Possible Link Between Chronic Periodontal Disease and Central Nervous System Pathologies

Systemic infection and/or inflammation has been related with an increased risk of brain abscesses, cerebrovascular disease, cognitive impairment and other pathological states of the brain. Therefore, it is plausible, that a chronic infection and inflammation disease, such as periodontitis, may affect the central nervous system (CNS). Chronic periodontal disease is a condition that causes breakdown of the supporting tissues of the teeth, alveolar bone and soft tissues. Chronic periodontitis is a multifactorial disease caused by dental plaque composed of pathogenic bacteria that triggers the immune response in susceptible hosts. Oral pathogenic bacteria is a source of chronic infection that can induce local and peripheral production of pro-inflammatory cytokines such as IL-1ß, IL-6 and TNF- , inflammatory mediators, as well as bacterial products such as lipopolysaccaride endotoxin. Viruses, such as herpes and Epstein-Barr, can also be found in periodontal pockets. It is well established that oral pathogenic microorganisms may cause systemic infection by transient or persistent bacteremia, disseminating within the body, and infiltrate distal sites and organs. It has been proposed that in vulnerable populations and under certain circumstances, bacterial and viral infections may enter the brain from the bloodstream. Once in the brain, infectious pathogens and inflammatory products may compromise vascular integrity. Thus, the potential role of the pathogenesis of chronic periodontitis in the development and progression of cerebral infection and inflammation can have a link. There is no direct evidence that determines whether oral diseases have a causal association with CNS pathologies, nonetheless there are several reports that have found oral periodontal pathogens lodged in the brain. Both inflammatory states may just share a casual connection with common risk factors and complex multifactorial etiologies. However, the possibility that pathogenic oral microorganisms disseminate to the bloodstream and reach the brain, initiating or exacerbating existing cerebral lesions, cannot be disregarded. In addition, not only periodontal pathogens may be involved in invading the brain, but also, the pro-inflammatory factors induced systemically by periodontitis, may play a role in CNS pathologies. This oral systemic link will be discussed in this paper. UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Neurociencias (CIN)UCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Efecto antibacteriano y antifúngico de tres enjuagues bucales comerciales con diferentes concentraciones de clorhexidina

Chlorhexidine was introduced almost seven decades ago and has a myriad of applications in dentistry. Few studies have evaluated the antimicrobial and antifungal capacity of different concentrations of chlorhexidine mouthwashes. Therefore, the aim of this study, was to evaluate in vitro, the antibacterial and antifungal capacity of three commercially available mouthwashes in Costa Rica, with different concentrations of chlorhexidine, 0.12%, 0.06%, and 0.03%. The experimental method selected was the Kirby-Bauer method to evaluate the antibacterial and antifungal effect of each compound by measuring the inhibitory effect on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Candida albicans strains, exposed to the antiseptic solutions. All samples showed some degree of antibacterial and antifungal effect. Even though we provide in vitro results, our findings are of relevance since all the species used in our experiment are microorganisms that may be present in dental plaque. Our results further support evidence that oral hygiene regimens may include mouthwashes with low doses of chlorhexidine and maintain reasonable antibacterial and antifungal efficacy.La clorhexidina se introdujo hace casi siete décadas y tiene una gran variedad de aplicaciones en odontología. Pocos estudios han evaluado la capacidad antimicrobiana y antifúngica de diferentes concentraciones de enjuagues bucales con clorhexidina. Por lo tanto, el objetivo de este estudio fue evaluar in vitro, la capacidad antibacteriana y antifúngica de tres enjuagues bucales disponibles comercialmente en Costa Rica, con diferentes concentraciones de clorhexidina, 0.12%, 0.06% y 0.03%. El método experimental seleccionado fue el método Kirby-Bauer para evaluar el efecto antibacteriano y antifúngico de cada compuesto midiendo el efecto inhibidor sobre Staphylococcus aureus, Enterococcus faecalis, Escherichia coli y Candida albicans, expuestos a la solución antiséptica. Todas las muestras mostraron algún grado de efecto antibacteriano y antifúngico. Aunque proporcionamos resultados in vitro, nuestros hallazgos son de relevancia, ya que todas las especies utilizadas en nuestro experimento son microorganismos que pueden estar presentes en la placa dental. Nuestros resultados respaldan aún más la evidencia de que los regímenes de higiene bucal pueden incluir enjuagues bucales con dosis bajas de clorhexidina y mantener una eficacia antibacteriana y antifúngica razonable.Laboratorios Stein///Costa RicaUniversidad de Costa Rica/[440-B9-022]/UCR/Costa RicaUCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Standarization of a protocol of immunohistochemistry for the detection of brain microglia in wistar rats

