Impacto do tratamento restaurador na prevenção da perda de dentes

A cross-sectional study was carried out to analyze tooth loss resulting from caries in relation to the number of times the extracted tooth had been restored, the type of caries diagnosed (primary or secondary), and socioeconomic indicators of patients from the city of Recife, Brazil. Ten public health centres and ten centres associated with health insurance companies were randomly selected. The size of the sample was calculated using a standard error of 2.5%. A confidence interval of 95% and a 50% prevalence of reasons for extractions were used for calculating the sample. The minimum size of the sample for meeting these requirements was 381 patients. Patients were randomly selected from the list of adults registered at each centre. A total of 410 patients were invited to take part in the study. The response rate was 100%, but 6 patients were excluded due to incompleteness of data in the questionnaire applied. An assessment was made to obtain the number of decayed, missing or filled teeth (DMFT index) and the reasons for extraction. The results showed a highly significant (p < 0.001) relationship between the number of times the tooth indicated for extraction had been restored and the reason for extraction being caries. Furthermore, the majority of teeth extracted due to caries had been restored two or more times. A highly statistically significant association was also observed between one indicator of use of dental services (F/DMFT) and extraction due to caries (p < 0.001). The findings questioned the belief that tooth loss can be prevented in the general population by merely providing restorative treatment.Um estudo transversal foi conduzido com o objetivo de analisar a perda dentária, pela razão cárie, em relação ao número de vezes que o dente extraído foi restaurado, tipo de cárie diagnosticada (primária ou secundária) e indicadores socioeconômicos de pacientes na cidade de Recife, Brasil. Dez centros do Sistema Público de Saúde e dez pertencentes a empresas de convênios foram sorteados. O tamanho da amostra foi calculado utilizando-se um erro padrão de 2.5%. O intervalo de confiança de 95% e uma prevalência de razões de extração na ordem de 50% foram usados para o cálculo da amostra. Uma amostra mínima requerida de 381 pacientes foi calculada, sendo examinados um total de 410 pacientes sorteados da lista de atendimento dos postos. 100% dos pacientes concordaram em participar da pesquisa, contudo, seis pacientes foram excluídos do estudo por apresentarem dados incompletos no questionário aplicado. Os pacientes foram examinados para a obtenção do CPOD e da razão das extrações. Cárie foi a principal razão para exodontia (p < 0,001). Analisando-se a relação entre o número de vezes que o dente foi restaurado e a razão da exodontia, observou-se um valor altamente significativo (p < 0,001), indicando que a maioria dos dentes extraídos pela razão cárie foram restaurados duas ou mais vezes. Foi observada uma relação altamente significativa estatisticamente entre um indicador de uso de serviços (O/CPOD) e exodontia devido a cárie (p < 0,001). Os achados demonstraram que é errônea a crença de que a perda dentária pode ser prevenida na população simplesmente pela restauração do dente

Marcadores salivares para a periodontite crônica no diabético tipo 2

Introdução: a periodontite crônica é a sexta doença infecciosa mais prevalente no mundo, seus fatores de risco são o aumento da idade, tabaco, fatores genéticos, obesidade e distúrbios sistêmicos como o diabetes.  O diabetes é uma pandemia tanto em países desenvolvidos como em desenvolvimento, é uma doença complexa com graus variados de complicações sistêmicas e orais. Assim, é urgente a necessidade de um método fácil para detectá-la permitindo a intervenção antes da progressão da doença periodontal. Á análise de metabólitos da saliva tem sido proposta como uma ferramenta efetiva para o diagnóstico e tratamento periodontal. Objetivo: discorrer sobre alternativas de diagnóstico de periodontite crônica em pacientes diabéticos tipo 2 utilizando marcadores salivares. Metodologia: Foi realizada uma busca eletrônica no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), para a realização do referido levantamento, utilizou-se os descritores “Type 2 diabetes mellitus, chronic periodontitis, Biomarkers, Saliva”.   Resultados: a detecção precoce da periodontite crônica não é apenas vital para reduzir a sua gravidade e prevenir complicações, mas também crítico para aumentar a taxa de sucesso da terapia. Conclusão: a utilização de biomarcadores na medicina é uma realidade difundida e tem relação direta com a modernização dos meios de saúde, na odontologia vem se pleiteando seu uso, mas ainda necessita de maiores estudos e aperfeiçoamentos das técnicas já empregadas com o intuito de diminuir seus custos, aumentar especificidade e acesso dos profissionais de saúde

