Efeito do tratamento periodontal nos parâmetros metabólicos e pressão arterial de pacientes portadores de síndrome metabólica : análise parcial de um ensaio clínico randomizado

A Síndrome Metabólica (SM) é uma condição de prevalência crescente no mundo e existe pouca informação sobre o efeito do tratamento periodontal nos parâmetros metabólicos em pacientes com SM. O objetivo desta tese é comparar o efeito do tratamento periodontal nos níveis de hemoglobina glicada, glicose em jejum, triglicerídeos, colesterol HDL, colesterol total, insulina, resistência à insulina, função de células beta, proteína C reativa (PCR) e pressão arterial (PA) em pacientes com periodontite e SM em um período de 6 meses. Metodologia/ Desenho: Esta tese compreende uma análise parcial de um ensaio clínico randomizado com indivíduos com diagnóstico concomitante de periodontite _ ≥ 2 sítios interproximais com perda de inserção (PI) ≥4 mm ou ≥2 sítios interproximal com profundidade de sondagem (PS) ≥ 5mm em dentes não-adjacentes e não no mesmo dente e SM (Federação Internacional do Diabetes-2009). Setenta e dois indivíduos foram randomizados para grupo teste (tratamento periodontal imediato) ou controle (tratamento periodontal tardio-após 6 meses). Os pacientes receberam avaliação odontológica e realizaram exames sanguíneos nos tempos inicial, 3 e 6 meses, além de tratamento médico para hiperglicemia, dislipidemia e hipertensão quando necessário. O desfecho primário foi alteração na hemoglobina glicada e os desfechos secundários foram alterações na glicose, triglicerídeos, colesterol total e HDL, insulina, resistência à insulina, função de células beta, PCR e PA. A análise estatística foi realizada utilizando o modelo de Equações de Estimações Generalizadas (GEE: Generalized Estimating Equations). Resultados: Não houveram diferenças significativas nos parâmetros periodontais e metabólicos em ambos os grupos no exame inicial. Houve redução significativa de placa, sangramento marginal, fatores retentivos de placa, sangramento subgengival, média de PS e de PI no grupo teste. Não houve diferença significativa nos parâmetros metabólicos e na pressão arterial aos 3 e 6 meses comparando-se indivíduos que receberam tratamento periodontal ou não. Na análise intra-grupo, indivíduos do grupo controle reduziram os níveis de insulina e resistência à insulina e aumentaram colesterol HDL aos 3 e 6 meses. Na análise do percentil 75º de hemoglobina glicada e de sangramento subgengival, a comparação intra-grupo mostrou redução significativa de hemoglobina glicada no grupo teste dos 3 para os 6 meses, além de melhora no grupo controle de insulina, resistência à insulina e HDL. Conclusão: A despeito da melhora nos parâmetros periodontais no grupo teste, não houve efeito do tratamento periodontal nos parâmetros metabólicos e na PA.Metabolic syndrome (MS) is a condition of increasing prevalence in the world and there is a little information on the effect of periodontal treatment on levels of metabolic parameters in patients with MS. The objective of this thesis is to compare the effect of periodontal treatment on levels of glycated hemoglobin, fasting glucose, triglycerides, HDL cholesterol, total cholesterol, insulin, insulin resistance, beta cell function, C-reactive protein (CRP) and blood pressure (BP) in patients with periodontitis and MS in a period of 6 months. Methods / Design: This thesis comprises a partial analysis of a randomized clinical trial with patients with concomitant diagnosis of periodontitis _ ≥ 2 interproximal sites with clinical attachment loss (CAL) ≥4 mm or ≥2 interproximal sites with probing depth (PD) ≥ 5mm in non-adjacent teeth and SM (International Diabetes Federation, 2009). Seventy-two subjects were randomly assigned to the test group (immediate periodontal treatment) or control (periodontal treatment after 6 months). Patients received dental evaluation and performed blood tests in baseline, 3 and 6 months, and medical treatment for hyperglycemia, dyslipidemia and hypertension when needed. The primary outcome was change in glycated hemoglobin and secondary outcomes were changes in glucose, triglycerides, total and HDL cholesterol, insulin, insulin resistance, beta cell function, CRP and BP. Statistical analysis was performed using Generalized Estimated Equations (GEE). Results: There is no significant differences in periodontal and metabolic parameters in both groups at baseline. There was a significant reduction of plaque, marginal bleeding, plaque retentive factors, subgingival bleeding, mean PS and PI in the test group. There is no significant difference in metabolic parameters and blood pressure at 3 and 6 months compared to subjects who received periodontal treatment or not. In the intra-group analysis, control subjects improved insulin levels, insulin resistance and HDL cholesterol at 3 and 6 months. In the analysis of 75 percentile of glycated hemoglobin and subgingival bleeding, intra-group comparison showed significant reduction of glycated hemoglobin in the test group of 3 to 6 months, and reduction in control group of insulin, insulin resistance and improvement of HDL. Conclusion: Despite the improvement in periodontal parameters in the test group, there was no effect of periodontal treatment on metabolic parameters and BP