Objetivo: Estandarizar un protocolo de inmunohistoquímica que se ha utilizado ampliamente en ratones de la cepa C57BL/6J para identificar microglia del sistema nervioso central en ratas de la cepa Wistar. Materiales y Métodos: La presente actividad de investigación se llevó a cabo en dos partes. En la primera parte se implementó un protocolo de inmunohistoquímica para identificar la microglia en el sistema nervioso central de 6 ratas de la cepa Wistar. Se utilizó un anticuerpo primario para rata y un anticuerpo secundario específico para el primario. Una vez establecido el protocolo en cerebro de ratas, se pasó a la segunda parte en donde se produjo un reto inmunológico con la aplicación intraperitoneal de lipopolisacárido en 2 ratas de la cepa Wistar, con el fin de evidenciar los cambios en la morfología de la microglia. Resultados y Discusión: Demostramos que sin realizar grandes modificaciones al protocolo original, este también puede utilizarse para la identificación de microglia en ratas adultas de la cepa Wistar. El establecimiento de este protocolo permitirá estudiar de una mejor manera la interacción bidireccional que se da entre el cerebro y el sistema inmunológico, en condiciones homeostáticas y ante diferentes estímulos fisiológicos y patológicos.Objective: Standardize a protocol of immunohistochemistry that has been widely used in C57BL/6J mice to identify microglia of the central nervous system in Wistar rats. Materials and Methods: This research activity was carried out in two parts. In the first part, a protocol of immunohistochemistry was implemented to identify microglia in the central nervous system of 6 Wistar rats. A primary antibody with reactivity to rat and a specific secondary antibody to the primary were used. Once the protocol was established in rats' brains, an immunological challenge was produced with the intraperitoneal application of lipopolysaccharide in 2 Wistar rats, in order to evidence the changes in microglia morphology. Results and Discussion: We demonstrate that without making major modifications to the original protocol, it can also be used to identify microglia in adult Wistar rats. In the near future, this immunostaining protocol will be applied to elucidate the bidirectional interaction between the brain and the immune system, under homeostatic conditions and different physiological and pathological stimuli.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Neurociencias (CIN)UCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Salud gingival y su relación con la ingesta de diferentes tipos de alimentos y el índice de masa corporal en escolares de 12 años

