Enfermedades periodontales como un problema de salud pública: el desafío del nivel primario de atención en salud

MicroRNAs: The Missing Link between Hypertension and Periodontitis?

Cardiovascular diseases are the leading cause of death worldwide, and arterial hypertension is a recognized cardiovascular risk factor that is responsible for high morbidity and mortality. Arterial hypertension is the result of an inflammatory process that results in the remodeling and thickening of the vascular walls, which is associated with an immunological response. Previous studies have attempted to demonstrate the relationship between oral disease, inflammation, and the development of systemic diseases. Currently, the existence of an association between periodontitis and hypertension is a controversial issue because the underlying pathophysiological processes and inflammatory mechanisms common to both diseases are unknown. This is due to the fact that periodontitis is a chronic inflammatory disease that affects the interface of teeth and surrounding tissues. However, the most likely explanation for understanding this association is related to low-grade chronic inflammation. An initial path in the study of the relationship between the mentioned pathologies is the possibility of an epigenetic influence, mediated by noncoding RNAs as microRNAs. Thus, in the present review we describe the role of microRNAs related to arterial hypertension and/or periodontitis. In addition, we identified 13 common microRNAs between periodontitis and hypertension. According to the predictions of the DIANA-mirPath program, they can regulate genes involved in 52 signaling pathways.

[Association between diet of the vegan population and self-perception of periodontal state in Metropolitan Lima]

OBJECTIVE

to determine the association between vegan diet and self-perceived periodontal status in a vegan population of Metropolitan Lima, Peru.

MATERIALS AND METHODS

a total of 240 people (120 vegans and 120 non-vegans) were surveyed in this study during the months of August to December 2020 in a virtual way. To evaluate self-perception of periodontal status and oral hygiene habits, the self-report of periodontal disease was used, which is validated with a Cronbach's alpha of 0.77. In addition, other variables such as age, sex, socioeconomic level, educational level, and tobacco consumption were registered. A Poisson regression with robust variance estimator was used both for the association of variables, and prevalence ratios were reported in a crude and adjusted model. The confidence level was 95 % and the significance level was p < 0.05.

RESULT

a statistically significant association was found between the appearance of reddish and/or swollen gums (PR = 0.67; 95 % CI: 0.25-0.54) and poor perception of the state of the gums (PR = 0.43; 95 % CI: 0.33-0.56) with the vegan diet. Finally, for the gum bleeding dimension during brushing, no statistically significant differences were observed between vegans and non-vegans.

Assessment of Cardiovascular Risk in Women with Periodontal Diseases According to C-reactive Protein Levels

Cardiovascular diseases (CVD) are highly prevalent non-communicable diseases worldwide. Periodontitis may act as a non-traditional cardiovascular risk (CVR) factor, linked by a low-grade systemic inflammation mediated by C-reactive protein (CRP). Patients with periodontitis reported higher serum CRP levels; however, a CRP systemic and periodontal correlation in gingival crevicular fluid (GCF) and its CVR impact have been barely studied. We aimed to assess the association between periodontal diseases and CVR in a group of adult women, based on serum high-sensitivity CRP (hs-CRP) levels; and secondly, to determine the association between serum and GCF CRP levels. Gingival crevicular fluid and blood samples were obtained from women with periodontitis, gingivitis, and healthy controls. Serum and GCF CRP were determined by turbidimetric method and Luminex technology, respectively. Data were analyzed and adjusted by CVR factors. All women presented moderate CVR, without an evident association between serum hs-CRP levels and periodontal diseases. While serum hs-CRP concentrations did not significantly differ between groups, patients with gingivitis and periodontitis showed higher CRP levels in GCF, which positively correlated to CRP detection in serum.

[Relationship between the number of brushings per day and periodontal self perception in 12-year-old school children from Ecuador]

Objective

To determine the number of brushings per day and periodontal self-perception in 12-year-old schoolchildren from the Machángara parish, in Cuenca Ecuador in 2016.

Materials and methods

A descriptive, retrospective, relational level study was conducted. The sample consisted of 205 records of 12-year-old schoolchildren residing in the Machángara parish, which belongs to the epidemiological map of oral health in Cuenca, performed by the Catholic University of Cuenca. For analysis of the data, descriptive statistics were used with frequencies and percentages for each of the variables and the Kendall Tau-b statistical test was performed to determine the correlation between the main variables of the study, according to a significance of 0.05.

Results

50.7% of adolescents were male, 49.3% female, and 94.1% were in public schools. It was found that 50.2% of the study population brushed three times a day, being 51.5% among females and 48.1% among males. The prevalence of periodontal self-perception was 85.4%: 86.1% in girls and 84.6% in boys. An inverse and significant negative correlation was found between the number of brushings per day and periodontal self-perception (Tau-b: -0.178; p: 0.004). Brushing frequency had an inverse and significant negative correlation with periodontal self-reporting for females (tau-b: -0.197; p value: 0.030) and a non significant correlation for males.

Conclusion

There is an inverse and significant negative correlation between the frequency of daily brushing and periodontal self-perception. Educational strategies regarding oral health are needed for adolescents from the Machángara parish of Cuenca.

Strategies for the prevention of periodontal disease and its impact on general health in Latin America. Section III: Prevention

Dental plaque removal and the understanding of risk factors, risk indicators and social determinants are important components in the prevention of periodontal disease. Periodontal diseases and dental caries are largely preventable conditions, but require a "common risk factor approach" with non-communicable diseases with the purpose of improving their prevention and control, and positive impact on health. The aim of this consensus was to identify the evidence and gaps in periodontal prevention in Latin American, and to propose individual and collective recommendations for the population, health professionals, dental practice and government. The prevention of periodontal diseases in Latin America has mainly been focused on oral hygiene instruction, use of toothbrushes and interproximal devices, but in some patients, it is necessary to use adjuncts to these measures, such as antimicrobial and/or probiotic products that are backed by broad scientific evidence. Some evidence has shown that there are inadequate knowledge, attitudes and practices among patients, dentist and other health professionals. The prevention of periodontal diseases and caries should be adopted as a healthy lifestyle routine, because of their local and systemic effects. Recently, new empowerment strategies have been proposed in order to generate behavioral changes. Periodontal diseases can often be prevented, or controlled by joined efforts between government health systems, scientific associations, universities, health professionals, private companies and communities. In conclusion, the relations between periodontal diseases, caries, healthy lifestyles and NCD's offer an ideal opportunity to change Latin American prevention strategies at both the individual level and population levels.

An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes

OBJECTIVE

In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature.

METHODS

A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed.

RESULTS

A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions.

CONCLUSIONS

Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.