Evaluation of Oral Hygiene in Patients with Visual Disabilities

Introduction: Patients with visual impairment present greater difficulty in achieving adequate oral hygiene due to restricted eyesight. Therefore, oral hygiene motivation and instruction methods should be adapted to these patients to understand the importance of bacterial plaque control, both for the health of dental tissues and periodontal tissues Objective: The objective of the present study was to compare the plaque index (PI) of patients with and without visual impairment before and after the institution of oral hygiene instructions through a Randomized Clinical Trial. Twenty patients with visual impairment (Group 1) from the Instituto dos Cegos and 20 without visual impairment (Group 2) from the ASCES Periodontia Clinic were selected. Data were collected through the IP of O'Leary and reevaluated every 21 days for four sessions. Results: in both groups, the mean of PI decreased with the time of evaluation, with a significant difference between the evaluations (p &lt;0.001). Group 1 had a mean PI higher than group 2 only in the fourth evaluation, but there was no significant difference (p&gt; 0.05). As for the mean of the PI assessments, group 2 presented a mean higher than group 1, but without significant difference (p&gt; 0.05). Conclusion: The study therefore suggests that there is no difference in PI in patients with or without visual impairment, and that the guidelines stimulate and motivate an improvement in oral hygiene conditions

A Fast Method for DEFB1-44C/G SNP Genotyping in Brazilian Patients with Periodontitis

Svrha: Defensini su kationski antimikrobni peptidi koji se pojavljuju u epitelnim stanicama. Imaju antimikrobna, antifungalna i antivirusna svojstva te su prirođena komponenta imunosnog odgovora. Jedna od hipoteza jest da peptidi štite usnu šupljinu. U ovom istraživanju procijenili smo polimorfizam gena DEFB1 kod dijabetičara s parodontitisom ili bez njega i rezultate usporedili sa zdravom kontrolnom skupinom. Materijali i metode: Koristili smo se testom Hairpin-Shaped Primer (HP) kako bismo istražili rasprostranjenost - 44 C/G SNP-a (rsl1800972) u 119 uzoraka ljudske DNK dobivene od dijabetičara i zdravih pacijenata. Rezultati: Rezultati su pokazali da između grupa nema razlika u rasprostranjenosti, te da je kod dijabetičara s parodontitisom češći homozigotni mutant. Zaključak: Potrebna su daljnja istraživanja kako bi se otkrila uloga polimorfizma DEFB1 kod dijabetičara s parodontitisom te utjecaj peptida na parodontne patogene.Aim: Defensins are cationic antimicrobial peptides expressed in epithelial cells. Such peptides exhibit antibacterial, antifungal and antiviral properties, and are a component of the innate immune response. It has been suggested that they have a protective role in the oral cavity. This study evaluated the DEFB1 polymorphism in diabetic patients with or without periodontitis in comparison to healthy controls. Material and Methods: We used Hairpin-Shaped Primer (HP) assay to study the distribution of the -44 C/G SNP (rs1800972) in 119 human DNAs obtained from diabetic patients and healthy control patients. Results: The results indicate that there are no differences in distribution between groups and that in diabetic periodontitis patients the homozygous mutant could be found more frequently. Conclusion: Further studies are necessary in order to investigate the role of DEFB1 polymorphisms in diabetic periodontitis patients and the influence of the peptide in periodontal pathogens