Research on gingival health of 12-year-old schoolchildren in Costa Rica is scarce. Since nutrition is an integral component of oral health, this study aimed to determine gingival status of 12-year-olds at Carmen Lyra Public School, San José, Costa Rica, and correlate these variables with the frequency of intake of different types of food and body mass index (BMI (kg/m2)). Sixty-two 12-year-old schoolchildren were recruited. A periodontist assessed Plaque Index (Silness and Löe,1964), presence of calculus, and Gingival Index (Löe and Silness, 1967). Gingivitis was defined as the presence of bleeding on probing (BOP) on at least one site, and the extent was classified according to the percentage of teeth whose gingiva presented BOP limited: 25-49% of teeth tested; extensive >50% of teeth tested. A semi-quantified food consumption frequency questionnaire was administered. BMI was calculated for each participant. Overall Plaque Index was 1.18. Calculus was present on 40.40% of the sample, 19.4% had supragingival calculus and 21% had either supragingival/subgingival calculus or both. Presence of calculus was related with number of bleeding surfaces (p=0.030). Number of teeth with calculus was related to bleeding(p=0.029), and number of bleeding surfaces (p=0.009). Gingival Index was 0.97, mild gingivitis. Gingivitis was present on 96.8% of children examined. Limited gingivitis was present in 11.5% of children and extensive gingivitis in 88.5%. None of the variables measured differed by gender. No relationships were found between the consumption of starchy foods, animal and vegetable protein sources, fruit, vegetables, fast foods, sugar sweetened beverages and desserts with Plaque Index, calculus, Gingival Index, and BOP. Teeth calculus was related with being overweight (chi-square=0.038). BMI for males was 20.21 and females 20.11. BMI was not related to BOP or calculus. Within the limitations of this pilot study, we concluded the prevalence of gingivitis and calculus is high in the sample examined. A greater sample is needed to determine correlations between the frequency of foods evaluated and gingival health.La investigación sobre la salud gingival en escolares de 12 años en Costa Rica es escasa. Dado que la nutrición es un componente integral de la salud oral, este estudio tuvo como objetivo determinar el estado de salud gingival de los niños de 12 años de la escuela Carmen Lyra, San José, Costa Rica, y correlacionar estas variables con la frecuencia de ingesta de diferentes tipos de alimentos y el índice de masa corporal (IMC (kg/m2)). Sesenta y dos escolares de 12 años fueron reclutados. Una periodoncista calibrada, evaluó el índice de placa (Silness y Löe, 1964), la presencia de cálculo y el índice gingival (Löe y Silness, 1967). La gingivitis se definió como la presencia de sangrado al sondaje en al menos un sitio. La extensión se clasificó de acuerdo con el porcentaje de dientes que presentaba sangrado al sondaje. Entre un 25-49% de los dientes con sangrado al sondaje, gingivitis limitada y extensiva, si presentaba más del 50% de dientes con sangrado al sondaje. Se administró un cuestionario de frecuencia de consumo de alimentos. El IMC se calculó para cada participante. El índice de placa fue de 1,18. El cálculo estuvo presente en el 40.40% de la muestra, el 19.4% tenía cálculo supragingival y el 21% tenía cálculo supragingival / subgingival o ambos. La presencia de cálculo se relacionó con el número de superficies sangrantes (p=0.030). El número de dientes con cálculo, se relacionó con el sangrado (p=0.029) y el número de superficies sangrantes (p=0.009). El índice gingival fue de 0.97, gingivitis leve. La gingivitis estuvo presente en el 96,8% de los niños examinados. La gingivitis limitada estuvo presente en el 11.5% de los niños y la gingivitis extensa en el 88.5%. Ninguna de las variables evaluadas difirió por género. No se encontraron relaciones entre el consumo de harinas, fuentes de proteínas animales y vegetales, frutas, verduras, comidas rápidas, bebidas azucaradas y postres con el índice de placa, cálculo, índice gingival y sangrado al sondaje. El cálculo se relacionó con el sobrepeso (chi-cuadrado =0.038). El IMC para los hombres fue 20.21 y las mujeres 20.11. El IMC no estaba relacionado con el sangrado al sondaje o cálculo. Dentro de las limitaciones de este estudio piloto, concluimos que la prevalencia de gingivitis y cálculo es alta en la muestra examinada. Se necesita una muestra mayor para determinar las correlaciones entre la ingesta de los diferentes tipos de alimentos evaluados y la salud gingival.Universidad de Costa Rica//UCR/Costa RicaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de MedicinaUCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Dentogingival Complex: Dimension Based on Biotypes

Objective: Estimate the DGC dimensions and determine whether the DGC dimension varies by gingival biotype. Methods: A cross-sectional study was performed in the Undergraduate and Prosthodontic Graduate Program clinics of the School of Dental Medicine, University of Puerto Rico from August 2011 to April 2012. A total of 53 participants who needed restorative crowns in their teeth were recruited. Prior to crown preparation, the gingiva was classified as having a thin, mixed or thick biotype, according to transparency, using a standardized 15 UNC Hu-Friedy® periodontal probe. The DGC dimension was measured by transulcus probing. Descriptive statistics were calculated in mesial, medial, and distal sites by phenotypes. Differences between and within the sites’ DGC dimension mean were determined using a Friedman test. The level of significance was 0.05. Results: Mean DGC dimensions, in millimeters, for all sites measured were: 3.09 (95% CI: 2.91-3.27), 3.40 (95% CI: 3.18-3.62), 2.70 (95% CI: 2.51-2.89), and 3.17 (95% CI: 2.94-3.41) in mesial, medial, and distal sites, respectively. In thick, mixed, and thin biotypes the mesial sites showed greater DGC dimension means than the medial and distal (p<0.05) sites. Mean DGC dimension was greater for the thin compared to mixed and thick biotypes at mesial, medial and distal sites (p<0.001). Nevertheless, the thick biotype presented the smallest DGC mean dimensions compared to mixed and thin biotypes at the same sites. Conclusion: The DGC dimensions in all sites were similar to those reported in the literature. DGC dimensions are different for thin, mixed and thick gingival biotypes.National Center for Research Resources/[U54 RR 026139-01A1]//Puerto RicoNational Institute on Minority Health and Health Disparities/[8U54 MD 007587-03]//Puerto RicoUCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Estado gingival y presencia de bacterias del complejo rojo en escolares de 12 años

