Periodontal disease affects oral cancer progression in a surrogate animal model for tobacco exposure

For decades, the link between poor oral hygiene and the increased prevalence of oral cancer has been suggested. Most recently, emerging evidence has suggested that chronic inflammatory diseases from the oral cavity (e.g., periodontal disease), to some extent, play a role in the development of oral squamous cell carcinoma (OSCC). The present study aimed to explore the direct impact of biofilm‑induced periodontitis in the carcinogenesis process using a tobacco surrogate animal model for oral cancer. A total of 42 Wistar rats were distributed into four experimental groups: Control group, periodontitis (Perio) group, 4‑nitroquinoline 1‑oxide (4‑NQO) group and 4NQO/Perio group. Periodontitis was stimulated by placing a ligature subgingivally, while oral carcinogenesis was induced by systemic administration of 4NQO in the drinking water for 20 weeks. It was observed that the Perio, 4NQO and 4NQO/Perio groups presented with significantly higher alveolar bone loss compared with that in the control group. Furthermore, all groups receiving 4NQO developed lesions on the dorsal surface of the tongue; however, the 4NQO/Perio group presented larger lesions compared with the 4NQO group. There was also a modest overall increase in the number of epithelial dysplasia and OSCC lesions in the 4NQO/Perio group. Notably, abnormal focal activation of cellular differentiation (cytokeratin 10‑positive cells) that extended near the basal cell layer of the mucosa was observed in rats receiving 4NQO alone, but was absent in rats receiving 4NQO and presenting with periodontal disease. Altogether, the presence of periodontitis combined with 4NQO administration augmented tumor size in the current rat model and tampered with the protective mechanisms of the cellular differentiation of epithelial cells.

Self-reported periodontitis in cannabis club members in Montevideo, Uruguay. An exploratory study

In 2013, the Oriental Republic of Uruguay enacted a law regulating the cannabis market, and since then, an increasing number of users has been registered. Previous reports based on data from other countries link cannabis smokers to worse periodontal health status. The aim of this study is to describe self-reported gingival and periodontal health status and estimate the prevalence of periodontitis among Uruguayan cannabis club members. A cross-sectional study was conducted on a convenience sample of cannabis club members in Uruguay. A survey was used to gather sociodemographic data and information on oral hygiene, use of cannabis and other drugs, and self-reported gingival and periodontal health status. Eight questions validated in Spanish were used to estimate the prevalence of total periodontitis and severe periodontitis, based on two previously implemented predictive models. The survey was completed by 50 people, of whom 68% were male and 78% were in the 20-40 year age range. Based on the first model, estimated prevalence was 12% for total periodontitis and 10% for severe periodontitis. Based on the second model, estimated prevalence was 36% for total periodontitis and 12% for severe periodontitis. These findings suggest that smoking cannabis could potentially have a detrimental effect on oral health status.

Can propranolol act as a chemopreventive agent during oral carcinogenesis? An experimental animal study

The multistep process of oral carcinogenesis provides a biological rationale for the use of chemoprevention in individuals at increased risk of developing oral cancer. We aimed to determine if low doses of propranolol can prevent the development of oral cancer using a tobacco-relevant and p53-associated animal model of cancer initiation. Twenty-six Wistar rats were randomly allocated into two groups, vehicle, and propranolol. All animals received 4-nitroquinoline N-oxide (4NQO) at 25 ppm diluted in the drinking water for 20 weeks. Animals from the propranolol group received propranolol (0.1 mg/kg) 5 days per week by gavage for 18 weeks. The clinical analysis was performed by measuring the area of the lesion and assessment of scores based on lesion appearance (papule; plaque; nodule or ulcerated). Histopathological analysis was performed to determine the presence of epithelial dysplasia or invasive squamous cell carcinoma (SCC). The average lesion area in 4NQO + vehicle and in 4NQO + propranolol groups were 0.20  and 0.28 mm2, respectively (P = 0.53). The percentage of cases clinically graded as papules, thick plaques, nodular areas, and ulcerated lesions was similar between groups (P = 0.94). Histopathological diagnosis also did not differ between groups (P = 0.65), with 54.5 and 70% of cases being diagnosed as SCC in 4NQO and in 4NQO + propranolol groups, respectively. In conclusion, daily doses propranolol at 0.1 mg/kg were not as effective as a chemopreventive therapy in an animal model of 4NQO-induced carcinogenesis.

