Clinical attachment loss in Chilean adult population: First Chilean National Dental Examination Survey

Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus

BACKGROUND AND OBJECTIVE

As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030.

METHODS

A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology.

RESULTS

Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology.

CONCLUSIONS

The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

The profile of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) in Rafsanjan City, southeast of Iran

Oral health status can be affected by some factors including drug abuse, systemic conditions and environmental pollutants. The present study was designed to investigate the most important and prevalent dental and oral conditions in adult population of Rafsanjan with the age of 35-70 years. Dental and oral health cohort center as part of the Rafsanjan Cohort Study (RCS) included in the prospective epidemiological research studies in IrAN was established in 2015. Of 9991 subjects enrolled in the RCS, 8682 people participated in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS). The OHBRCS included 4021 men and 4661 women with the mean age of 49.94 ± 9.51. The most prevalent of oral lesion in total population was candidiasis and the least was aphthous lesion. The prevalence of candidiasis, white and red lesions, periodontal pocket, dental calculus, CAL and the mean of DMFT were higher in the male group than that of female group (p < 0.05). Candidiasis, herpes, oral cancer, white and red lesions were more prevalent in the older age groups (p < 0.05). The mean of DMFT index in total population was 21.30 and was higher among opium users, men and older age (p < 0.05). Also, the opium users had a higher rate of CAL, periodontal pocket, red and white lesions, and candidiasis but a lower rate of BOP (p < 0.05). Younger people had more decayed and filling teeth compared to other age groups, whereas older people had more missing teeth and a higher DMFT index (p < 0.001).

Epidemiology of mid-buccal gingival recessions according to the 2018 Classification System in South America: Results from two population-based studies

AIM

The aim of this investigation was to estimate the prevalence, severity and extent of mid-buccal gingival recessions (GRs; classified according to the 2018 Classification System) and to identify their risk indicators in the South American population.

MATERIALS AND METHODS

Epidemiological data from two cross-sectional studies-performed on 1070 South American adolescents and 1456 Chilean adults-were obtained. All participants received a full-mouth periodontal examination by calibrated examiners. GR prevalence was defined as the presence of at least one mid-buccal GR ≥ 1 mm. GRs were also categorized into different recession types (RTs) according to the 2018 World Workshop Classification System. Analyses for RT risk indicators were also performed. All analyses were carried out at the participant level.

RESULTS

The prevalence of mid-buccal GRs was 14.1% in South American adolescents and 90.9% in Chilean adults. In South American adolescents, the prevalence of RTs was 4.3% for RT1 GRs, 10.7% for RT2 GRs and 1.7% for RT3 GRs. In Chilean adults, the prevalence of RT1 GRs was 0.3%, while the prevalence of RT2 and RT3 GRs was 85.8% and 77.4%, respectively. Full-Mouth Bleeding Score (FMBS; <25%) was associated with the presence of RT1 GRs in adolescents. The risk indicators for RT2/RT3 GRs mainly overlapped with those for periodontitis.

CONCLUSIONS

Mid-buccal GRs affected 14.1% of South American adolescents, whereas they affected most of the Chilean adult population (>90%). While RT1 GRs are more commonly observed in a non-representative cohort of South American adolescents (when compared to Chilean adults), the majority of Chilean adults exhibit RT2/RT3 GRs.

Multiple imputation methods for missing multilevel ordinal outcomes

BACKGROUND

Multiple imputation (MI) is an established technique for handling missing data in observational studies. Joint modelling (JM) and fully conditional specification (FCS) are commonly used methods for imputing multilevel data. However, MI methods for multilevel ordinal outcome variables have not been well studied, especially when cluster size is informative on the outcome. The purpose of this study is to describe and compare different MI strategies for dealing with multilevel ordinal outcomes when informative cluster size (ICS) exists.

METHODS

We conducted comprehensive Monte Carlo simulation studies to compare the performance of five strategies: complete case analysis (CCA), FCS, FCS+CS (including cluster size (CS) in the imputation model), JM, and JM+CS under various scenarios. We evaluated their performance using a proportional odds logistic regression model estimated with cluster weighted generalized estimating equations (CWGEE).