The incidence of gingival fissures associated with toothbrushing : clinical trial randomized

Objetivo: Comparar a incidência de fissuras gengivais após o uso de escovas macias e médias. Material e Métodos: 35 participantes (14-20 anos), com perda de inserção periodontal (PAL) ≤1mm, foram randomizados para usar escova dental macia ou média em desenho experimental cruzado com um período de intervalo de 10 dias entre os dois períodos de 28 dias. Fissuras gengivais foram avaliadas com o uso de uma solução evidenciadora. Fotografias foram realizadas dos quadrantes selecionados a cada 2-3 dias em 12 sessões. Os registros fotográficos foram avaliados por um examinador cego. Estimativa de Equações Generalizadas foram usadas para avaliar a associação entre fissuras gengivais, tipo de escova, tempo, sexo, idade, frequência de escovação auto-reportada, placa e PAL. Resultados: 25% dos participantes apresentaram pelo menos uma fissura gengival. Uma alta incidência de fissuras foi observada após o uso de escovas médias. Em um modelo multivariado, o risco de desenvolvimento de fissuras foi 2 vezes maior com o uso de escova média comparado ao uso de escova macia. A presença de PAL vestibular este associada com um risco aumentado de 5.19. O risco de ocorrer fissuras também aumentou com o tempo e foi mais alto em homens comparado com mulheres. Conclusões: Fissuras gengivais são um achado comum associadas com a escovação. Uso de escovas médias, sexo masculino, tempo e PAL prévia são fatores de risco significativos para a incidência de fissuras gengivais.Aim: To compare the incidence of gingival fissures after the use of soft and medium-hard toothbrushes. Material & Methods: 35 participants (14-20 years old), with periodontal attachment loss (PAL) ≤1mm, were assigned to soft or medium-hard toothbrushes in a cross-over design with a wash-out of 10 days between two 28-days periods. Gingival fissures were assessed using a disclosing solution. Pictures were taken from a selected quadrant every 2-3 days in 12 sessions. Picture files were evaluated by a blind examiner. Generalized estimating equations were used to evaluate the association between gingival fissures, toothbrush type, time, gender, age, self-reported brushing frequency, plaque and PAL. Results: 25% of the participants presented at least one gingival fissure. Higher incidence of fissures was observed after use of medium-hard toothbrushes. In the multivariable model, the risk of fissure development was 2 times higher with medium-hard compared to soft toothbrushes. The presence of buccal PAL was associated with a 5.19 times increased risk. The risk of fissure occurrence also increased with time and was higher in males than females. Conclusions: Gingival fissures are a common feature associated with toothbrushing. Medium-hard toothbrushes, male gender, time and previous PAL are significant risk factors for the incidence of gingival fissures

Efeito do tratamento periodontal nos parâmetros metabólicos e pressão arterial de pacientes portadores de síndrome metabólica : análise parcial de um ensaio clínico randomizado