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial

The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, using Mann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gumline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77 vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

Effects of Chronic Ethanol Consumption and Ovariectomy on the Spontaneous Alveolar Bone Loss in Rats

Postmenopausal estrogen deficiency and ethanol (EtOH) abuse are known risk factors for different diseases including bone tissues. However, little is known about the synergic effects of EtOH abuse and estrogen deficiency on alveolar bone loss in women. The present study evaluated the effects of EtOH chronic exposure and ovariectomy on the alveolar bone loss in female rats. For this, 40 female Wistar rats were randomly divided into 4 groups: control, EtOH exposure, ovariectomy (OVX), and OVX plus EtOH exposure. Initially, half of the animals were ovariectomized at 75 days of age. After that, the groups received distilled water or EtOH 6.5 g/kg/day (20% w/v) for 55 days via gavage. Thereafter, animals were sacrificed and the mandibles were collected, dissected, and separated into hemimandibles. Alveolar bone loss was evaluated by measuring the distance between the cementoenamel junction and the alveolar bone crest through a stereomicroscope in 3 different anatomical regions of the tissue. One-way ANOVA and post hoc Tukey were used to compare groups (p < 0.05). The results showed that the ovariectomy and EtOH exposure per se were able to induce alveolar bone loss, and their association did intensify significantly the effect. Therefore, OVX associated with heavy EtOH exposure increase the spontaneous alveolar bone loss in rats.

Effect of Obesity and/or Ligature-induced Periodontitis on Aortic Wall Thickness in Wistar Rats

The purpose of this study was to evaluate aortic wall thickness after periodontal disease and/or obesity induction in a Wistar rat model.Sixty male Wistar rats were randomly divided into four groups: control (CT), periodontal disease (PD), obesity (OB), and obesity plus periodontal disease (OB+PD). Groups OB and OB+PD received cafeteria diet for 17 weeks. After they had acquired obesity (week 12), periodontal disease was induced by placing a silk ligature on the maxillary right second molar of groups PD and OB+PD. During the experimental period, body weight and Lee index were assessed. Mean alveolar bone loss (ABL) was evaluated, and aortas were prepared for histometric analysis of the aortic wall by ImageJ software. Body weight and Lee index increased in rats exposed to cafeteria diet. Mean ABL was higher in Groups PD and OB+PD than in control and OB (p<0.05). ABL was 18% higher in Group OB+PD than in Group PD, with statistically significant difference (p<0.001). Aortas were thicker in Groups OB and OB+PD than in control and PD groups, respectively (2.31mm ± 0.28 and 2.33 ± 0.29 vs. 2.18 ± 0.26 and 2.14 ± 0.27). Group OB differed significantly from the control group (p=0.036), and OB+PD and OB differed significantly from PD (p=0.004 and p= 0.001, respectively). Obesity alters aortic wall thickness in Wistar rats. However, the presence of periodontal disease did not affect the aortic wall thickness under the conditions of the present study.

Tooth loss and associated factors in the elderly in Cruz Alta, Brazil: a crosssectional study

The aim of this study was to evaluate severe tooth loss and associated factors among the elderly. A homebased crosssectional study, using random probabilistic sampling, was conducted with elderly persons from Cruz Alta, Rio Grande do Sul, Brazil. Oral health was examined and a structured questionnaire was answered. Associations between severe tooth loss and independent variables were determined using Poisson regression with robust variance. The level of significance adopted was 5%. Overall, 287 elderly persons were included. Among the elderly, 86 (29.9%) were edentulous, and 282 (98.3%) had lost at least one tooth. In this sample, median tooth loss was 21 (mean±standard deviation: 19.69±8.21). The sample was dichotomized into two groups according to the definition of severe tooth loss: less than nine remaining teeth or ≥9 remaining teeth. The prevalence of severe tooth loss was 60.3% (n=173). Females were associated with higher prevalence ratio (PR) of severe tooth loss (PR; 95% CI: 1.77; 1.39 - 2.24). Higher level of education was associated with lower PR of severe tooth loss (PR; 95% CI: 0.48; 0.30 - 0.77). The lack of access to dental care was associated with severe tooth loss (PR; 95% CI: 1.38; 1.13 - 1.67). Conversely, frequency of toothbrushing was not significantly associated with severe tooth loss (PR; 95% CI: 0.88; 0.73 - 1.06). High prevalence of severe tooth loss among the elderly was observed and found to be associated with sex, level of education, and access to dental care.

