O impacto das revisões de literatura na ciência odontológica e na clínica periodontal : o exemplo de uma revisão sistemática de estatinas como adjuvante à terapia periodontal

As revisões sistemáticas são consideradas os desenhos experimentais capazes de guiar os cuidados em saúde. Contudo, as revisões narrativas ainda são largamente publicadas até o presente momento. No âmbito do tratamento das doenças periodontais, diversos estudos têm reportado que o uso adjuvante de estatinas à terapia periodontal mecânica pode acarretar melhorias nos parâmetros clínicos periodontais, como adicionais reduções de profundidade de sondagem e ganhos de inserção clínica. O objetivo deste trabalho é contextualizar a informação advinda de uma revisão sistemática realizada sobre um tema clínico significativo e compreender qual o seu papel como suporte da atenção ao paciente periodontal, a partir da compreensão obtida no estudo bibliométrico de revisões de literatura. No estudo bibliométrico, uma amostra representativa das revisões de literatura, publicadas na base Scopus, foi selecionada. Tipo de revisão, número de citações, ano de publicação, temática do estudo e outras variáveis foram coletadas. Nesse estudo, observou-se que o número de revisões sistemática tem aumentado significativamente ao longo dos anos quando comparados com o número de revisões narrativas. Apesar disso, o número ajustado de citações das revisões sistemáticas não difere significativamente das recebidas nas revisões narrativas. Já na revisão sistemática de uso adjuvante de estatinas, uma estratégia de busca nas bases Pubmed, Scopus e Embase foi realizada para identificar todos os ensaios clínicos que tenham utilizado estatinas como adjuvantes ao tratamento periodontal mecânico em comparação à terapia periodontal mecânica isolada ou associada a placebo. Quinze estudos foram selecionados. Observou-se que, na maioria dos estudos, o uso adjuvante de estatina apresentou adicionais reduções de profundidade de sondagem e ganhos de inserção clínica quando comparado com seus respectivos grupos controles. Contudo, a alta heterogeneidade desse resultado e o grande número de estudos ser executado por um mesmo grupo de pesquisa são fatores limitadores dessa revisão sistemática. Dessa maneira, pode-se concluir que o número de revisões sistemáticas vem aumentando a longo do tempo, porém o seu número de citações parece não acompanhar as mesmas tendências. Além disso, o uso adjuvante de estatina na terapia periodontal ainda não deve ser recomendado até a execução de outros estudos com melhor qualidade.Systematic review is considered the experimental design capable of guiding the health care. However, narrative reviews are broadly published nowadays. Regarding periodontal diseases treatment, several studies reported that the adjuvant use of statins to mechanical periodontal treatment may promote additional improvements in clinical periodontal parameters, such as additional reduction in probing depth and clinical attachment gain. This study aimed to contextualize the information obtained in a systematic review about a significant clinical thematic and comprehend is its role in the periodontal care, through information gathered in a bibliometric study of literature review studies in Dentistry. In the bibliometric study, a representative sample of literature reviews studies, published in Scopus database, was selected. Type of review, number of citations, year of publication, study thematic, and other variables were collected. It was showed that the number of systematic reviews increased throughout the years in comparison to narrative reviews. Additionally, the Dentistry clinical fields presented the highest number of published systematic reviews. Despite of that, the mean adjusted number of citations granted for systematic reviews did not differ from the narrative ones. Regarding the performed systematic review, a search strategy was conducted on Pubmed, Scopus, and Embase databases to identify all clinical trials that used statins as adjuvant to mechanical periodontal treatment in comparison to mechanical periodontal treatment alone or in association with placebo. Fifteen studies were included. It was showed that most of the included studies presented additional reduction in probing depth and clinical attachment gain in comparison to their control groups. However, the high heterogeneity among the studies and the high number of studies conducted by the same research group are limitations of the present systematic review. It was concluded that the number of systematic review are increasing dramatically throughout the years, but this trend is not followed by the number of citations granted to this type of study. Furthermore, the adjuvant use of statin in the mechanical periodontal therapy may not be recommended until further well-designed studies have been published

Tooth loss and associated factors in adolescents : impact of extractions for orthodontic reason

Aim: To investigate tooth loss and its determinants in adolescents, considering the effect of extractions due to orthodontics reasons. Methods: This cross-sectional study was performed in students from public and private schools aged 15-19 years old from Passo Fundo, Brazil. The proportional randomly chosen sample included 736 adolescents. Clinical examinations and interviews were performed. Associations between prevalence of tooth loss and exposure variables studied were analysed by Poisson Regression with uni- and multivariate robust variance in two models. One model comprised students who had experienced tooth loss without orthodontic reasons and the other with all of the subjects presenting tooth loss. Results: Prevalence of tooth loss was 21.1% (mean of 0.42). Higher chances for tooth loss were found in the following features: non-whites (PR=1.72; CI95%:1.15-2.60), poorly schooling mothers (PR=2.2; CI95%:0.96-5.02), from public schools (PR=4.16; CI95%:0.98-17.59), smokers (PR=1.91; CI95%:1.15-3.17). Conclusion:Demographic, socioeconomic and behavioural conditions were strongly associated with tooth loss. These associations were more evident when extractions for orthodontic reasons were not included in the analytical models