The objective of this study was to determine the gingival state and presence of red complex bacteria in saliva samples of 12-year-old schoolchildren. A calibrated periodontist evaluated biofilm index (BI) (Silness and Löe, 1964), presence of calculus, and gingival index (GI) (Silness and Löe, 1967) in sixty two 12-year-old students of Carmen Lyra School. Saliva samples were collected from each student. The DNA of each sample was extracted and amplified by the polymerase chain reaction (PCR) technique, using specific primers. The BI was 1.18. Calculus was present in 40.40% of the schoolchildren examined; 19.4% was supragingival calculus and 21% both supragingival and subgingival calculus. The GI was 0.97, which according to Silness and Löe is mild gingivitis. Gingivitis was present in 96.8% of the children examined. Regarding the PCR tests: 18 of the samples (31.58%) did not present any of the bacteria analyzed and the remaining 39 samples (68.42%) were positive for at least the presence of red complex bacteria. Within the limitations of this study, it is concluded that the prevalence of gingivitis and calculus is high in the sample examined, and the gingival state observed in the study population, may be related to the presence of red complex bacteria.El objetivo de este estudio era determinar el estado gingival y la presencia de bacterias del complejo rojo en muestras de saliva de niños de 12 años de la Escuela Carmen Lyra. Una periodoncista calibrada evaluó en 62 estudiantes de 12 años de la Escuela Carmen Lyra, el índice de biofilme (IB) (Silness y Löe, 1964), la presencia de cálculo y el índice gingival (IG) (Silness y Löe, 1967). Se recolectaron muestras de saliva de cada estudiante. El ADN de cada muestra fue extraído y amplificado por medio de la prueba PCR, empleando primers específicos, para determinar la presencia de bacterias del complejo rojo. El IB fue de 1.18. El cálculo estuvo presente en el 40.40% de la muestra, se encontró 19.4% de cálculo en supragingival y 21% tanto en supragingival como en subgingival. El IG fue de 0.97, que de acuerdo con Silness y Löe es una gingivitis leve. La gingivitis estuvo presente en el 96.8 % de los niños examinados. Con respecto a las pruebas PCR: 18 de las muestras (31.58 %) no presentaron ninguna de las bacterias analizadas y las 39 muestras restantes (68.42 %) fueron positivas por lo menos a la presencia de las bacterias del complejo rojo. Dentro de las limitaciones de este estudio, se concluye que la prevalencia de gingivitis y cálculo es alta en la muestra examinada y el estado gingival observado puede estar relacionado con la presencia de bacterias del complejo rojo.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigación en Biología Celular y Molecular (CIBCM)UCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: a cross-sectional study

Background: Gingivitis is a common oral health problem. Untreated gingivitis may progress to periodontitis, a common cause of tooth loss. The prevalence of gingivitis and calculus among Puerto Rican children is unknown. Understanding this prevalence can support early public health preventative strategies. This study aims to estimate the prevalence of gingivitis and calculus among 12-year-old Puerto Ricans by health region and to explore differences in distribution by school type (proxy for socio-economic status) and gender. Methods: A probability-based sample of 113 schools was selected proportional to enrollment size and stratified by health region, school type, and gender. Two trained examiners evaluated the presence of gingivitis and both supragingival and subgingival dental calculus. Gingivitis was defined as the presence of gingival bleeding upon gentle probing (BOP) in at least one site, and the extent of the problem was classified according to the percentage of teeth whose gingiva presented BOP (limited: 25–49% of the teeth tested; extensive: >50% of teeth tested). Logistic and linear regression models, adjusted for health regions, were used to compare gingivitis and calculus prevalence and extent between genders and school types. Results: Gingivitis was found in 80.41% of the 1586 children evaluated. Urban-public schoolchildren had a slightly higher prevalence (83.24%) compared to private (79.15%, p = 0.16); those in rural-public (77.59%) and private schools had similar prevalence (p = 0.15). Extensive gingivitis was present in 60.81% of all children. The mean percentage of sites presenting BOP (BOP%) was 17.79%. Rural and urban public schoolchildren presented significantly higher BOP% compared to children from private schools (p = 0.0005, p = 0.002, respectively). Dental calculus was detected in 61.59% of the sample, boys presenting significantly higher (p = 0.005) total and supragingival calculus. Rural-public schoolchildren had a significantly higher prevalence of subgingival calculus compared to private schoolchildren (p = 0.02). Conclusions: Gingivitis prevalence is higher among 12-year-old Puerto Ricans compared to data reported for U.S. adolescents. Public schoolchildren presented significantly higher BOP% sites compared to private schoolchildren. Boys presented a significantly higher total and supragingival calculus prevalence than girls. Oral health disparities related to gender and school type were identified by this study. Studies exploring the reasons for these disparities are recommended.National Institutes of Health/[S21MD001830]//Puerto RicoColgate-Palmolive (Caribe) Inc.///Puerto RicoUCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Efficacy in reducing dentine hypersensitivity of a regimen using a toothpaste containing 8% arginine and calcium carbonate, a mouthwash containing 0.8% arginine, pyrophosphate and PVM/MA copolymer and a toothbrush compared to potassium and negative control regimens: An eight-week randomized clinical trial

Objective Evaluate the efficacy of three regimens integrating toothpaste, toothbrush and mouthwash in reducing dentine hypersensitivity. Methods Eight-week single-centre, three-cell, double-blind, randomized study was conducted in the Dominican Republic. Subjects entered one of the three regimens: (1) toothpaste containing 8% arginine and 1450 ppm mono-fluorophosphate, in a calcium carbonate base, a soft-bristle toothbrush followed by a mouthwash containing 0.8% arginine, PVM/MA copolymer, pyrophosphates, and 0.05% sodium fluoride; (2) toothpaste containing 5% potassium nitrate and 1450 ppm sodium fluoride, a soft-bristle toothbrush, followed by a mouthwash containing 0.51% potassium chloride and 230 ppm sodium fluoride; and (3) toothpaste containing 1450 ppm mono-fluorophosphate, a soft-bristle toothbrush followed by a fluoride/arginine free mouthwash. Tactile and Air-Blast dentine hypersensitivity measurements were performed at baseline, two, four, and eight weeks. For treatment group comparisons, ANCOVA and post hoc Tukey's pair-wise (α = 0.05) were used. Kaplan–Meier survival analysis was performed to evaluate Time to Treatment Improvement. Results 120 subjects were enrolled, 118 completed the study. The Tactile hypersensitivity mean scores showed statistically significant improvement at two, four and eight (p ≤ 0.001) weeks in the arginine regime; the potassium regime did not show significant (p ≥ 0.05) improvement. Air-Blast Hypersensitivity scores had a statistically significant decrease at two (p = 0.006), four (p = 0.006) and eight (p = 0.002) weeks in arginine and potassium regimes (p ≤ 0.05). The most effective treatment proved to be arginine (p ≤ 0.05) compared to the potassium regime. Conclusion Arginine regimen provided the greatest reduction in Tactile and Air-Blast dentine hypersensitivity compared to potassium and negative control regimens; and provides faster dentine hypersensitivity relief than potassium regimen.Colgate-Palmolive Company///Estados UnidosUCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí

Guest Editorial (Odovtos 21(2))

Childhood overweight and obesity are serious public health problems worldwide. Factors such as inadequate nutrition and decreased practice of exercise, are modifiable variables, therefore, overweight and obesity should be prevented from very early ages, to reduce the likelihood of suffering later in life of diabetes, cardiovascular disease, stroke, and some types of cancer. In addition, overweight and obesity, are linked to leading causes of deaths globally.UCR::Vicerrectoría de Docencia::Salud::Facultad de Odontologí