Associação da raspagem com antibioticoterapia em um caso de periodontite agressiva generalizada

The treatment of aggressive periodontitis is a challenge to the clinician, therefore the search for effective treatment protocols of this disease is important. The aim of this case report was demonstrate the effectiveness of the combination of systemic antibiotics with non-surgical periodontal therapy in the treatment of generalized aggressive periodontitis. a 27-year-old patient (RCS), smoker for 11 years (10 cigarettes/day on average), with no systemic alteration, attended the periodontal clinic with a complaint abnormal dental position. After the clinical examination, the diagnosis of generalized aggressive periodontitis was defined. The non-surgical periodontal treatment was executed associated with administration of amoxicillin plus metronidazole for ten days. Clinical parameters (Clinical Attachment level, marginal gingival level, periodontal probing depth, bleeding on probing, plaque index and gingival index) and radiographic parameters (distance between the cemento-enamel junction and the bone crest) were evaluated before and after non-surgical periodontal treatment, after antibiotic therapy and three, six and 12 months after the treatment. After one year follow-up, the results showed improvement in clinical and radiographic parameters with stabilized and decreased tooth mobility and absence of tooth loss. It was concluded that the association of non-surgical periodontal therapy with the administration of amoxicillin/metronidazole was effective in the treatment of generalized aggressive periodontitis.

Tratamento multidisciplinar: relato de casos clínicos

Introduction: Adult patients are more prone to periodontal disease mainly caused by poor plaque control. In these patients, orthodontic movement is not contraindicated, but it is necessary to evaluate their periodontal status so that we can establish the appropriate treatment plan. Objective: The objective of this article is to describe and discuss the clinical cases of severely periodontally compromised individuals in need of oral rehabilitation. Methods: The study consisted of orthodontic treatment of two cases with periodontal involvement. After clinical and radiographic examinations, the cases were analyzed by a multidisciplinary team of Orthodontics, Periodontics and Prosthodontics, in order to provide the patient with the best possible esthetic, functional and stability outcomes. Periodontal treatment consisted of supra and subgingival scaling prior to orthodontic treatment, and regular maintenance performed on a quarterly basis throughout orthodontic movement. Activation was carried out every 45 to 50 days, with light forces. Retention remains to the present day, even after completion of the rehabilitation. Conclusion: Multidisciplinary oral rehabilitation treatment yields satisfactory results. The interaction between Orthodontics and Periodontics reveals that patients with reduced, but healthy periodontium, can receive orthodontic treatment as long as the forces applied do not exceed patient's biological limits.

Instrumentation of dental implants: a literature review

The aim of this study was to review the literature on the systems used to decontaminate the implant's surface. Different instruments have been proposed, but there is no agreement in the literature about which methods would be more efficient with no damage to the implant surface. It was reported the use of plastic, carbon fiber, stainless-steel and titanium curettes and also the use of other systems such as ultrasonic points with different tips, rubber cups and air abrasion. Literature review: In most of the studies, the injury caused on the titanium surface at the time of instrumentation was examined. In others, the cell adhesion on the titanium dental implants following instrumentation of the implant surface was observed. Moreover, to enhance cleaning around implants, ultrasonic systems were recently tested. Conclusion: Metal instruments can lead to major damage to implant surface, therefore, they are not indicated for decontamination of dental implants surfaces. Furthermore, non-metallic instruments, such as plastic curettes, rubber cups, air abrasion and some ultrasonic systems seem to be better choices to remove calculus and plaque of the sub- and supra-gingival peri-implant area. It is noteworthy that more studies evaluating the effects of these systems are required to establish best practices to be used in the treatment of patients with dental implants.