Self reported dentin hypersensitivity in south brazilian adolescents: occurrence and risk indicators

The aim of this study was to assess the occurrence of selfreported dentin hypersensitivity (DH) and its risk indicators in adolescents from a southern Brazilian city. 736 students (1519 years old) were randomly selected from 20 public and private schools in the city of Passo Fundo, Brazil. DH was assessed through the answers on a Likert scale to the question: "Do you have tooth sensitivity?".Participants underwent a clinical examination in which present teeth were counted, and answered an interview based on a structured questionnaire on sociode mographic information, history of dental bleaching, orthodontic treatment and oral health habits. The dependent variable (DH) was dichotomized at the point where hypersen sitivity occurs fairly often or always. Data were analyzed by multivariable logistic regression, including demographic, health history, socioeconomic and behavioral variables. Results: 556 (75.5%) subjects reported having sensitive teeth never, rarely or sometimes, while 180 (24.5%) reported having sensitive teeth fairly often or always. In the final model, number of present teeth, age, skin color, flossing, smoking, bleaching and orthodontic history were not associated with selfreported DH. Females showed significantly greater chance of having DH than males [odds ratio (OR)=1.91; 95% confidence interval (95%CI) 1.342.72]. The likelihood of DH in students at public schools was 63% higher than in those at private schools (OR=1.63 95%, CI 1.012.75). DH is a common perception among adolescents and is associated with female gender and studying at public schools.

Effect of red wine and its major components on periodontitis and systemic inflammation in rats

OBJECTIVES

To evaluate the influence of red wine exposure, alcohol, grape juice and resveratrol in the occurrence of spontaneous and ligature induced periodontitis as well as CRP, TNFα and IL-6 levels in Wistar rats.

METHODOLOGY

50 male Wistar rats were randomly assigned to 5 groups (Control, Red Wine, Grape Juice, 12% Alcohol and 0.05mg/mL Resveratrol). All groups were fed with laboratory rat chow and liquid intake according to group allocation. After 8 weeks, ligatures were placed around the maxillary right second molars. The contra-lateral molars remained as intra-group controls. After 14 days, animals were killed, blood samples collected and specimens prepared for analysis. Group comparisons were performed by ANOVA. A cut-off point in the 75th percentile in the side without ligature was used for definition of spontaneous periodontitis.

RESULTS

All animals completed the experiment. According to mean alveolar bone loss, no statistically significant differences were found. Animals exposed to red wine presented a lower occurrence of spontaneous periodontitis, lower levels of TNF-α (0.97 ng/mL) and CRP (0.29 mmol/μL) compared to controls (1.97 ng/mL, p = 0.008 and 0.45 mmol/ μL, p less than or equal to 0.05 respectively).

CONCLUSION

Red wine exposure potentially affects the occurrence of spontaneous periodontitis, CRP and TNF-α levels in Wistar rats.

Correlation between crestal alveolar bone loss with intracanal bacteria and apical lesion area in necrotic teeth

OBJECTIVE

This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth.

DESIGN

Data from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3 mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria.

RESULTS

No statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (p > 0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (p = 0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area.

CONCLUSIONS

It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.

Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial

OBJECTIVE

To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease.

MATERIALS AND METHODS

A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy.

RESULTS

The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1.

CONCLUSION

Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.

