH in direct pulp capping procedures. Methods A randomized clinical trial was conducted that included 169 patients (mean age, 11.3 years) from the Maipo district (Chile). The inclusion criterion was patients with 1 carious permanent tooth with pulpal exposure, a candidate for a direct pulp capping procedure. The patients were randomly allocated to one of the experimental groups (CH, Biodentine, or mineral trioxide aggregate [MTA]). Clinical follow‐up examinations were performed at 1 week, 3 months, 6 months, and 1 year. The Fisher exact test was performed. Results At the follow‐up examination at 1 week, the patients showed 100% clinical success. At 3 months, there was 1 failure in the CH group. At 6 months, there were 4 new failures (1 in the CH group and 3 in the MTA group). At 1 year, there was another failure in the CH group. There were no statistically significant differences among the experimental groups. Conclusions CSMs appear to be suitable materials to replace CH. Although no significant differences were found among the materials studied, Biodentine and MTA offered some advantages over CH. HighlightsThis trial compared the efficacy of calcium hydroxide, MTA, and Biodentine as pulp capping materials in young permanent molars.MTA and Biodentine are suitable materials to replace calcium hydroxide in pulp capping procedures.Pulp capping in carious teeth is a successful treatment when done under good clinical protocol.

Placental biomarkers and angiogenic factors in oral fluids of patients with preeclampsia

The objectives of this study are to explore the feasibility of measuring endothelial and placental biomarkers in saliva and gingival crevicular fluid (GCF) and to determine if patients with preeclampsia (PE) have a different profile of these biomarkers in oral fluids.

Trends and Most Frequent Methods of Suicide in Chile Between 2001 and 2010

BACKGROUND Despite the many studies trying to evaluate the magnitude of suicide in Chile, none of them include the new valid data, recently published by the DEIS of the Chilean Health Ministry. AIM This paper sought to describe how suicide rates changed among Chileans who were at least 15 years of age during the period of 2001-2010; these rates were stratified by sex, age, urban/rural status, and region of the country. METHOD An exploratory and temporal study was conducted. Suicide mortality rates were calculated by collecting information from the Chilean Ministry of Healths death registry between 2001 and 2010 among subjects who were at least 15 years of age. Crude and age-adjusted mortality rates were computed. RESULTS The standardized suicide rate in Chile during 2001-2010 was 14.7 deaths per 100,000, the highest in South America. The minimum age-adjusted suicide rate observed during the examined period was 13.49 per 100,000 in 2005, and the maximum, 16.67 per 100,000 in 2008. Suicide rates among men were up to 4.8 times the suicide rates among women. In addition, rates in rural areas were double compared with urban areas. Hanging was the most common suicide method, followed by use of firearms and explosives in men and poisoning in women. Finally, there was a progressive increase in suicide rates in the southernmost regions of the country. CONCLUSION Suicide rates in Chile are relatively high among male subjects in rural areas. There is a disturbing increase in suicide rates among younger individuals and women, although these rates remain lower among younger individuals and women than among adults in general.

Effect of tongue position on masseter and temporalis electromyographic activity during swallowing and maximal voluntary clenching: a cross-sectional study

The purpose of this study was to measure and compare the tonic electromyographic (EMG) activity of the temporalis and masseter muscles following placement of the tongue either on the palate or in the floor of the mouth during swallowing and maximal voluntary clenching (MVC). Thirty healthy dental students with natural dentition and bilateral molar support, between the ages of 18 and 22, with no prior history of oro-facial injury, or current or past pain in the jaw, mouth or tongue participated in the study. Tonic masseter and temporalis EMG activities were recorded using surface electrodes. Subjects were instructed to passively place the tongue either on the anterior hard palate or in the floor of the mouth during swallowing and MVC. At each tongue position, the resulting EMG was recorded. During swallowing, no significant difference in EMG activity was found either for the masseter (P-value = 0.1592) or the temporalis (P-value = 0.0546) muscles, regardless of the tongue position. During MVC, there was a statistically significant difference for both the masseter (P-value = 0.0016) and the temporalis (P-value = 0.0277) muscles with lower levels recorded with the tongue in the floor of the mouth. This study found that in normal, pain-free subjects, placing the tongue in the floor of the mouth significantly reduces masticatory muscle activity during MVC. Thus, it may be considered as a possible therapeutic option to decrease masticatory muscle activity; however, further research is needed in patients with oro-facial pain.