Prosthetic Rehabilitation in Older Adult with Free Gingival Graft: Case Report

Aim: The aim of the present study was to perform the clinical evaluation of the thickness of the soft tissue around dental implants using a free gingival graft obtained from the palate. Background: Rehabilitation in elderly patients improves physiological functions and quality of life, and when this rehabilitation involves a surgical stage, it becomes a challenge, even for more experienced surgeons. Methods: a 64-year-old, white, female patient with a complaint of difficulty chewing and discomfort stemming from her dental status. Rehabilitation was proposed involving a multidisciplinary approach to reestablish esthetics, function and wellbeing. For such, 4.1 Bone Level Tapered® implants were installed. During the presurgical preparation, a free gingival graft was planned to increase the gingival area using the Miller technique. After establishing the suitability of the oral environment, impressions were made in alginate for the fabrication of an acrylic surgical stent to protect the donor site on the hard palate and minimize the morbidity of the surgical intervention. Conclusion: In the case reported, the increase in the gingival tissue using a free gingival graft provided satisfactory peri-implant health in an older patient &nbsp;throughout annual follow-up for 15 years

Association of Polymorphism of the MBL2 Gene in Type 2 Diabetic Patients with Periodontitis: A Preliminary Study

Svrha: Lektin koji veže manozu (MBL) važan je protein urođenog imunološkog sustava. Sposoban je vezati se za šećerne skupine na površini mnogih mikroorganizama i aktivirati komplement u interakciji sa serinskim proteazama. Mutacije ekspresije humanog gena MBL2 povezane su s nekoliko infektivnih bolesti; ovom preliminarnom istraživanju svrha je bila odrediti povezanost polimorfizma na eksonu-1 gena MBL2 i parodontne bolesti kod pacijenata s dijabetesom tipa 2. Ispitanici i postupci: Istraživanjem je bilo obuhvaćeno 50 pacijenata s dijabetesom i svi su na početku bili na kliničkom parodontološkom pregledu na kojemu je na šest mjesta na zubu bila određena dubina sondiranja džepova, krvarenje nakon tog postupka, klinička recesija, zubni plak i broj vlastitih zuba kod pojedinog sudionika. Parodontna bolest definira se kao gubitak pričvrstka od pet milimetara ili više na četiri ili više mjesta, a barem na jednomu treba biti izmjeren džep od četiri ili više milimetara (Beckov kriterij). Bilo je provedeno i prikupljanje stanica oralne sluznice brisom, a detekcija polimorfizma obavljena je tehnikom kvantitativnog RT-PCR-a (real time PCR) pomoću analize krivulje temperature mekšanja. Rezultati: Podaci su pokazali da nema statistički znatnih razlika u frekvenciji genotipova (p=0,564) ili alela (p=0,643) između zdravih ispitanika i onih s parodontitisom. Zaključak: U istraživanom uzorku polimorfizam eksona 1 gena MBL2 nije se mogao povezati s parodontnom bolesti.Aim: Mannose-binding lectin (MBL) is an important protein of the innate immune system. It is able to bind to sugar groups encountered on the surfaces of a wide range of microorganisms and interacts with serine proteases (MASPs) to effect the activation of complement. Mutations of the expressed human MBL2 gene have been associated with several infections; this preliminary study thus sets out to assess the association between the polymorphism in exon-1 of the MBL2 gene and periodontal disease in type 2 diabetic patients. Material and Methods: The sample comprised 50 diabetic patients, who were submitted to a clinical periodontal examination that evaluated in six sites per tooth probing depth, bleeding on probing, clinical recession, dental plaque and the number of teeth present. Periodontal disease was defined as 4+ sites of loss of attachment of 5+ mm, with one or more of those sites having a pocket of 4+ mm (Beck’s criteria). The collection of scaling cells from the oral mucosa was carried out and the detection of polymorphism was made by the technique of real time PCR (RT-PCR) using the melting temperature curve analysis. Results: The data revealed that no statistically significant differences in the genotype (p=0.564) or the allele (p=0.643) frequencies were observed among the healthy individuals or those with periodontitis. Conclusions: The polymorphism in exon-1 of the MBL2 gene was not related to the periodontal disease in the sample evaluated

Are there differences between partial and total periodontal examination of the mouth?