Association between history of orthodontic treatment and sociodemographic factors in adolescents

The aim of this study was to assess history of orthodontic treatment and its determinants in adolescents. This was a crosssectional study conducted in the city of Passo Fundo, Brazil, on a representative sample of adolescents aged 15 to 19 years, regularly enrolled in 20 high schools. A structured questionnaire was applied to assess demographic, behavioral and health variables. The association between history of orthodontic treatment and the dependent variables was analyzed by the chi-square test or Fisher's exact test. Additionally, multivariate regression with robust variance was performed. A total 736 students were examined and interviewed, of whom 57. 6% had undergone orthodontic treatment, while 42. 4% had not. In the multivariable analysis, the following variables were significantly associated with history of orthodontic treatment: female (PR= 1. 26; 95% CI: 1. 11-1. 43), white (PR= 1. 32; 95% CI: 1. 11-1. 56), mothers with higher level of education (PR=1. 49; 95% CI: 1. 28 -1. 74), tooth loss (PR=1. 21; 95% CI: 1. 06-1. 39), and concern about oral health (PR=0. 69; 95% CI: 0. 61-0. 78). Attending a private school was not significantly associated with history of orthodontic treatment (p>0. 05). This study found a high rate for history of orthodontic treatment among adolescents, associated with gender, ethnicity, adolescent's mother with higher education, and tooth loss. Concern about oral health was a protective factor for orthodontic treatment.

Spontaneous alveolar bone loss after 4NQO exposure in Wistar rats

OBJECTIVE

This study evaluated the effect of an experimental carcinogenic, 4-Nitroquinoline 1-oxide (4NQO), in the spontaneous alveolar bone loss (ABL) in an animal model.

DESIGN

Twenty-two male Wistar rats were included in this study. They were randomly divided into two groups: the control group (n = 10) received food and water ad libitum, and the test group (n = 12) receive the same food; however, 25 ppm of 4NQO was diluted in the drinking water. All animals were euthanized after 20 weeks, and the tongues were removed and analyzed macroscopically to determine the presence of oral mucosal lesions. All specimens were paraffin-embedded and histological sections were obtained. The microscopic analysis was based on routine procedure (haematoxylin and eosin stain). The analysis of spontaneous ABL was performed by a calibrated examiner using standardized photographs and imaging software. Differences in spontaneous ABL were assessed among the three resulting groups: control, 4NQO with oral squamous cell carcinoma (OSCC), and 4NQO without OSCC.

RESULTS

In the 4NQO-treated group, nine animals developed OSCC. The animals in the 4NQO with OSCC group presented significantly more spontaneous ABL (0.65 ± 0.21 mm) than the control group (0.34 ± 0.05) (p < 0.001). The animals in the 4NQO without OSCC group showed a mean spontaneous ABL of 0.47 ± 0.13 mm, which was not statistically significant different when compared to the control group (p = 0.096).

CONCLUSIONS

It was concluded that the presence of OSCC enhanced spontaneous ABL in Wistar rats when compared to control animals. Additionally, it was shown that, solely, administration of 4NQO may not be considered responsible for alveolar bone destruction.

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD).

Association between post-orthodontic treatment gingival margin alterations and symphysis dimensions

Orthodontic therapy is known to be associated with the development of gingival recession. Several factors may be involved in the causal chain of this outcome, including anatomical and behavioral aspects. Among the anatomical aspects, the dimensions of the mandibular symphysis could play a predisposing role. This study evaluated the relationship between the mandibular symphysis dimensions prior to orthodontic therapy and the development of gingival recessions on the lower incisors and cuspids. Records from 189 orthodontically treated adolescents were evaluated, including radiographs, casts and intra-oral photographs. Symphysis dimensions were assessed by cephalograms. Gingival margin alterations were determined in photographs and cast models. Association between gingival margin alterations and symphysis dimensions was tested by chi-square (α=0.05). Occurrence of gingival recession increased after orthodontic therapy. No association was observed on average of symphysis dimensions and the occurrence of gingival recessions. It may be concluded that pretreatment symphysis dimensions may not be used as predictors of gingival recession after orthodontic therapy.