Achados clínicos, genéticos e microbiológicos de uma família com periodontite agressiva de Maceió

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Conhecimento de cárie dental e doença periodontal de professores do ensino fundamental segundo o tipo de instituição (pública ou privada)

Aim: observe the knowledge of dental caries and periodontal disease of primary schoolteachers, according to type of institution (public and private) from Araraquara city. methodology: for that participants were 113 teachers from public schools and 57 from private schools. The instrument of analysis was based on a questionnaire with closed and open questions concerning the etiology, prevention and development of dental caries and periodontal disease. Results: 97,3% of public ́s schoolteachers and 91,2% of private ́s schoolteachers answered that they knows what is dental caries, but they didn ́t answer correctly about the caries etiology as being multifactorial and about methods of prevention. Both of schoolteachers (public and private) had more sucessful when answered about bacterial plaque than periodontal disease and yours manifestation. Conclusion: the dental knowledge of schoolteachers in public and private school was evaluated and limited educational programs should be directed to both public and private schoolteachers, in order to increase the level of dental knowledge of them, so that they can act as educational agents with the children.

Elaboração de um Jogo Digital Educacional sobre Saúde Bucal Direcionado para a População Infantil

Objective: The aim of this study was to develop an educational oral health digital game for 5-to-7-year-old children. Method: The game, called “Dr. Trata Dente”, was based on the approach to three different oral health-related topics: a) bacterial plaque and the main diseases caused by it; b) oral hygiene methods for bacterial plaque control; c) dental caries and preventive measures for this disease. These topics were discussed in sequential order in three different stages of the game. Dr. Trata Dente is represented by the figure of a little super-hero dentist, who talks to the children about oral health during the game. The game is sub-divided according to its propositions to the children, into an association game, a memory game and a coloring game. After its development, the game was evaluated by three professionals of each of the following areas: Dentistry, Pedagogy and Psychology (n=9), who verified the suitability of the concepts presented in the game as regards oral health, linguistic abilities worked with the children, fulfillment of the intended didactic criteria, and the playful aspect of the game. Results: According to the dentists, the dental concepts presented in the game are adequate. According to the pedagogues, the choice of a super-hero was correct and the given explanations are well elaborated, organized and have accessible language, although long. For the psychologists, the game has a potential positive effect on the children’s learning, but there should be more interaction of the character with the children. After this evaluation, changes were made in the game according to the professionals’ suggestions. Conclusion: It was concluded that in spite of the suggested alterations, the game is suitable for teaching oral health by means of children’s play.

Avaliação do perfil de risco de cárie dentária em gestantes de Araraquara, Brasil

The knowledge of risk of carried during pregnant is essential for an appropriate treatment using educational and preventives actions to mother for a good care of their oral health and that of children. The main objective of present retrospective study was to identify the risk of caries of pregnants (aged 15-44, mean= 25 years) came to clinic of Preventive Odontology of Araraquara-UNSEP from 1999 to 2007, using 166 medical records obtained by the third pregraduate year students, following the pre-established guidelines. The information collected includes: classification of caries risk diagnosis, pregnancy trimester, carbohydrates ingestion (between or during foods), dental plaques (O'Leary's plaque control registry) and the number of teeth with caries. The statistical analysis used the Chi2 and ANOVA tests. Most of patients showed a 25 % or more of teeth surfaces with dental plaques (92.1 %) and carbohydrates consumption among foods (89.2 %). The mean (SD) of carried and restores teeth was of 7.9 (5.1) and 4.0 (3.4), respectively and the posterior teeth were the more involved by caries/restorations. As regards the diagnosis of caries risk, classification of high risk was observed in the 38.5 % of pregnants, moderate in the 47.6 %) and low in the 13.9 %. There was a statistically significant association (p= 0.001) between the carbohydrates consumption and the diagnosis of caries risk. The plaque's rate was similar in the different trimesters of pregnancy (f= 0.223; p= 0.803). The caries risk of most pregnant women was high or moderate and it was associated with the consumption of carbohydrates.