Dental care and the COVID-19 pandemic: the precautionary principle and the best available evidence

The precautionary principle is part of evidence-based healthcare. However, since it is not always based in the most qualified evidence, it is frequently questioned. The emergence of a highly contagious disease, with increased levels of morbimortality, an acute respiratory syndrome, the so called Coronavirus Disease 2019 (COVID-19), led health professionals to look for the best alternatives to save lives. In this sense, the precautionary principle was evocated. The precautionary principle is used both preventively and therapeutically when knowledge about how to manage problems/diseases/conditions that are especially life-threatening. The aim of this short communication is to make a reflection about the precautionary principle, the dental profession and COVID-19. It is important to have in mind that in such a disease, guidelines, protocols and approaches can change very fast, since a continuous evaluation of all policies is mandatory

Brazilian dentistry research productivity : state level socioeconomic, educational and structural factors

Aim: To explore socioeconomic, educational and research factors associated with dental research productivity at the state level in Brazil. Methods: The authors used the Scopus database to identify dental articles published from 2006 to 2016 associated with Brazilian universities at the state level. Several social, economic, educational and research structure variables were obtained from the census and National Research Council to predict the rate of articles per 100 thousand inhabitants among the 27 Brazilian states. Rates were fitted in linear weighted least-squared regression with stepwise technique. Twenty-two variables were grouped in six blocks (social, economic, general education, dental education, research workforce and structure). Results: A total of 21189 articles were published, and the state of São Paulo accounted for 46%, followed by Rio Grande do Sul with 9.4%; four states did not publish any articles. There were an average (± standard deviation) of 2.6 (±1.98) published articles per 100 researchers and 13.4 (±9.6) articles per 100 thousand inhabitants. Research structure and workforce explained 92.4% and 87.2% of state variability, respectively, while the final model explained 94.5%. One extra PhD and one extra undergraduate researcher per 100 thousand inhabitants were associated with 11.3 more and 3.5 fewer articles, respectively, while every 10 points (range 0-100) on the Human Development Index (Education Component) was associated with 3.3 more articles. Conclusion: State scientific output has several associated factors, but research workforce and general education variables seem to be good predictors. Large disparities among state research outputs have been described and must be addressed by research and development policies

The impact of maintenance on peri-implant health

Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient’s profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual

Effects of low molecular weight heparin on alveolar bone loss in wistar rats

This study aimed to assess the effects of low molecular weight heparin (LMWH) on alveolar bone loss (ABL), blood count, and counting of megakaryocytes and adipocytes in male Wistar rats. Forty male 60-day Wistar rats were randomly divided into four groups: Control (C), Periodontal Disease (PD), Heparin (Hp) and Heparin + Periodontal Disease (Hp+PD). LMWH was applied for 60 days at doses of 1 ml/kg/day. Blood samples were collected at baseline, 30 and 60. On day-49, PD and Hp+PD groups were subjected to ligature-induced periodontitis around second upper right molar. The left side was assessed as spontaneous alveolar bone loss. Mean ABL in the side with ligature showed significantly different between C (0.35±0.07 mm) and Hp+DP (0.49±0.09 mm) groups (p<0.001), between PD (0.55±0.11 mm) and Hp (0.32±0.06 mm) groups (p<0.001) and between Hp and Hp+DP groups (p<0.001). No significant differences were found among groups for ABL in the side without ligature. Animal weight, food intake, and water consumption showed no statistically significant difference among groups. Megakaryocytes and adipocytes were counted using optical microscopy and no statistically significant differences were found. Within-groups, there were an increase and a decrease, respectively, in the counting of lymphocytes (p=0.005 for C and p=0.009 for Hp+PD groups only) and leukocytes (p=0.003 for C, p=0.001 for PD, p=0.002 for Hp, and p<0.001 for Hp+PD groups). There was no decrease in the number of platelets in the three collection periods. LMWH was not able to affect ABL, but it may change the blood counting, especially increasing lymphocytes

Prevalência de perda dentária e fatores associados em adolescentes institucionalizados: um estudo transversal

This study aimed to assess the prevalence of tooth loss and associated factors in institutionalized adolescents. This cross-sectional study included 68 male adolescents incarcerated from Socio-Educational Assistance Center (CASE) aged between 15 and 19 years. Questionnaires were applied individually to assess sociodemographical, economical, medical, behavioral and oral health self-perception variables. All present teeth were evaluated by Decay, Missing, Filling (DMF) Index. The prevalence of tooth loss was analyzed in individuals with ≥1 tooth loss. Associations between tooth loss and exposure variables studied were analyzed by Poisson Regression with robust variance estimation. The prevalence of tooth loss was 47.06%. First molars in the mandible and maxilla and central incisor in the maxilla were the most absent teeth. In the multivariate model, number of decayed teeth, and those that reported daily use of medication were associated with higher tooth loss. Besides, tooth loss was associated with decayed tooth and daily use of medication. Oral health promotion and treatment should be implemented in these institutions to reduce the prevalence of dental loss in these adolescents.Esse estudo objetivou avaliar a prevalência de perda dentária e fatores associados em adolescentes institucionalizados. Esse estudo transversal incluiu 68 adolescentes do sexo masculino de um Centro de Atendimento Socioeducativo (CASE) com idades entre 15 e 19 anos. Questionários estruturados foram aplicados individualmente para acessar variáveis sociodemográficas, econômicas, médicas, comportamentais e autopercepção de saúde bucal. Todos os dentes presentes foram avaliados pelo Índice de dentes Cariados, Perdidos e Obturados (CPOD). A prevalência de perda dentária foi analisada em indivíduos com ≥1 dente perdido. Associações entre perda dentária e variáveis de exposição foram analisadas por regressão de Poisson com estimativa de variância robusta. A prevalência de perda dentária foi 47,06%. Primeiros molares na mandíbula e maxila e incisivos centrais na maxila foram os dentes mais ausentes. No modelo multivariado, número de dentes cariados esteve associado com perda dentária, e aqueles que faziam uso diário de medicações foram associados a maior perda dentária. Além disso, perda dentária foi associada com cárie dentária e uso diário de medicação. Promoção de saúde bucal e seu tratamento devem ser implementados nessas instituições para reduzir a prevalência de perda dentária nesses adolescente

Associated Factors With Self-reported Systemic Arterial Hypertension and Diabetes in Brazilian Older Adults: Populational-Based Cross-Sectional Study

Objective: This cross-sectional study aimed to assess the prevalence and associated factors of Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) in older adults.Materials and Methods: Self-reported SAH and DM (outcomes) were obtained through a structured questionnaire. This questionnaire also collected the independent variables (sociodemographic characteristics, use of medication and access to the oral health service). Obesity, physical activity, and tooth loss were assessed using validated instruments. Crude and adjusted Poisson regression with a robust error variance were performed to determine the prevalence ratio (PR) and 95% confidence interval (CI).Results: A total of 282 older adults were included, with the prevalence of 71.28% and 21.63% for SAH and DM, respectively. SAH was significantly associated with increase in the individuals’ age (PR:1.01; 95%CI:1.00–1.02) and the positive diagnosis for obesity (PR:1.24; 95%CI:1.09–1.43). Those that do not use drugs for other conditions  (PR:0.74; 95%CI:0.60–0.71) presented significantly lower PR for SAH. Non-sedentary older adults have the lower RP of DM (PR: 0.42; 95%CI: 0.24–0.74).Conclusions: A high prevalence of SAH and DM was observed among the older adults, and the main associated factors were mainly related to demographic characteristics, general health and behavioral habits

How efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone in the horizontal bone gain? A systematic review and meta-analysis

A systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to horizontal guided bone regeneration, ?how efficacious is the combination of substitute bone graft with autogenous bo

Antimicrobial potential of essential oils mouthrinses with and without alcohol : a randomized clinical trial

Aim: This study aimed to compare the microbiological potential and gustatory perception of essential oils (EO) mouthrinses containing and not containing alcohol. Methods:Twenty healthy adult volunteers rinsed with 10mL of the following test solutions: EO with alcohol, EO without alcohol, or a control solution (saline solution with mint essence). A washout period of at least seven days was adopted after a single-use protocol of the respective solution. All participants used all three tested substances. Antimicrobial potential was assessed by counting salivary total viable bacteria both before and after each rinse. Gustatory perception was evaluated using the Visual Analogue Scale (VAS). Multiple comparisons were performed with the Wilcoxon test, using Bonferroni correction. Results: Both EO solutions presented a higher antimicrobial potential in comparison to the control solution (p<0.017). However, no significant difference in antimicrobial potential was observed between EO containing or not containing alcohol (p=0.218). VAS of EO with alcohol (median: 2.7) was similar to control solution (median: 1.6) (p=0.287). A better gustatory perception was observed of the EO without alcohol (median 7.6) when compared to the control solution (p<0.0001). When EO groups were compared, EO without alcohol also demonstrated a significantly better gustatory perception (p=0.001). Conclusion: Mouthrinse containing EO without alcohol presented a better taste perception when compared to the EO with alcohol, but no difference was observed in the antimicrobial potential of both EO solutions after a single rinse protocol