RESULTS

The simulation results showed that including CS in the imputation model can significantly improve estimation accuracy when ICS exists. FCS provided more accurate and robust estimation than JM, followed by CCA for multilevel ordinal outcomes. We further applied these strategies to a real dental study to assess the association between metabolic syndrome and clinical attachment loss scores. The results based on FCS + CS indicated that the power of the analysis would increase after carrying out the appropriate MI strategy.

CONCLUSIONS

MI is an effective tool to increase the accuracy and power of the downstream statistical analysis for missing ordinal outcomes. FCS slightly outperforms JM when imputing multilevel ordinal outcomes. When there is plausible ICS, we recommend including CS in the imputation phase.

Impact of COVID-19 Pandemic on Quality of Life of Type II Diabetes Patients With Periodontitis

Background: Confinement due to the COVID-19 pandemic has made dental treatments impossible in Chile and many other countries, including diabetic patients with periodontitis. The aim of the present study was to evaluate the impact of periodontal therapy in terms of oral health-related quality of life (OHRQoL) during the COVID-19 pandemic in a cohort of diabetic patients with periodontitis. Material and Methods: Thirty-eight diabetic patients with stage III-IV periodontitis, enrolled for periodontal therapy, were screened. Periodontal clinical parameters including clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP) as well as glycated hemoglobin (HbA1c) were evaluated at baseline and 3 months follow-up prior the pandemic. The OHRQoL changes by means of Oral Health Impact Profile (OHIP-14) and a self-reported oral health questionnaire were assessed at baseline (prior pandemic) and during the pandemic via telemonitoring. Results: Thirty-one patients received non-surgical periodontal therapy prior to the pandemic. Out of the 31 patients, four died due to COVID-19 resulting in 27 patients available for telemonitoring at the time of the pandemic. Periodontal therapy significantly improved CAL, PPD and BOP (p < 0.05) but not HbA1c (p > 0.05) between baseline and 3 months follow-up pior to the pandemic. Total OHIP-14 scores significantly improved between baseline and the middle of pandemic (intragroup comparison p = 0.00411). In particular, OHIP-14 scores related to the "Physical pain" (intragroup comparison p = 0.04) and "Psychological disability" (intragroup comparison p = 0.00) significantly improved between baseline and the middle of pandemic. Conclusions: In diabetic type II patients with periodontitis periodontal therapy tends to improve the oral health-related quality of life despite the COVID-19 pandemic.

Performance of the 2017 AAP/EFP case definition compared to the CDC/AAP definition in population-based studies

BACKGROUND

Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies.

METHODS

Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from 5 countries; Argentina, Chile, Colombia, Ecuador and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard.

RESULTS

According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as stage I (39.2%) or stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis while the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.912 (95% CI = 0.89 - 0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as stage IV (81.3%) whereas stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity in moderate (99.7%) and severe periodontitis (100%) but low specificity in both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.573 (95% CI = 0.53 - 0.62).

CONCLUSIONS

This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis. This article is protected by copyright. All rights reserved.

Assessment of Cardiovascular Risk in Women with Periodontal Diseases According to C-reactive Protein Levels

Cardiovascular diseases (CVD) are highly prevalent non-communicable diseases worldwide. Periodontitis may act as a non-traditional cardiovascular risk (CVR) factor, linked by a low-grade systemic inflammation mediated by C-reactive protein (CRP). Patients with periodontitis reported higher serum CRP levels; however, a CRP systemic and periodontal correlation in gingival crevicular fluid (GCF) and its CVR impact have been barely studied. We aimed to assess the association between periodontal diseases and CVR in a group of adult women, based on serum high-sensitivity CRP (hs-CRP) levels; and secondly, to determine the association between serum and GCF CRP levels. Gingival crevicular fluid and blood samples were obtained from women with periodontitis, gingivitis, and healthy controls. Serum and GCF CRP were determined by turbidimetric method and Luminex technology, respectively. Data were analyzed and adjusted by CVR factors. All women presented moderate CVR, without an evident association between serum hs-CRP levels and periodontal diseases. While serum hs-CRP concentrations did not significantly differ between groups, patients with gingivitis and periodontitis showed higher CRP levels in GCF, which positively correlated to CRP detection in serum.