Background: Diagnosis of periodontal disease for epidemiologic survey is difficult due to complexity of periodontal exam. The aim of this study was &nbsp;to compare data from a full-mouth examination and a partial-mouth examination, observing the agreement between both methods of presenting the Community Periodontal Index (CPI). Methods and Findings: The population comprised of male and female subjects, aged 18 years and over, attending public health centers in the city of Recife, Brazil. A total of 505 patients participated in this study. Each participant completed a form and underwent periodontal examination. Firstly, for each tooth present one of the periodontal conditions was determined: periodontal health, gingival bleeding, dental calculus, shallow periodontal pockets and deep periodontal pockets, according to CPI. Finally, partial data (10 index teeth) was recorded derived from the total version of CPI. Bivariate analysis of frequencies and means was performed. Mc Nemar test was used to calculate the level of statistical significance of the association tested. There are significant statistical differences between partial and full-mouth examination (p&lt;0.001). According to gender, men classified as score 1 presented the same prevalence in both methods; partial recording overestimated 0.2% of women classified as score 1; percentile difference among men was higher for subjects classified as score 0. Among subjects with at least one tooth with deep periodontal pocket, percentile difference between different approaches was higher among elders (60 years and over). Conclusions: Considering the variable age, the smaller amount of lost information refers to periodontal pockets in individuals aged 18 to 30 years of age. In older individuals classified as periodontally healthy and with gingival bleeding no loss of information was observed. Partial examination of the mouth underestimated the presence of periodontal pockets and overestimated the presence of calculus and bleeding. A high concordance between the partial and total examination was observed

Periodontal Condition and Tooth Loss in Rheumatoid Arthritis Patients

Svrha rada: Parodontopatije i reumatoidni artritis (RA) slični su u osnovnim patološkim procesima. Kronična upala i disfunkcija sustava imunosti glavna su obilježja obiju bolesti koje potiču citokini kao medijatori upale. U ovoj studiji procijenjeno je stanje parodonta i gubitak zuba kod oboljelih od reumatoidnog artritisa te je njihovo stanje uspoređeno sa zdravim sudionicima u istraživanju. Materijali i metode: U istraživanju je sudjelovalo 106 pacijenata – 53 s dijagnosticiranim RA-om i 53 zdravih u kontrolnoj skupini. Svi su bili razvrstani prema spolu i dobi. Zabilježeni su i podaci o socijalno-ekonomskom statusu te o oralnom i sistemskom zdravlju. Klinički stomatološki pregled sastojao se od šest mjerenja svakog zuba. Vrijednosti dobivene za krvarenje pri sondiranju (BOP), dubina sondiranja (PD), razina kliničkog pričvrstka (CAL) i broj zuba zabilježeni su za svakog pacijenta. Dijagnoze parodontitisa postavljene su na temelju kriterija Američke akademije za parodontologiju (American Academy of Periodontology), a RA je dijagnosticiran prema mjerilima Američkoga studija reumatologije (American College of Rheumatology). Rezultati: Pacijenti s RA-om imali su mnogo viši postotak BOP-a te znatno veći CAL u usporedbi s kontrolnom skupinom (p < 0,001 za svaki indeks). U skupinama nije bilo razlike u gubitku zuba. Zaključak: Pacijenti s dijagnozom RA imali su lošije stanje parodonta nego sistemski zdravi.Aim: Periodontal disease and rheumatoid arthritis (RA) have similar underlying pathological processes. Chronic inflammation and immune dysfunction are central to both diseases, and both are modulated by cytokines, as mediators of inflammation. This study evaluated the periodontal condition and tooth loss in RA patients and compared them with systemically healthy patients. Material and Methods: In total, 106 subjects participated: 53 with RA and 53 healthy controls, paired by gender and age. We recorded socioeconomic data and information about oral and systemic health. Clinical examinations were performed at six sites per tooth. Bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and total number of teeth were recorded. The diagnosis of the periodontal condition followed the American Academy of Periodontology criteria. RA was diagnosed according to the American College of Rheumatology guidelines. Results: The RA group exhibited a significantly higher percentage of BOP and a significantly higher CAL compared with the control group (p < 0.001 for each). There was no difference in tooth loss between the groups. Conclusion: The RA patients exhibited worse periodontal conditions than systemically healthy patients