A Síndrome Metabólica (SM) é uma condição de prevalência crescente no mundo e existe pouca informação sobre o efeito do tratamento periodontal nos parâmetros metabólicos em pacientes com SM. O objetivo desta tese é comparar o efeito do tratamento periodontal nos níveis de hemoglobina glicada, glicose em jejum, triglicerídeos, colesterol HDL, colesterol total, insulina, resistência à insulina, função de células beta, proteína C reativa (PCR) e pressão arterial (PA) em pacientes com periodontite e SM em um período de 6 meses. Metodologia/ Desenho: Esta tese compreende uma análise parcial de um ensaio clínico randomizado com indivíduos com diagnóstico concomitante de periodontite _ ≥ 2 sítios interproximais com perda de inserção (PI) ≥4 mm ou ≥2 sítios interproximal com profundidade de sondagem (PS) ≥ 5mm em dentes não-adjacentes e não no mesmo dente e SM (Federação Internacional do Diabetes-2009). Setenta e dois indivíduos foram randomizados para grupo teste (tratamento periodontal imediato) ou controle (tratamento periodontal tardio-após 6 meses). Os pacientes receberam avaliação odontológica e realizaram exames sanguíneos nos tempos inicial, 3 e 6 meses, além de tratamento médico para hiperglicemia, dislipidemia e hipertensão quando necessário. O desfecho primário foi alteração na hemoglobina glicada e os desfechos secundários foram alterações na glicose, triglicerídeos, colesterol total e HDL, insulina, resistência à insulina, função de células beta, PCR e PA. A análise estatística foi realizada utilizando o modelo de Equações de Estimações Generalizadas (GEE: Generalized Estimating Equations). Resultados: Não houveram diferenças significativas nos parâmetros periodontais e metabólicos em ambos os grupos no exame inicial. Houve redução significativa de placa, sangramento marginal, fatores retentivos de placa, sangramento subgengival, média de PS e de PI no grupo teste. Não houve diferença significativa nos parâmetros metabólicos e na pressão arterial aos 3 e 6 meses comparando-se indivíduos que receberam tratamento periodontal ou não. Na análise intra-grupo, indivíduos do grupo controle reduziram os níveis de insulina e resistência à insulina e aumentaram colesterol HDL aos 3 e 6 meses. Na análise do percentil 75º de hemoglobina glicada e de sangramento subgengival, a comparação intra-grupo mostrou redução significativa de hemoglobina glicada no grupo teste dos 3 para os 6 meses, além de melhora no grupo controle de insulina, resistência à insulina e HDL. Conclusão: A despeito da melhora nos parâmetros periodontais no grupo teste, não houve efeito do tratamento periodontal nos parâmetros metabólicos e na PA.Metabolic syndrome (MS) is a condition of increasing prevalence in the world and there is a little information on the effect of periodontal treatment on levels of metabolic parameters in patients with MS. The objective of this thesis is to compare the effect of periodontal treatment on levels of glycated hemoglobin, fasting glucose, triglycerides, HDL cholesterol, total cholesterol, insulin, insulin resistance, beta cell function, C-reactive protein (CRP) and blood pressure (BP) in patients with periodontitis and MS in a period of 6 months. Methods / Design: This thesis comprises a partial analysis of a randomized clinical trial with patients with concomitant diagnosis of periodontitis _ ≥ 2 interproximal sites with clinical attachment loss (CAL) ≥4 mm or ≥2 interproximal sites with probing depth (PD) ≥ 5mm in non-adjacent teeth and SM (International Diabetes Federation, 2009). Seventy-two subjects were randomly assigned to the test group (immediate periodontal treatment) or control (periodontal treatment after 6 months). Patients received dental evaluation and performed blood tests in baseline, 3 and 6 months, and medical treatment for hyperglycemia, dyslipidemia and hypertension when needed. The primary outcome was change in glycated hemoglobin and secondary outcomes were changes in glucose, triglycerides, total and HDL cholesterol, insulin, insulin resistance, beta cell function, CRP and BP. Statistical analysis was performed using Generalized Estimated Equations (GEE). Results: There is no significant differences in periodontal and metabolic parameters in both groups at baseline. There was a significant reduction of plaque, marginal bleeding, plaque retentive factors, subgingival bleeding, mean PS and PI in the test group. There is no significant difference in metabolic parameters and blood pressure at 3 and 6 months compared to subjects who received periodontal treatment or not. In the intra-group analysis, control subjects improved insulin levels, insulin resistance and HDL cholesterol at 3 and 6 months. In the analysis of 75 percentile of glycated hemoglobin and subgingival bleeding, intra-group comparison showed significant reduction of glycated hemoglobin in the test group of 3 to 6 months, and reduction in control group of insulin, insulin resistance and improvement of HDL. Conclusion: Despite the improvement in periodontal parameters in the test group, there was no effect of periodontal treatment on metabolic parameters and BP

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

Abstract In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms

Chlorhexidine with or without alcohol against biofilm formation : efficacy, adverse events and taste preference

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms

Chlorhexidine with or without alcohol against biofilm formation : efficacy, adverse events and taste preference

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms