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

Repeated metronidazole and amoxicillin treatment of periodontitis. A follow-up study

Background: The prevailing concept is that little or no clear benefit is derived from antibiotic therapy in chronic periodontitis. Studies to determine the effect of metronidazole plus amoxicillin (M+A) on adult periodontitis are questionable because standard design for clinical trials was usually not used. In addition, there is no information about the effect of M+A as the sole therapy for periodontitis. Methods: A randomized, triple- blind, controlled clinical trial was used to determine the effect of systemic administration of M+A, as the sole therapy, in progressive adult periodontitis. Forty-six subjects with moderate to advanced adult periodontitis who showed ≥2 mm attachment loss in at least 2 sites in the previous 2 months were entered in the study. Subjects were randomly distributed to a group who received 21 tablets of metronidazole 250 mg plus amoxicillin 500 mg, or to a group receiving a placebo (1 tablet every 8 hours for 1 week)

Effects of metronidazole plus amoxicillin in progressive untreated adult periodontitis: results of a single 1-week course after 2 and 4 months

A randomized, double-blind, clinical study was done to assess the microbiological and clinical effects of metronidazole plus amoxicillin (M+A) as the only therapy in 46 patients with moderate to advanced progressive adult periodontitis. Patients were included in the study after at least 2 sites showed > or =2 mm clinical attachment loss. Bleeding on probing, probing depth, and clinical attachment level were measured using on automated probe. The percentage of surfaces with plaque was recorded at day 0, and at 2 and 4 months after therapy. No effort was made to change the oral hygiene habits of patients. Identification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia was assessed utilizing DNA technology at day 0 and 2 months after therapy. Twenty-three patients received metronidazole 250 mg plus amoxicillin 500 mg, 3 times/day for a week and 23 a placebo. Two patients in the placebo group were dropped at 2 months because they had taken antibiotics for medical reasons. Statistical analyses of differences between groups was done using the Mann-Whitney test, and the differences within each group were tested with ANOVA. There were no significant changes in surfaces with plaque in either group after therapy. The percentage of bleeding sites decreased significantly from baseline to 2 and 4 months in the M+A group (P = 0.001), and increased in the placebo group. Differences in bleeding on probing between groups were significant at 2 (P = 0.018), and 4 months (P = 0.005). The mean attachment level values at 2 and 4 months post-therapy improved significantly in the M+A group compared to the placebo group (P = 0.001). Treatment with M+A resulted in a significant mean reduction in probing depth at 2 and 4 months compared to baseline values (P = 0.001). The M+A group showed a significant reduction of sites with high levels of Pg (P = 0.001) at 2 months compared with baseline values, and there was a significant reduction of sites with Pg and Pi in the M+A group compared with the placebo group. The results showed that a combined M+A treatment as the only therapy changes the proportion of some subgingival microorganisms and allows a significant improvement in clinical conditions

Respuesta inmune Th1 en la osteoarthritis de la articulación temporomandibular

Propósito. La osteoartritis temporomandibular es una enfermedad articular degenerativa, caracterizada por la destrucción del cartílago y hueso articular consecutiva a la respuesta inflamatoria e inmune desarrollada. En el presente trabajo se evalúa la expresión a nivel de ARN mensajero de diversas citoquinas proinflamatorias en los sinoviocitos articulares de individuos afectados por osteoartritis temporomandibular. Material y métodos. En 12 pacientes afectados de osteoartritis temporomandibular y en 6 sujetos sanos se evaluó la expresión de citoquinas en sinoviocitos de la articulación temporomandibular mediante la técnica de PCR cuantitativa en tiempo real. Resultados. Significativamente mayores niveles de IL-1β, IL-2, IL-12, IL-17, TNFα, TNFβ e IFNγ fueron observados en pacientes afectados de osteoartritis temporomandibular en comparación a sujetos sanos. En los sujetos enfermos la citoquina predominante fue IL-12 y en los sanos fue IL-10. Conclusión. Tomados en conjunto, nuestros datos demuestran una asociación de elevados niveles de citoquinas propias de una respuesta inmune Th1 y la destrucción observada durante la osteoartritis temporomandibular

Levels of interleukin-1β, -8, and -10 and RANTES in gingnival crevicular fluid and cell populations in adult periodontitis patients and the effect of periodontal treatment

Background: Various cytokines have been identified at sites of chronic inflammation such as periodontitis. Cytokines are synthesized in response to bacteria and their products, inducing and maintaining an inflammatory response in the periodontium. The purpose of the present study was to investigate the involvement of interleukin-1β (IL-1β), IL-8, and IL-10 and RANTES (regulated on activation, normally T cell expressed and secreted) and the cell populations associated with the immune response in destructive periodontitis, as well as the effect of periodontal therapy on cytokine levels in gingival crevicular fluid (GCF). Methods: Data were obtained from 12 patients with moderate to advanced periodontitis and 6 healthy controls. Patients presenting at least 2 sites with ≥2 mm clinical attachment loss were included in the destructive periodontitis group. After monitoring for 4 months, only 6 patients showed destructive periodontitis and GCF samples and soft tissues biopsies were collecte

New knowledge of the pathogenesis of periodontal disease.

The aim of this study was to evaluate the relationship between the accumulation of interleukins IL-1beta, TNF-alpha, IL-8, and chemokine RANTES (Regulated upon Activation Normal T-cell Expressed and Secreted) in gingival fluid and periodontal support tissues in patients with periodontitis. A review is also provided of apoptotic processes as events of major importance, highlighting the presence of TUNEL cells and ultrastructural morphologic changes associated with cell apoptosis. There appears to be further evidence to support the important role of inflammation control. Cytokines may be considered as markers of the progression and severity of periodontitis as well as indicators of an appropiate response to treatment. However, further studies are needed to support and characterize this concept

Prevalance of clinical attachment loss in adolescents in Santo Domingo, Dominican Republic

Background: Data on periodontal conditions in adolescents in the Dominican Republic are scarce. The aim of the present crosssectional study was to estimate the prevalence of periodontal attachment loss among Dominican adolescents. This study did not attempt to classify the disease into aggressive and chronic periodontitis. Methods: A random sample of 2,007 Dominican adolescents was obtained. A probability, weighted sample was selected using a complex, multi-stage probability sampling design. The study was clustered in 26 schools and 106 classes. The study subjects were clinically examined under field conditions by a single calibrated examiner who measured gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Results: The prevalence of clinical attachment loss ≥1 mm was 49.5%, with the prevalence ranging between 48.7% and 50.2%, depending on age and gender. Clinical attachment loss ≥2 mm was found in 15% of the students and attachment loss ≥3 mm in 4.0% of the students. Logistic regression model revealed that only age significantly increased the probability of having clinical attachment loss. Conclusion: We conclude that clinical attachment loss is common in adolescents in Santo Domingo, Dominican Republic, suggesting the necessity for improved standards of prevention, diagnosis, and treatment of these lesions

Levels of cytokine receptor activator of nuclear factor κB ligand in gingival crevicular fluid in untreated chronic periodontitis patients

Background: Receptor activator of nuclear factor κB ligand (RANK-L) is a cytokine involved in the regulation of osteoclastogenesis in bone remodeling and inflammatory osteolysis. One of the major causes of tooth loss in humans is bone destruction. The aim of our study was to determine the presence of RANK-L in gingival crevicular fluid (GCF) samples from adult patients with untreated chronic periodontitis and in healthy controls. We also identified the RANK-L present in lesions undergoing episodic attachment loss from GCF. Methods: GCF samples were collected from two periodontally affected sites (probing depth ≥5 mm, attachment loss ≥3 mm) in 20 patients (N = 40). After monitoring for 4 months, seven patients showed active periodontal disease, and GCF samples were collected from one active and one inactive site (N = 14 samples). The comparison with healthy controls was carried out by collecting GCF samples from 12 healthy volunteers (N = 24 samples). GCF was collected using a paper strip, and enzymelinked immunosorbent assay (ELISA) was performed to determine the total amount of RANK-L. Results: RANK-L was found in a higher proportion (85%) of samples from patients than from controls (46%). The total amount of RANK-L was significantly higher in patients (115.53 ± 78.18 picograms [pg]) than in healthy subjects (63.08 ± 55.08 pg) (P = 0.003). Active sites, presumably associated with tissue destruction, had significantly higher levels of RANK-L than their inactive counterparts (125.95 pg versus 91.80 pg, P = 0.007). Conclusion: GCF total amount of RANK-L is significantly increased in periodontal disease, supporting its role in the alveolar bone loss developed in this disease

The subgingival microbiome in health and periodontitis and its relationship with community biomass and inflammation

The goals of this study were to better understand the ecology of oral subgingival communities in health and periodontitis and elucidate the relationship between inflammation and the subgingival microbiome. Accordingly, we used 454-pyrosequencing of 16S rRNA gene libraries and quantitative PCR to characterize the subgingival microbiome of 22 subjects with chronic periodontitis. Each subject was sampled at two sites with similar periodontal destruction but differing in the presence of bleeding, a clinical indicator of increased inflammation. Communities in periodontitis were also compared with those from 10 healthy individuals. In periodontitis, presence of bleeding was not associated with different α-diversity or with a distinct microbiome, however, bleeding sites showed higher total bacterial load. In contrast, communities in health and periodontitis largely differed, with higher diversity and biomass in periodontitis. Shifts in community structure from health to periodontitis resembled ecological succession, with emergence of newly dominant taxa in periodontitis without replacement of primary health-associated species. That is, periodontitis communities had higher proportions of Spirochetes, Synergistetes, Firmicutes and Chloroflexi, among other taxa, while the proportions of Actinobacteria, particularly Actinomyces, were higher in health. Total Actinomyces load, however, remained constant from health to periodontitis. Moreover, an association existed between biomass and community structure in periodontitis, with the proportion of specific taxa correlating with bacterial load. Our study provides a global-scale framework for the ecological events in subgingival communities that underline the development of periodontitis. The association, in periodontitis, between inflammation, community biomass and community structure and their role in disease progression warrant further investigation