Tratamiento quirúrgico vs terapia periodontal básica: estudios longitudinales en periodoncia clínica

Las enfermedades periodontales son unas graves infecciones bacterianas que destruyen las fibras de inserción y el hueso de soporte que mantienen los dientes en la boca. Sin tratar, esta enfermedad puede llevar a la pérdida dental (Medical Dictionary). Los estudios longitudinales han centrado su atención hacia la periodontitis crónica. Se ha documentado el decisivo papel de la placa bacteriana en la iniciación y en el mantenimiento de la gingivitis, y que, los efectos dañinos sobre los tejidos y la gravedad de estos efectos están regulados por una compleja interacción entre el parásito y huésped. El tratamiento de la lesión periodontal cumple, para el tratamiento periodontal básico, con el propósito de eliminar y prevenir la recurrencia de los depósitos bacterianos localizados en las superficies dentarias supragingivales y subgingivales y, para el tratamiento quirúrgico con el objetivo de crear acceso para el desbridamiento profesional correcto de las superficies radiculares infectadas y establecer una morfología gingival adecuada que facilite el autocontrol de la placa por parte del paciente. Diferentes técnicas se han utilizado para alcanzar el objetivo de mejorar el pronóstico de los dientes a largo plazo. Desafortunadamente no son muchos los estudios que consiguen demostrar la efectividad de las técnicas utilizadas, con una evolución a lo largo del tiempo dejando entonces algunas incertidumbres. Periodontal diseases are bacterial infections that destroy the attachment fibres and supporting bone that hold the teeth in the mouth. Left untreated, these diseases can lead to tooth loss (Medical Dictionary). Longitudinal studies centred their attention on chronic periodontitis. It has been documented the decisive role played by microbiological plaque in the initiation of gingivitis and that, the harmful effect on the tissues and its severity, are controlled by the complex host-parasite interaction. Treatment of periodontal lesion can be carried out either by non-surgical treatment, to eliminate and prevent the recurrence of bacterial deposits, or by surgical treatment, to create access for professional debridment of infected root surface and establish adequate gingival morphology to facilitate self plaque control. Different techniques are used to achieve the objective to improve teeth long term prognosis. Unfortunately no many studies have been able to demonstrate the effectiveness of the used technique in a long term intervals leaving unclear some questions

Conocimiento y actitud del odontólogo frente al manejo del tabaquismo: estudio comparativo entre España, Italia y Venezuela

espanolIntroduccion: El Odontologo es capaz de ejercer un gran impacto en el tabaquismo a traves de su contacto con los pacientes y la deteccion precoz de lesiones bucales. El objetivo de este estudio fue determinar el conocimiento y la actitud de los odontologos frente al tabaquismo en tres paises distintos. Materiales y metodos: Se realizo una encuesta a 293 odontologos, 93 de ellos localizados en Caracas (OV), 90 con practica odontologica en Madrid (OE) y 110 en Milan (OI). Resultados: 46 OE y 22 OI indicaron ser fumadores, mientras que tan solo 10 OV admitieron ser fumadores. 80 (86,02%) OV, 66 (73,33%) OE y todos los OI refirieron registrar en la historia datos relacionados con tabaquismo en la primera consulta del paciente. La mayoria motiva a sus pacientes a dejar de fumar, sin embargo, 72,04% (67) OV, 55,55% (50) OE y 100% OI no recomiendan ninguna terapia de apoyo. Solo 7 odontologos (2,38%) (2 OV y 5 OE) reconocieron el medicamento Bupropion pero ningun odontologo lo ha indicado. Finalmente, 137 odontologos han diagnosticado cancer bucal, de los cuales 108 eran OI. Conclusiones: Los odontologos, independientemente del pais, tienen actitudes positivas para participar en el control del tabaquismo, pero no manejan la informacion relacionada ni ejercen un rol activo en la cesacion. Probablemente esta situacion se deba a la falta de entrenamiento durante sus estudios de pre y/o postgrado lo cual amerita una revision de los planes curriculares de Odontologia a nivel mundial. EnglishIntroduction: Health care professionals have an important role in tobacco control. Dentists are capable of having a great impact in smoking cessation due to their regular contact with patients and the rapid detection of oral signs produced by smoking. Unfortunately, there are few dentists actively involved in smoking control. The aim of this study was to investigate various aspects of dentists' beliefs and practices with respect to smoking cessation. Materials & Methods: A questionnaire about smoking cessation was filled in person by 293 dentists. 93 dentists were from Caracas-Venezuela (VD), 90 were from Madrid-Spain (SD) and 110 from Milan-Italy (ID). Results: 46 SD and 22 ID were smokers. Only 10 VD admitted to smoke. 80 (86.02%) VD, 66 (73.33%) SD and 100% of ID said that they recorded smoking status during the first consultation. However, none routinely update their records on smoking status. The majority of respondents encourage their patients to stop smoking, though, 72.04% (67) VD, 55.55% (50) SD and 100% ID do not recommend or prescribe any cessation therapy. Just 7 (2.38%) of all dentists had heard about the use of Bupropion, however, they had never indicated. Finally, 137 dentists (108 ID) have diagnosed oral cancer in their patients. Conclusions: Dentists have positive attitudes to being involved in smoking cessation interventions, but they do not manage all the information related to it. It is probably due to a lack of training or education during their undergraduate and postgraduate studies. Further studies should evaluate inclusion of smoking cessation instruction in Venezuelan, Spanish and Italian dentistry curriculum

A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis

systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol 2013; 40: 227-241. doi: 10.1111/jcpe.12026. Abstract Aims: To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods: Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results: The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of À0.407 and À0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). Conclusions: The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial

Effect of venlafaxine on bone loss associated with ligature-induced periodontitis in Wistar rats

<p>Abstract</p> <p>Background</p> <p>The present study investigated the effects of venlafaxine, an antidepressant drug with immunoregulatory properties on the inflammatory response and bone loss associated with experimental periodontal disease (EPD).</p> <p>Materials and Methods</p> <p>Wistar rats were subjected to a ligature placement around the second upper left molar. The treated groups received orally venlafaxine (10 or 50 mg/kg) one hour before the experimental periodontal disease induction and daily for 10 days. Vehicle-treated experimental periodontal disease and a sham-operated (SO) controls were included. Bone loss was analyzed morphometrically and histopathological analysis was based on cell influx, alveolar bone, and cementum integrity. Lipid peroxidation quantification and immunohistochemistry to TNF-α and iNOS were performed.</p> <p>Results</p> <p>Experimental periodontal disease rats showed an intense bone loss compared to SO ones (SO = 1.61 ± 1.36; EPD = 4.47 ± 1.98 mm, p < 0.001) and evidenced increased cellular infiltration and immunoreactivity for TNF-α and iNOS. Venlafaxine treatment while at low dose (10 mg/kg) afforded no significant protection against bone loss (3.25 ± 1.26 mm), a high dose (50 mg/kg) caused significantly enhanced bone loss (6.81 ± 3.31 mm, p < 0.05). Venlafaxine effectively decreased the lipid peroxidation but showed no significant change in TNF-α or iNOS immunoreactivity.</p> <p>Conclusion</p> <p>The increased bone loss associated with high dose venlafaxine may possibly be a result of synaptic inhibition of serotonin uptake.</p

Lengua geográfica y dermatitis atópica: una asociación frecuente

El interés de esta comunicación es llamar la atención sobre una enfermedad de gran prevalencia conocida como Dermatitis atópica y su relación con la manifestación en la mucosa bucal bajo la forma de un criterio menor denominado lengua geográfica. Se considera importante hacer un adecuado diagnóstico diferencial entre este concepto como patología lingual primaria o asociada a otras enfermedades

Afectación oral de las enfermedades comunes en la infancia con carácter exantemático

Determinadas enfermedades exantémicas de la infancia pueden cursar con manifestaciones en la región oral, siendo en ocasiones pioneras al resto de las lesiones. Para evitar complicaciones que puedan retrasar la correcta evolución y recuperación de los pacientes, y dada la morbilidad con la que cursan algunas entidades a nivel oral, se presenta una revisión en la cual se insiste en la necesidad de hacer una adecuada exploración oral ante cualquier enfermedad infecciosa o exantemática, aún cuando no consulten por síntomas a dicho nivel, para poder diagnosticar y tratar de forma precoz las lesiones orales asociadas a estas entidades