Prevalence of self-reported halitosis and associated factors in adolescents from Southern Brazil

The aim of this study was to assess the prevalence of selfreported halitosis and associated factors in adolescents from Passo Fundo, Brazil. Additionally, we studied adolescents' concern with their own breath and whether anyone had ever told them that they had halitosis. A crosssectional observational survey was conducted on 15to 19year old high school students from public and private schools in the city of Passo Fundo, Brazil. The random sample consisted of 736 adolescents from 20 schools. An interview with a structured questionnaire was administered. The prevalence of selfreported halitosis and associated factors was analyzed by either the chisquare test or Fisher's exact test. The prevalence of selfreported halitosis was 39.67%. The mother's level of education was associated with the outcome. Gender and behavioral habits were not associated with selfreported halitosis. Halitosis reported by others presented a prevalence of 10.73% and was associated to male gender and oral hygiene habits. Individuals with less toothbrushing frequency and no use of dental floss were associated to halitosis reported by others. It was observed that 88.58% of the participants are concerned with halitosis. It is concluded that there is high prevalence of selfreported halitosis, which is associated with a socioeconomic pattern. Most adolescents report concern with their own breath.

Self-reported Use of Dental Floss over 13 Years: Relationship with Family Income, Mother's Age and Educational Level

PURPOSE

To determine whether family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over a 13-year period in a city in southern Brazil.

MATERIALS AND METHODS

A comparison of two household surveys was carried out where mothers of the family were interviewed using a structured questionnaire in order to obtain demographic, behavioural and socioeconomic information. In total, 852 and 984 households were included in 1996 and 2009, respectively. Self-reported use of dental floss was assessed dichotomously (yes/no). Poisson regression models were fitted to study the association between sociodemographic variables with the use of dental floss. Proportion ratios (PR) and 95% confidence intervals (95% CI) were reported.

RESULTS

The proportion of dental floss use increased from 48% to 59% over 13 years. The probability of dental floss use increased 1.23 times from 1996 to 2009 (PR = 1.23; 95% CI 1.13-1.34). Households with mothers ≥50 years old presented a 28% lower probability of using dental floss than households with mothers ≤35 years old. In households with higher family income and higher educational level of the mother, probabilities of flossing were 90% and 97% higher.

CONCLUSION

Family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over 13 years.

Correlation between gingival thickness and gingival recession in humans

Gingival recession is characterized by the apical migration of the gingival margin, exposing the root surface. Studies have demonstrated several etiological factors for gingival recession such as periodontitis, traumatic toothbrushing, use of oral piercing, and past orthodontic therapy, among others. It might not be possible to identify and quantify the influence of each factor, and gingival recession at some sites may be the result of the combination of these factors. Gingival recession affects individuals at all ages, with prevalence increasing as time passes. The aim of this study was to observe whether there is correlation between gingival thickness and gingival recession. Fifty-five subjects of both genders aged 18-35 years participated in the study. The volunteers were under treatment at the School of Dentistry of the Federal University of Rio Grande do Sul. Buccal gingival thickness was measured on incisors, canines and bicuspids, under anesthesia, following inclusion and exclusion criteria. Statistical analysis was performed with STATA version 10.1. The results had a Pearson Correlation Coefficient of -0.216. Linear regression had a statistically significant pvalue of 0.025. It may be concluded that there is weak negative correlation between gingival thickness and gingival recession.

Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case-control study

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women. The findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth, showing that osteoporosis/osteopenia has had an influence on the progression of periodontitis.

INTRODUCTION

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women and explored the effects of use of osteoporosis medication and tooth loss on this association.

METHODS

This case-control study involved 521 postmenopausal women, with minimum age of 50 years, in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions/medications, and lifestyle habits were recorded. A complete periodontal examination was performed and periodontitis was diagnosed. Bone mineral density was evaluated through lumbar spine and femoral bone densitometry, obtained using dual-energy X-ray absorptiometry. Logistic regression was used to calculate the strength of association between the occurrences of osteoporosis/osteopenia and periodontitis.