Characterization of Oral Health Status in Chilean Patients with X-Linked Hypophosphatemia

X-Linked Hypophosphatemia (XLH) is the most common cause of inherited hypophosphatemic rickets. Dental involvement, including spontaneous abscesses and/or fistulae, is an important part of the disease and has not been completely defined, especially in cohorts from developing countries. To describe oral health status in a cohort of Chilean patients with XLH and explore its correlation with biochemical presentation and treatment, we conducted a cross-sectional observational study of patients with PHEX mutation-confirmed XLH. All patients had an oral clinical exam, radiographic evaluation; clinical and biochemical data were obtained to determine their association with oral features. Twenty-six patients were included, 77% adults and 23% children. Most adults (89%) had past or current dental pulp pathology (abscesses and/or fistulae). Pulpal chamber enlargement and radiolucent apical lesions were common radiological features (94 and 74%, respectively). In children, abscess and/or fistulae were also common (33%). Caries index, which was determined by dmft/DMFT, was higher than the Chilean national average. Early and long-term therapy with phosphate and activated vitamin D was associated with lower carious index and attachment loss. XLH patients frequently present with high pulpal involvement and carious index. Conventional therapy was associated with lower carious index and attachment loss. These data highlight the importance of early and periodical dental care in order to prevent dental damage and assure a good quality of oral health for XLH patients.

Periodontal Treatment Protocol for Decompensated Diabetes Patients

Background: Decompensated diabetes is associated with a higher prevalence and severity of periodontitis and poorer response to periodontal therapy. It is conceivable that periodontal therapy may cause systemic and local complications in this type of patients. The aim of the present study was to identify and describe the best available evidence for the treatment of periodontitis in decompensated diabetics.

Material and methods: An expert committee including participants from different areas gathered to discuss and develop a treatment guideline under the guidance of the Cochrane Associate Center, Faculty of Dentistry, University of Chile. In total, four research questions were prepared. The questions prepared related to decompensated diabetic patients (glycated hemoglobin >8) were, (1) Does the exposure to periodontal treatment increase the risk of infectious or systemic complications? (2) Does the antibiotic treatment or prophylaxis, compared to not giving it, reduce infectious complications? (3) Does the exposure to periodontal treatment, compared to no treatment, reduce the glycated hemoglobin levels (HbA1c)? Last question was related to diabetic patients, (4) Does the exposure to a higher level of HbA1c, compared to stable levels, increase the risk of infectious complications? Based on these questions, a search strategy was developed using MEDLINE and EPISTEMONIKOS. Only systematic reviews were considered.

Results: For question 1, the search yielded 12 records in EPISTEMONIKOS and 23 in MEDLINE. None of these studies addressed the question. For question 2, the search yielded 58 records in EPISTEMONIKOS and 11 in MEDLINE. None of these studies addressed the question. For question 3, the search yielded 16 records in EPISTEMONIKOS and 11 in MEDLINE. Thirteen addressed the question. For question 4, the search yielded 7 records in EPISTEMONIKOS and 9 in MEDLINE. One addressed the question.

Conclusions: In decompensated diabetic patients, there is lack of scientific information about risk of infectious or systemic complications as a result of periodontal treatment and about the impact of antibiotic treatment or prophylaxis on reduction if infectious complications. A defined HbA1c threshold for dental and periodontal treatment in diabetic patients has yet to be determined. Finally, periodontal treatment does have an impact on HbA1c levels.

Soluble Neuropilin-1 in gingival crevicular fluid from periodontitis patients: An exploratory cross-sectional study

BACKGROUND

Soluble Neuropilin-1 (sNRP-1) is a glycoprotein with angiogenic and immune regulatory functions, which correspond to processes deeply involved with periodontal diseases. This study's objective was to determine the concentration of sNRP-1 in gingival crevicular fluid (GCF) samples of severe periodontitis (stages III-IV) compared to mild-moderate (stages I-II) periodontitis patients.

MATERIALS AND METHODS

An exploratory cross-sectional study was conducted, including 36 adults subjected to a complete periodontal exam, which recorded the following periodontal parameters: periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival index (GI) and periodontal inflamed surface area (PISA). Periodontitis was defined by two periodontists using the case definition proposed by the 2017 World Workshop for periodontal diseases. GCF samples were collected to determine the levels of sNRP-1 via ELISA. The results were analyzed using descriptive statistics, Mann-Whitney, Kruskal Wallis, and Spearman tests.

RESULTS

The levels of sNRP-1 in patient's GCF with periodontitis in stages III-IV showed a median of 38.385 ​ng/mL (iqr 30.98), in comparison with 20.085 ​ng/mL (iqr 12.74) for stages I-II (p ​= ​0.202). Regardless of the periodontitis stage, we observed a positive correlation between the levels of sNRP-1 in BOP (Rho: 0.45; p ​= ​0.0048), PISA (Rho: 0.50; p ​= ​0.0019), PD (Rho: 0.3; p ​= ​0.015) and GI (Rho: 0.37; p ​= ​0.02).

CONCLUSIONS

The GCF-sNRP-1 concentration was positively related to periodontal clinical inflammatory parameters and probably could be involved in pro-inflammatory and angiogenic mechanisms observed in periodontitis. Additional studies are necessary to confirm these preliminary results.

MMP-8, TRAP-5, and OPG Levels in GCF Diagnostic Potential to Discriminate between Healthy Patients', Mild and Severe Periodontitis Sites

Biomarkers represent promising aids in periodontitis, host-mediate diseases of the tooth-supporting tissues. We assessed the diagnostic potential of matrix metalloproteinase-8 (MMP-8), tartrate-resistant acid phosphatase-5 (TRAP-5), and osteoprotegerin (OPG) to discriminate between healthy patients’, mild and severe periodontitis sites. Thirty-one otherwise healthy volunteers with and without periodontal disease were enrolled at the Faculty of Dentistry, University of Chile. Periodontal parameters were examined and gingival crevicular fluid was sampled from mild periodontitis sites (M; n = 42), severe periodontitis sites (S; n = 59), and healthy volunteer sites (H; n = 30). TRAP-5 and OPG were determined by commercial multiplex assay and MMP-8 by the immunofluorometric (IFMA) method. STATA software was used. All biomarkers showed a good discrimination performance. MMP-8 had the overall best performance in regression models and Receiver Operating Characteristic (ROC) curves, with high discrimination of healthy from periodontitis sites (area under the curve (AUC) = 0.901). OPG showed a very high diagnostic precision (AUC ≥ 0.95) to identify severe periodontitis sites (S versus H + M), while TRAP-5 identified both healthy and severe sites. As conclusions, MMP-8, TRAP-5, and OPG present a high precision potential in the identification of periodontal disease destruction, with MMP-8 as the most accurate diagnostic biomarker.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

OBJECTIVE

The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D).

METHODOLOGY

A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05.

RESULTS

Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05).

CONCLUSIONS

SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study

BACKGROUND

The co-occurrence of caries and periodontitis and a possible association is still a matter of debate. Thus, the aim of the study was to determine the co-occurrence of caries and periodontitis in Chilean adults.

METHODS

Evaluation of periodontal and dental status in 994 adults (35-44 years old) based on the First Chilean National Examination Survey 2007-2008. The prevalence of caries was defined as the percentage of participants with one or more teeth with untreated caries by using the D component of the DMFT index (DT ≠ 0). The prevalence of periodontitis was determined using standard case definitions for population-based surveillance of periodontitis described by the CDC-AAP.

RESULTS

Individuals with caries had an approximately 40% higher prevalence of severe (29.3% vs 20.8%, p < 0.05) and a 13% higher prevalence of total periodontitis (89.3% vs 78.4%, p < 0.05) than those without caries. Ordinal logistic regression revealed a positive association between periodontitis and the number of teeth with caries (DT ≠ 0; 3 or 4 teeth with caries: OR 1.74; CI = 1.12-2.29 p < 0.05; 5 or more teeth with caries: OR 2.47; CI = 1.66-3.67 p < 0.01).

CONCLUSION

Dental caries is associated with the severity and prevalence of periodontitis in Chilean adults. Individuals with 3 or more teeth with untreated caries are more likely to suffer from periodontal disease.

Attitudes, Perceptions, and Preferences of Individuals from Temuco (Chile) About Denture Marking

Denture marking (DM) helps identify edentulous people with different methods. Analyzing perceptions and attitudes of denture wearers would enable understanding of the practical aspects, an analysis still absent in South America. Fifty-three individual candidates for removable dentures were instructed on disaster victim identification (DVI) and the usefulness of DM for this purpose. They were physically shown eight DM systems and a questionnaire to which they responded by highlighting preferences in those systems. Although 98.11% did not know that dentures could be marked, only 9.43% denied interest in some type of DM. The 90.57% would mark their dentures with some system, preferring the inclusion of QR codes or a micro SIM card. The proven weaknesses of DVI and propensity for disaster mean this community in Chile is an opportunity to implement DM systems. Obstacles may come not from patients but from their dentists, educational institutions, or a lack of public policies.

Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: A randomized clinical trial

AIM

To evaluate the impact of two non-surgical periodontal treatment modalities on metabolic and periodontal clinical parameters in subjects with type 2 diabetes mellitus (T2DM) and poor glycaemic control and chronic periodontitis.

MATERIAL AND METHODS

A randomized controlled clinical trial was conducted. Ninety-three T2DM subjects with glycosylated haemoglobin (HbA1c) > 7% were randomly assigned to one of two groups receiving scaling with root planing in multiple sessions quadrant-by-quadrant (Q by Q) or within 24 hr (one stage). Periodontal parameters, HbA1c, glycaemia blood levels (FPG) and C-reactive protein (CRP) values were assessed at baseline and at 3 and 6 months post-therapy.

RESULTS

At 6 months, HbA1c had decreased by 0.48% in the Q by Q group and by 0.18% in the one-stage group (p = 0.455). After therapy, subjects with an initial HbA1c < 9% showed an increase of 0.31% (p = 0.145), compared with a decrease of 0.88% (p = 0.006) in those with an initial HbA1c ≥ 9%. Periodontal parameters improved significantly (p < 0.0001) post-therapy, with similar results for both treatment modalities.

CONCLUSION

Periodontal therapy had the greatest impact on HbA1c reduction on patients with an HbA1c > 9% regardless of treatment modality. Both modalities resulted in significant improvements in periodontal parameters.

Helicobacter pylori in human health and disease: Mechanisms for local gastric and systemic effects

Helicobacter pylori (H. pylori) is present in roughly 50% of the human population worldwide and infection levels reach over 70% in developing countries. The infection has classically been associated with different gastro-intestinal diseases, but also with extra gastric diseases. Despite such associations, the bacterium frequently persists in the human host without inducing disease, and it has been suggested that H. pylori may also play a beneficial role in health. To understand how H. pylori can produce such diverse effects in the human host, several studies have focused on understanding the local and systemic effects triggered by this bacterium. One of the main mechanisms by which H. pylori is thought to damage the host is by inducing local and systemic inflammation. However, more recently, studies are beginning to focus on the effects of H. pylori and its metabolism on the gastric and intestinal microbiome. The objective of this review is to discuss how H. pylori has co-evolved with humans, how H. pylori presence is associated with positive and negative effects in human health and how inflammation and/or changes in the microbiome are associated with the observed outcomes.

Spectral components in electromyograms from four regions of the human masseter, in natural dentate and edentulous subjects with removable prostheses and implants

OBJECTIVE

To compare the frequency or spectral components between different regions of the superficial masseter in young natural dentate and total edentulous older adults rehabilitated with removable prostheses and fixed-implant support. A secondary objective was to compare these components between the three groups.

DESIGN

21 young natural dentate and 28 edentulous (14 with removable prostheses and 14 with fixed-implant support) were assessed. High-density surface electromyography (sEMG) was recorded in four portions of the superficial masseter during submaximal isometric bites. Spectral components were obtained through a spectral analysis of the sEMG signals. An analysis of mixed models was used to compare the spectral components.

RESULTS

In all groups, the spectral components of the anterior portion were lower than in the posterior region (p < 0.05). Both edentulous groups showed lower spectral components and median frequency slope than the natural dentate group (p < 0.05). The removable prostheses group showed the greatest differences with natural dentate group.

CONCLUSIONS

There were significant differences in the spectral components recorded in the different regions of the superficial masseter. The lower spectral components and fatigability of older adults rehabilitated with prostheses could be a cause of a greater loss of type II fibers, especially in the removable prostheses group.

Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up

Objective

The aim of this double-blind, placebo-controlled and parallel- arm randomized clinical trial was to evaluate the effects of Lactobacillus rhamnosus SP1-containing probiotic sachet and azithromycin tablets as an adjunct to nonsurgical therapy in clinical parameters and in presence and levels of Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.

Material and Methods

Forty-seven systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically and microbiologically at baseline for 3, 6 and 9 months after therapy. Subgingival plaque samples were collected from four periodontal sites with clinical attachment level ≥1 mm, probing pocket depth ≥4 mm and bleeding on probing, one site in each quadrant. Samples were cultivated and processed using the PCR technique. Patients received nonsurgical therapy including scaling and root planing (SRP) and were randomly assigned to a probiotic (n=16), antibiotic (n = 16) or placebo (n = 15) group. L. rhamnosus SP1 was taken once a day for 3 months. Azithromycin 500mg was taken once a day for 5 days.

Results

All groups showed improvements in clinical and microbiological parameters at all time points evaluated. Probiotic and antibiotic groups showed greater reductions in cultivable microbiota compared with baseline. The placebo group showed greater reduction in number of subjects with P. gingivalis compared with baseline. However, there were no significant differences between groups.

Conclusions

The adjunctive use of L. rhamnosus SP1 sachets and azithromycin during initial therapy resulted in similar clinical and microbiological improvements compared with the placebo group.

Oxidative Stress in the Local and Systemic Events of Apical Periodontitis

Oxidative stress is involved in the pathogenesis of a variety of inflammatory disorders. Apical periodontitis (AP) usually results in the formation of an osteolytic apical lesion (AL) caused by the immune response to endodontic infection. Reactive oxygen species (ROS) produced by phagocytic cells in response to bacterial challenge represent an important host defense mechanism, but disturbed redox balance results in tissue injury. This mini review focuses on the role of oxidative stress in the local and associated systemic events in chronic apical periodontitis. During endodontic infection, ligation of Toll-like receptors (TLRs) on phagocytes' surface triggers activation, phagocytosis, synthesis of ROS, activation of humoral and cellular responses, and production of inflammatory mediators, such as, cytokines and matrix metalloproteinases (MMPs). The increment in ROS perturbs the normal redox balance and shifts cells into a state of oxidative stress. ROS induce molecular damage and disturbed redox signaling, that result in the loss of bone homeostasis, increased pro-inflammatory mediators, and MMP overexpression and activation, leading to apical tissue breakdown. On the other hand, oxidative stress has been strongly involved in the pathogenesis of atherosclerosis, where a chronic inflammatory process develops in the arterial wall. Chronic AP is associated with an increased risk of cardiovascular diseases (CVD) and especially atherogenesis. The potential mechanisms linking these diseases are also discussed.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability

The major infectious diseases in Chile encompass the periodontal diseases, with a combined prevalence that rises up to 90% of the population. Thus, the population-based surveillance of periodontal diseases plays a central role for assessing their prevalence and for planning, implementing, and evaluating preventive and control programs. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide.

Prevalence, severity, and risk indicators of gingival inflammation in a multi-center study on South American adults: a cross sectional study

Objectives:

The aim of this study is to investigate the prevalence and severity of gingival inflammation and associated risk indicators in South American adults.

Material and Methods:

Multi-stage samples totaling 1,650 adults from Porto Alegre (Brazil), Tucumán (Argentina), and Santiago (Chile) were assessed. The sampling procedure consisted of a 4-stage process. Examinations were performed in mobile dental units by calibrated examiners. A multivariable logistic regression model was utilized for associating variables as indicators of gingival inflammation (GI) (Gingival Index ≥0.5). Statistical significance was set at 0.05.

Results:

A total of 96.5% of the adults have GI. Regarding the severity of GI, 22.5% of participants examined have mild GI, 74.0% have moderate GI, and 3.6% have severe GI. The multivariate analyses identify the main risk indicators for GI as adults with higher mean of Calculus Index (OR=18.59); with a Visible Plaque Index ≥30% (OR=14.56); living in Santiago (OR=7.17); having ≤12 years of schooling (OR=2.18), and females (OR=1.93).

Conclusions:

This study shows a high prevalence and severity of gingival inflammation, being the first one performed in adult populations in three cities of South America.

Epidemiology of oral health conditions in older people

The main conditions of interest when considering the epidemiology of oral diseases among older people are tooth loss, dental caries, periodontitis, dry mouth and oral pre-cancer/cancer, along with oral-health-related quality of life (OHRQoL). This article presents an overview of what is known about the epidemiology of each of the main conditions of interest among older populations.

Prevalence and predictors for clinical attachment loss in adolescents in Latin America: cross-sectional study

AIM

To describe the prevalence, severity and extension of clinical attachment loss (CAL) and to study the predictors in 15- to 19-year-old adolescents from high schools in the Latin America.

MATERIALS AND METHODS

A cross-sectional, epidemiological study was performed. The sample included 1070 high school adolescents 15-19 years of age from Santiago de Chile (Chile), Buenos Aires, Córdoba, Mendoza (Argentina), Montevideo (Uruguay), Quito (Ecuador) and Medellín (Colombia). Calibrated examiners performed full mouth, six sites per tooth clinical examination.

RESULTS

There was a response rate of 100%. The prevalence of CAL ≥3 mm in ≥1 site was 32.6%, probing pocket depth ≥4 mm was 59.3% and bleeding on probing (BoP) ≥25% was 28.6%. The logistic regression analysis adjusted for cities revealed that smoking (OR = 1.6), attending public school (OR = 2.3) and having a BoP ≥25% (OR = 4.2) were positively associated with CAL ≥3 mm in ≥ 1 site.

CONCLUSION

Clinical attachment loss was prevalent in Latin America adolescents and it is associated with smoking, attendance public school and BoP.

Integrity of the oral tissues in patients with solid-organ transplants

The relationship between the use of immunosuppressants in solid-organ transplant patients and oral tissue abnormalities has been recognized. The objective of this study was to determine the state of oral tissue integrity in renal, heart, and liver transplant patients who are on continuous medical and dental control. Forty patients of both sexes were clinically evaluated at the Clinical Hospital of the University of Chile to identify pathologies of oral mucosa, gingival enlargement (GE), decayed, missing, filled teeth (DMFT) index, and salivary flow. The average age of the transplant subjects was 49.4 years, and the age range was 19 to 69 years. Most subjects maintained a good level of oral hygiene, and the rate mean of DMFT was 14.7. The degree of involvement of the oral mucosa and GE was low (10%). Unlike other studies, the frequency of oral mucosal diseases and GE was low despite the fact that these patients were immunosuppressed. Care and continuous monitoring seem to be of vital importance in maintaining the oral health of transplant patients.