Microbiological changes after periodontal therapy in diabetic patients with inadequate metabolic control

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação das alterações no nível da crista óssea e na estabilidade de implantes em função instalados na região anterior da maxila enxertada com osso autógeno ou rhBMP-2

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Intraoral fluoride levels after use of conventional and high-fluoride dentifrices

This study aimed to evaluate saliva and plaque as indicators of intraoral fluoride (F) levels after the use of conventional and high-fluoride dentifrices.Subjects were randomly assigned to brush their teeth with conventional (1000 ppm F), high-fluoride (5000 ppm F), and placebo dentifrices (fluoride free) for 10 days, following a double-blind, crossover protocol. Saliva and plaque samples were collected on the morning of the 5(th) and 10th days, respectively at 1 and 12 h after brushing, and analyzed with an ion-selective electrode after HMDS-facilitated diffusion. Data were analyzed by two-way repeated measures ANOVA, Tukey's test and Spearman's correlation coefficient (p < 0.05).Plaque and salivary F levels were significantly increased after the use of conventional and high-fluoride dentifrices when compared to values obtained for placebo, except plaque 12 h after the use of conventional dentifrice. A positive and significant correlation was found between fluoride concentrations in plaque and saliva for both times of sample collection.Both indicators assessed were able to detect significant differences among treatments and between times after brushing. The use of a high-fluoride dentifrice is able to significantly increase intraoral fluoride levels throughout the day, being therefore a useful therapy for patients at high caries risk.A dentifrice with high fluoride concentration could be regarded as a useful therapy of F delivery for high caries-risk patients, since intraoral F levels were sustained throughout most of the day after using this formulation.

Effects of Yersinia enterocolitica O:3 derivatives on B lymphocyte activation in vivo

The potential sequelae of intestinal infection with Yersinia enterocolitica include reactive arthritis, erythema nodosum, Reiter's syndrome and other autoimmune diseases. The role of the immune response in the pathogenesis of these diseases has not been fully defined, but autoimmune manifestations may be a consequence of the increase in autoantibodies as a result of polyclonal B-cell activation induced by Yersinia. We investigated the effects of Y enterocolitica 0:3 derivatives on B lymphocyte activation in vivo. Groups of five specific pathogen free (SPF) Swiss mice were inoculated with bacterial cell extract, Yersinia outermembrane proteins (Yops) or lipopolysaccharide (LPS) obtained from Y enterocolitica 0:3 and their immunoglobulin-secreting spleen cells were detected by isotype-specific protein A plaque assay. The presence of specific anti-Yersinia antibodies and autoantibodies was determined in mouse sera by ELISA. In all experiments a marked increase in the number of secretory cells of different isotypes was observed as early as the third day after inoculation. IgG and IgM anti-Yersinia antibodies were detected in the sera of all inoculated mice, and autoantibodies against myosin in the sera of those inoculated with bacterial cell extract. The sera from animals stimulated with LPS reacted with myelin, actin and laminin, while the sera from mice inoculated with Yops reacted with myelin, thyroglobulin and cardiolipin. These results suggest that SPF Swiss mice inoculated with any one of the Y enterocolitica derivatives tested exhibited polyclonal activation of B lymphocytes as a result of stimulation by various bacterial components and not only LPS stimulation.

Activation of monocytes and cytokine production in patients with peripheral atherosclerosis obliterans

Background: Arterial peripheral disease is a condition caused by the blocked blood flow resulting from arterial cholesterol deposits within the arms, legs and aorta. Studies have shown that macrophages in atherosclerotic plaque are highly activated, which makes these cells important antigen-presenting cells that develop a specific immune response, in which LDLox is the inducing antigen. As functional changes of cells which participate in the atherogenesis process may occur in the peripheral blood, the objectives of the present study were to evaluate plasma levels of anti-inflammatory and inflammatory cytokines including TNF-alpha, IFN-gamma, interleukin-6 (IL-6), IL-10 and TGF-beta in patients with peripheral arteriosclerosis obliterans, to assess the monocyte activation level in peripheral blood through the ability of these cells to release hydrogen peroxide (H(2)O(2)) and to develop fungicidal activity against Candida albicans (C. albicans) in vitro.Methods: TNF-alpha, IFN-gamma, IL-6, IL-10 and TGF-beta from plasma of patients were detected by ELISA. Monocyte cultures activated in vitro with TNF-alpha and IFN-gamma were evaluated by fungicidal activity against C. albicans by culture plating and Colony Forming Unit (CFU) recovery, and by H(2)O(2) production.Results: Plasma levels of all cytokines were significantly higher in patients compared to those detected in control subjects. Control group monocytes did not release substantial levels of H(2)O(2) in vitro, but these levels were significantly increased after activation with IFN-gamma and TNF-alpha. Monocytes of patients, before and after activation, responded less than those of control subjects. Similar results were found when fungicidal activity was evaluated. The results seen in patients were always significantly smaller than among control subjects. Conclusions: The results revealed an unresponsiveness of patient monocytes in vitro probably due to the high activation process occurring in vivo as corroborated by high plasma cytokine levels.

Morphological characteristics of neuromuscular junctions of the opossum (Didelphis albiventris) extraocular muscles: a scanning-electron-microscopic study

Three types of neuromuscular junctions were described in the extraocular muscles of the opossum. The present study demonstrates the three-dimensional characteristics of these neuromuscular junctions after HCl connective tissue digestion. Adult opossum of both sexes were used and the neuromuscular junctions of the extraocular muscles were examined after removal of the intramuscular connective tissue and basal layer. This material was examined with a scanning electron microscope. Two types of 'en plaque' neuromuscular junction were described: the continuous type revealed elongated and branched primary synaptic grooves separated from each other by sarcolemma protuberances with different sizes, and the discontinuous or punctiform type which presents very shallow and discontinuous grooves when compared with the former. The multiple neuromuscular junctions were observed as two or three junctions associated with the same muscular fiber. The multiple junctions were present in thin fibers (around 11 microm caliber); the en plaque junctions were associated with large diameter fibers (around 21 microm). This study confirms and reveals the detailed morphological characteristics of the three neuromuscular junction types previously described by transmission electron microscope in the extraocular muscles of opossum.

The effect of blue light on periodontal biofilm growth in vitro

We have previously shown that blue light eliminates the black-pigmented oral bacteria Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, and Prevotella melaninogenica. In the present study, the in vitro photosensitivity of the above black-pigmented microorganisms and four Fusobacteria species (Fusobacterium nucleatum ss. nucleatum, F. nucleatum ss. vincentii, F. nucleatum ss. polymorphum, Fusobacterium periodonticum) was investigated in pure cultures and human dental plaque suspensions. We also tested the hypothesis that phototargeting the above eight key periodontopathogens in plaque-derived biofilms in vitro would control growth within the dental biofilm environment. Cultures of the eight bacteria were exposed to blue light at 455 nm with power density of 80 mW/cm(2) and energy fluence of 4.8 J/cm(2). High-performance liquid chromatography (HPLC) analysis of bacteria was performed to demonstrate the presence and amounts of porphyrin molecules within microorganisms. Suspensions of human dental plaque bacteria were also exposed once to blue light at 455 nm with power density of 50 mW/cm(2) and energy fluence of 12 J/cm(2). Microbial biofilms developed from the same plaque were exposed to 455 nm blue light at 50 mW/cm(2) once daily for 4 min (12 J/cm(2)) over a period of 3 days (4 exposures) in order to investigate the cumulative action of phototherapy on the eight photosensitive pathogens as well as on biofilm growth. Bacterial growth was evaluated using the colony-forming unit (CFU) assay. The selective phototargeting of pathogens was studied using whole genomic probes in the checkerboard DNA-DNA format. In cultures, all eight species showed significant growth reduction (p < 0.05). HPLC demonstrated various porphyrin patterns and amounts of porphyrins in bacteria. Following phototherapy, the mean survival fractions were reduced by 28.5 and 48.2 % in plaque suspensions and biofilms, respectively, (p < 0.05). DNA probe analysis showed significant reduction in relative abundances of the eight bacteria as a group in plaque suspensions and biofilms. The cumulative blue light treatment suppressed biofilm growth in vitro. This may introduce a new avenue of prophylactic treatment for periodontal diseases.

Effects of pH and fluoride concentration of dentifrices on fluoride levels in saliva, biofilm, and biofilm fluid in vivo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)