RESULTS

Women with osteoporosis/osteopenia were twice as likely to present periodontitis, as were those with normal bone mineral density, even after adjusting for smoking, age, family income, and last visit to dentist (odds ratios (OR)adjusted=2.24, 95% CI [1.24-4.06], p=0.008). Among nonusers of osteoporosis medication (ORadjusted=2.51, 95% CI [1.33-4.73], p=0.004) and women with at least 10 remaining teeth (ORadjusted=2.50 95% CI [1.18-5.27], p=0.02), the odds ratio was higher and statistically significant.

CONCLUSIONS

These findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth.

Supragingival plaque removal with and without dentifrice: a randomized controlled clinical trial

The aim of this study was to compare the efficacy of dental plaque removal by brushing with and without conventional dentifrice. Twenty-four students aged 17 to 28 years participated in this randomized controlled clinical trial. Quadrants 1-3 or 2-4 were randomly allocated to the test group (brushing without dentifrice) or control group (brushing with dentifrice). After 72 h of cessation of oral hygiene, Quigley & Hein (Turesky) plaque index was assessed before and after brushing by a calibrated and blind examiner. Overtime and intergroup comparisons were performed by Student's paired sample t-test at 5% significance level. The results showed that both groups after toothbrushing presented statistically significant reductions in plaque, with no differences between them (from 3.06 ± 0.54 to 1.27 ± 0.26 versus from 3.07 ± 0.52 to 1.31 ± 0.23). A separate analysis of the buccal and lingual aspects also showed no significant differences between groups. It may be concluded that the use of a conventional dentifrice during toothbrushing does not seem to enhance plaque removal capacity.

Analysis of gingival margin esthetic clinical conditions by dental students

It has been suggested that one of the main factors contributing to the perception of esthetics is the position of the gingival tissues in the upper arch. The aim of this study was to evaluate the esthetic perception of dental students regarding different pictures of classical periodontal situations related to the gingival margin. This was an observational cross-sectional study involving 161 dental students. Five clinical situations defined by pictures from books were presented to the students. The cases included unchanged periodontium, gingival smile, uneven gingiva, localized gingival recession and generalized gingival recession. Esthetic perception was evaluated by a Visual Analogue Scale (VAS). The different situations were compared by One-way ANOVA, with Tukey test as post-hoc. The results showed statistically significant differences between groups (p < 0.05). The best esthetics was attributed to the periodontium without changes in shape (7.60 +/- 1.80), followed by gingival smile (6.92 +/- 2.34). The worst esthetic situation in this evaluation was the uneven gingiva (3.45 +/- 2.00). In the intermediate group are the gingival recessions. The perception of localized (5.19 +/- 1.91) and generalized (5.69 +/- 2.18) gingival recession did not differ significantly. This study concluded that different positions of the gingival tissues affect the esthetic perception of smile.

Effect of the topical application of triclosan in periodontally treated patients

The aim of this clinical parallel, double-blind study was to evaluate the effect of irrigating, with 0.6% triclosan, periodontal pockets 2 4 mm showing persisting signs of inflammation 90 days after sub-gingival scaling and root planing. 14 patients, aged 35-61 years, were randomly assigned to test group (TG) or placebo group (PG). In TG, pockets were rinsed with 10 ml of triclosan while in PG, pockets were rinsed with placebo. Irrigations were repeated fort-nightly for 70 days (total 6 rinses). Clinical examinations consisted of Plaque Index (PlI), Gingival Index (GI), Bleeding on Probing (BOP), Periodontal Probing Depth (PPD) and Clinical Attachment Level (CAL). Median values of PlI, GI and BOP were analyzed over time with the Friedman test and for the multiple comparisons with Wilcoxon and Mann-Whitney tests. Means for PPD, and CAL were analyzed with repeated measurements ANOVA (p<0.05). There were no statistically significant differences in the PlI and GI between groups. BOP was reduced significantly in both groups in a similar fashion. Significant reductions in PPD were observed for both groups. TG showed a PPD reduction of 0.8 mm whereas PG reduced 0.4 mm. No difference was found among groups for PPD. CAL gain for the TG group was 0.7 mm and for the PG of 0.5 mm. Only the gains observed for the TG group were significant. It can be concluded that 0.6% triclosan or placebo irrigation, 3 months after non-surgical treatment, of sites with persistent signs of inflammation, produced similar results.