Root and canal morphology of mandibular premolars using cone-beam computed tomography in a Chilean and Belgian subpopulation: a cross-sectional study

ObjectiveTo describe mandibular premolar root and canal morphology and its variability in Chilean and Belgian samples using cone-beam computed tomography.MethodsA cross-sectional and descriptive study was conducted. A total of 402 mandibular premolars were examined using cone-beam computed tomography images of Chilean and Belgian patients. Premolars that met the inclusion criteria were studied in relation to the number of roots, number of canals, root canal configuration, presence of C-shaped configuration, tooth length, and root length.ResultsThe mandibular first premolar frequently presented with one root (94% Chilean; 100% Belgian), as did the mandibular second premolar (99% Chilean; 98% Belgian). One canal was present in 69% of Chilean, and 83% of Belgian mandibular first premolars, and in 95% of Chilean and 91% of Belgian second premolars. A type I root canal configuration was found in 69% of Chilean and 83% of Belgian first premolars and in 95% of Chilean and 92% of Belgian second premolars.ConclusionsThe anatomical parameters analyzed in the Chilean and Belgian samples are similar. However, it should be noted that there are anatomical variations in mandibular premolars.

Effect of Mechanical Debridement on Distal Periodontal Aspects of Second Molars After the Extraction of Third Molars: A Systematic Review

BACKGROUND The risk of periodontal defects after the extraction of third molars continues to challenge clinicians. METHODS Intervention trials, including subgingival scaling and/or root planing, were systematically reviewed. Data sources included the Cochrane Oral Health Group Trials Register and MEDLINE. The primary outcome was postoperative change in pocket probing depth (PD). RESULTS The electronic search yielded 751 abstracts, and manual searching added one study. From them, four trials fulfilled the inclusion criteria and were selected for review. The overall sample size of the studies was small, ranging from 15 to 30 participants. Only one trial was considered to present with low risk for bias in the sequence generation, the concealment of allocation to treatment, and the strategy for masking. The lack of information provided by the authors of the remaining studies resulted in unclear or high risk of bias for the chief dimensions of trial quality. The heterogeneity of the studies did not allow the use of meta-analysis to summarize the results of several studies. Preliminary evidence originating from a small study suggests that ultrasonic root debridement of the second molar and a three-visit plaque control program may have a beneficial effect on PD levels on the second molar. CONCLUSION The available intervention trials on this topic have important limitations, and, consequently, there is insufficient evidence to recommend the use of mechanical debridement of second molars after the extraction of third molars.

Comparison of clinical and electromyographic rest vertical dimensions in dolichofacial and brachyfacial young adults: A cross-sectional study

Statement of problem. Therapeutic procedures that increase occlusal vertical dimension (OVD) may have different responses in patients with different craniofacial vertical patterns. The effect on these patients of increasing their OVD is not well understood. Purpose. The purpose of this clinical study was to compare measurements of vertical jaw separation (VJS) in patients with brachyfacial and dolichofacial craniofacial patterns in 2 vertical dimensions: the clinical rest/postural vertical dimension (CR/PVD) and electromyographic rest vertical dimension (EMGRVD). Material and methods. Sixty healthy dental students were selected at random after a lateral skull radiograph was made. The Ricketts (VERT index) analysis was used to determine 30 brachyfacial (G1) and 30 dolichofacial (G2) types. The VJS was measured for G1 and G2 types in the 2 rest vertical dimensions specified. CR/PVD was recorded using 2 methods: swallowing (CR/PVD‐P1) and the phonetic breathing method (CR/PVD‐P2). The Shapiro‐Wilk test was used for data distribution, and the Mann‐Whitney U test was used to accept or reject the null hypothesis (&agr;=.05). Results. Mean VJS in CR/PVD‐P1 was 1.92 ±1.14 mm for the brachyfacial and 1.36 ±0.58 mm for the dolichofacial facial group (P=.05). The mean VJS in CR/PVD‐P2 was 1.89 ±1.17 mm for the brachyfacial and 1.31 ±0.58 mm for the dolichofacial group (P=.03). The mean VJS in EMGRVD was 8.23 ±2.21 mm for the brachyfacial and 16.55 ±4.29 mm the dolichofacial group (P<.001). Conclusions. CR/PVD measurements in dolichofacial individuals were lower than those in brachyfacial individuals. EMGRVD measurements were higher in dolichofacial individuals than those in brachyfacial individuals. Biomechanical, physiological, and behavioral reasons might explain such diversity.

Definition of aggressive periodontitis in periodontal research. A systematic review

Since its introduction in 1999, the term aggressive periodontitis (AgP) has been the topic of many investigations. Articles supporting the International Workshop for a Classification of Periodontal Diseases list several disease features, but do not offer operational criteria for identifying cases. Consequently, considerable variation in the understanding of AgP can be anticipated. AIM To systematically assess the definitions of AgP reported in original periodontal research. METHODS A systematic review of original research on AgP published in English. RESULTS The electronic search yielded 833 abstracts. Of these, 472 publications fulfilled the inclusion criteria and were appraised. In 26.5% of the publications, no information on AgP operationalization is presented, but reference is made to another article. In 12.7% of the publications, no information is provided as to how the cases were defined. Many combinations of criteria for case definition were found. CONCLUSIONS This study revealed significant heterogeneity in the understanding and use of the term AgP in original research and poor documentation of the identification of cases. The direction and magnitude of the influence of misclassification and selection bias are unknown, but ought to be considered by the critical reader, professionals and patients using this term.