Association among menopause, hormone replacement therapy, and periodontal attachment loss in southern Brazilian women

BACKGROUND

The aim of the present study was to evaluate the association among menopause, hormone replacement therapy (HRT), and periodontal attachment loss (PAL).

METHODS

Three hundred twenty-eight women (40 to 69 years old) who participated in a previous oral survey in South Brazil were included. Women who reported not having their monthly menstrual cycles for >or=12 months were classified as postmenopausal. Postmenopausal women were categorized according to HRT. Women with >or=30% teeth with PAL >or=5 mm were classified as having periodontitis. The data were analyzed using a multivariable logistic regression model and adjusted for age, smoking, socioeconomic status, and dental care.

RESULTS

The prevalence of periodontitis was significantly greater among postmenopausal women not using HRT (HRT-) than among premenopausal women (64.4% versus 46.3%; P = 0.005). Similarly, the multivariable analysis demonstrated a significantly higher chance of having periodontitis in postmenopausal HRT- women than in premenopausal women (odds ratio [OR], 2.1; 95% confidence interval [CI]: 1.1 to 4.0). In contrast, no significant differences were observed in the prevalence of periodontitis between postmenopausal women using HRT (HRT+) and premenopausal women (48.8% versus 46.3%; P = 0.77). After adjusting for cofactors, postmenopausal HRT+ women did not have a greater likelihood of having periodontitis than premenopausal women (OR, 1.2; 95% CI: 0.6 to 2.5). No significant differences in tooth loss were observed among the study groups after adjusting for confounders.

CONCLUSIONS

Postmenopausal HRT- women had a greater chance of having periodontitis than premenopausal women. In contrast, postmenopausal HRT+ women and premenopausal women had similar periodontal status. HRT may have a beneficial effect on periodontal health.

Effect of chewing gums on the production of volatile sulfur compounds (VSC) in vivo

The aim of the present study was to evaluate the effect of two chewing gums on the production of volatile sulfur-containing compounds (VSC) in vivo. Fourteen periodontally healthy participants (20-35 years old) were included in the test panel. Test gum 1 (TG1) contained sucrose and Test gum 2 (TG2) contained xylitol and zinc citrate. Two series of tests were conducted with a double-blind cross-over design. Following an overnight refrain from oral hygiene, VSC was measured before and at 5, 15, 30, 45 and 60 minutes of chewing the test gums. In the second series, VSC production was monitored prior to and up to 30 minutes after a rinse with cysteine 6 mM alone or after a rinse followed by chewing the test gums. For the first test, the results were analyzed by repeated measurements ANOVA for intra-group and paired sample t test for intergroup comparisons. In the second series, percent reduction of VSC was compared by Friedman and Wilcoxon tests (p < .05). The test gums did not differ in terms of VSC production, with values ranging from 146 ppb after 5 minutes to 86 ppb after 60 minutes. Similar reductions in VSC production following cysteine were observed for both test gums, with the largest reductions (71% to 52%) observed after 5 and 15 minutes. It can be concluded that VSC production is diminished after chewing gum and that the use of chewing gums reduces temporarily the VSC production enhanced by cysteine rinses.

Clinical and radiographic evaluation of periodontal and peri-implant conditions in patients with implant-supported prosthesis

The aim of the present study was to clinically and radiographically assess the peri-implant and periodontal conditions in partially edentulous patients with implant-supported fixtures installed, at least, one year prior to the study. 41 patients were examined by a calibrated examiner in relation to the following implant-associated parameters: Modified Plaque Index (mPlI), Modified Bleeding Index (mBI), probing depth (PD), clinical attachment level (CAL) and bleeding on probing of the bottom of the crevice (BOP). Also, the remaining teeth were assessed in terms of Plaque Index (PlI), Gingival Index (GI), PD, CAL and BOP. The peri-implant bone loss was evaluated by means of periapical radiographs. Measurements of pre-operatory and final bone levels allowed an estimation of bone loss associated to teeth and a comparison with bone loss around implants. None of the individuals presented late loss of implants until the examination took place. No statistically significant differences were observed between PlI (0.90+/-0.07) and mPlI (0.82+/-0.13), or between GI (0.11+/-0.02) and mBI (0.10+/-0.02). However, PD, CAL and BOP values were higher in implants than in teeth (Wald Test, p<0.01). Implants presented a mean annual bone loss during the study period of 0.77 mm (SE=0.06). Teeth virtually did not present any bone loss (mean value of 0.36%) whereas implants exhibited a bone loss value of 17.11%. Plaque accumulation and marginal inflammation did not differ between teeth and implants. However, subgingival inflammation was higher in implants than in teeth. The destruction measurements suggest greater losses in implants, as expected because of tissue remodelation.

Clinical and Radiographic Effects of Enamel Matrix Derivative in the Treatment of Intrabony Periodontal Defects: A 12-Month Longitudinal Placebo-Controlled Clinical Trial in Adult Periodontitis Patients

BACKGROUND

This randomized, double-masked, placebo-controlled clinical trial evaluated the effect of enamel matrix derivative (EMD) on clinical and radiographic parameters of periodontal intrabony defects.

METHODS

A split-mouth design was used in 16 chronic periodontitis patients who had similar defects (> or =6 mm of probing depth). Both groups underwent scaling and root planing and were acid-etched with EDTA. The test sites received the EMD solution and the controls a placebo. Clinical examinations of all 16 patients and radiographs of 14 patients were available at baseline and 6 and 12 months after surgery. Clinical outcomes included probing depth (PD) and clinical attachment level (CAL); radiographic analysis was performed using computerized linear measurements. Intergroup comparisons were performed by paired samples t test, and over time comparisons were made by general linear model (alpha = 0.05).

RESULTS

A statistically significant improvement over time for PD and CAL and a decrease of the vertical component of the defect was detected in both groups. Comparisons between groups revealed at baseline a mean+/-SD value of CAL of 12.93+/-2.00 and 13.47+/-2.93 for test and control groups, respectively. These values decreased to 10.92+/-1.92 and 11.31+/-1.86 after 12 months for test and control. No statistically significant differences could be observed between groups. PD displayed similar results from 7.57+/-1.02 and 7.38+/-1.16 for test and control groups at baseline to 3.40+/-1.82 and 2.99+/-1.07 after 12 months. If the data are divided into smokers and non-smokers, no differences are observed.

CONCLUSION

Use of EMD did not result in more improvement in clinical and radiographic parameters compared to the placebo.

Treatment of dentin hypersensitivity by Nd:YAG laser

BACKGROUND, AIMS

Promising results using Nd:YAG laser against dentin hypersensitivity have been reported. The aim of this double-blind, controlled, split-mouth designed clinical trial was to assess the effect of a single Nd:YAG laser application on alleviating hypersensitivity.

METHODS/RESULTS

Seventeen subjects participated in the study. Each of them had two teeth treated; one with the laser activated and one with nonactivated (placebo), for 2 min The assessment of pain was performed by a VAS, after an air blast at baseline immediately after treatment, at 1 week, 4 weeks and 16 weeks. Mean values of VAS for test and control teeth were compared by paired t-test (alpha = 0.05). The results showed mean baseline VAS values of 6.59 (+/- 1.65) and 6.14(+/- 1.95) for test and control teeth, respectively. Immediately after treatment, these values decreased to 4.09(+/- 2.28) and 3.89(+/- 2.11), respectively. After 1 week, 4 weeks and 16 weeks the mean values for test and control teeth were 3.85 +/- 2.36, 4.03 +/- 1.95, 3.60 +/- 2.66, and 4.44 +/- 2.56, 3.41 +/- 2.30, 3.42 +/- 2.30, respectively. There were no statistically significant differences between test and control at any time. However, both groups improved significantly (P < 0.05) from baseline to immediately after application, and at 1 week, 4 weeks and 16 weeks, respectively. The changes that occurred between immediately after application and 1 week, 4 weeks and 16 weeks, respectively, were not statistically significant.

CONCLUSION

It is concluded that the effect of treatment of hypersensitive teeth with Nd:YAG laser is not different from placebo. The observed effects seem to last for at least 16 weeks.