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PURPOSE: Obesity and its associated metabolic disorders, such as T2DM and MeS, are a growing public health problem worldwide. Our goal was the identification of protein patterns that are uniquely characteristic of higher BMI, MeS, and T2DM in a Brazilian population. EXPERIMENTAL DESIGN: Saliva and plasma proteomes, clinical parameters were analyzed in a population from the state of Rio de Janeiro, Brazil, a mixed-race population. Volunteers were sorted by their BMI into normal (n = 29), overweight (n = 25), and obese (n = 15) and were compared with individuals with MeS (n = 23) and T2DM (n = 11). RESULTS: The Random Forest (RF) predictive model revealed that three clinical variables, BMI, HOMA-IR, and fasting blood glucose, are most important for predicting MeS and T2DM. A total of six plasmatic proteins (ABCD4, LDB1, PDZ, podoplanin, lipirin-alpha-3, and WRS) and six salivary proteins (hemoglobin subunit beta, POTEE, T cell receptor alpha variable 9-2, lactotransferrin, cystatin-S, carbonic anhydrase 6), are enhanced in T2DM and in MeS. CONCLUSIONS AND CLINICAL RELEVANCE: Our data revealed similar alterations in protein composition across individuals with abnormal weight gain, T2DM, and MeS. This finding confirms the close link between these conditions at the molecular level in the studied population, potentially enhancing our understanding of these diseases and paving the way for the development of novel diagnostic tools.
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Objective: The authors' aim in this systematic review was to verify the scientific evidence for difference of oxidative stress biomarkers in individuals with type 2 diabetes mellitus with and without periodontitis. Material and Methods: Observational studies, baseline data of prospective and interventional studies were searched on the following databases: Virtual Health Library, Web of Science, PubMed, Embase, Scopus, Cochrane Library, Opengrey and Google Scholar. The electronic search was performed in June 01, 2020 until May 17, 2024 with alerts until June 01, 2024. The quality assessment and the certainty of the evidence of the included studies were evaluated through Fowkes and Fulton's checklist and GRADEpro Guideline Development Tool. Results: Of 988 relevant articles, the authors included 9 studies for the final analysis. Among those studies, 4 cross-sectional, 3 case-control, and 2 interventional studies were included. The analysis of non-randomized clinical trials properly reported most of the criteria analyzed in Summary questions (Bias, Confounding and Chance) as present in 3 studies. In six studies confounding factors were no detected. Due to the variation in the study results and clinical/methodological heterogeneity, a meta-analysis was not appropriate. The studies reported high concentrations of oxidizing agents and low antioxidants levels in individuals with type 2 diabetes mellitus and periodontitis when compared to with no periodontitis. Conclusion: Considering the few studies found, the methodological flaws, few markers studied and absence homogeneity in the evaluation of redox balance markers, as well as, the very low certainty of the evidence among included studies, it was not possible to determine whether there are or not differences in the oxidative stress levels in individuals with type 2 diabetes with and without periodontitis, and therefore, further prospective observational and interventional studies are recommended. (AU)
Objetivo: O objetivo dos autores nesta revisão sistemática foi verificar a evidência científica para a diferença de biomarcadores de estresse oxidativo em indivíduos com diabetes mellitus tipo 2 com e sem periodontite. Material e Métodos: estudos observacionais, dados de base de estudos prospectivos e intervencionistas foram pesquisados nas seguintes bases de dados: Biblioteca Virtual em Saúde, Web of Science, PubMed, Embase, Scopus, Cochrane Library, Opengrey e Google Scholar. A busca eletrônica foi realizada no período de 01 de junho de 2020 até 17 de maio de 2024, com alertas até 01 de junho de 2024. A avaliação da qualidade e a certeza da evidência dos estudos incluídos foi realizada através da lista de checagem Fowkes and Fulton's e da Ferramenta de desenvolvimento de diretrizes GRADEpro. Resultados: Dos 988 artigos relevantes, os autores incluíram 9 estudos para a análise final. Entre esses estudos, foram incluídos 4 estudos transversais, 3 de caso-controle e 2 de intervenção. A análise dos ensaios clínicos não randomizados relatou adequadamente a maioria dos critérios analisados nas questões resumo (Viés, Confundimento e Resultados ao caso) presentes em 3 estudos. Fatores de confusão não foram detectados em seis estudos. Devido à variação nos resultados do estudo e à heterogeneidade clínica/metodológica, não foi possível realizar uma meta-análise. Os estudos relataram altas concentrações de agentes oxidantes e baixos níveis de antioxidantes em indivíduos com diabetes mellitus tipo 2 e periodontite quando comparados a indivíduos sem periodontite. Conclusão: Considerando os poucos estudos encontrados, as falhas metodológicas, poucos marcadores estudados e ausência de homogeneidade na avaliação dos marcadores do balanço redox, bem como a baixíssima certeza da evidência entre os estudos incluídos, não foi possível determinar se há diferenças nos níveis de estresse oxidativo em indivíduos com diabetes tipo 2 associado e não à periodontite e, portanto, outras observações prospectivas e estudos de intervenção são recomendados (AU)
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Doenças Periodontais , Periodontite , Estresse Oxidativo , Diabetes Mellitus Tipo 2 , Radicais Livres , AntioxidantesRESUMO
OBJECTIVES: To evaluate the colonization dynamics of subgingival microbiota established over six months around newly installed dental implants in periodontally healthy individuals, compared with their corresponding teeth. METHODOLOGY: Seventeen healthy individuals assigned to receive single dental implants participated in the study. Subgingival biofilm was sampled from all implant sites and contralateral/ antagonist teeth on days 7, 30, 90, and 180 after implant installation. Microbiological analysis was performed using the Checkerboard DNA-DNA hybridization technique for detection of classical oral taxa and non-oral microorganisms. Significant differences were estimated by Mann-Whitney and Friedman tests, while associations between implants/teeth and target species levels were assessed by linear regression analysis (LRA). Significance level was set at 5%. RESULTS: Levels of some species were significantly higher in teeth compared to implants, respectively, at day 7 ( V.parvula , 6 × 10 5 vs 3 × 105 ; Milleri streptococci , 2 × 10 6 vs 6 × 10 5 ; Capnocytophaga spp., 2 × 10 6 vs 9 × 10 5 ; E.corrodens , 2 × 10 6 vs 5 × 10 5 ; N. mucosa , 2 × 10 6 vs 5 × 10 5 ; S.noxia , 2 × 10 6 vs 3 × 10 5 ; T.socranskii , 2 × 10 6 vs 5 × 10 5 ; H.alvei , 4 × 10 5 vs 2 × 10 5 ; and Neisseria spp., 6 × 10 5 vs 4 × 10 4 ), day 30 ( V.parvula , 5 × 10 5 vs 10 5 ; Capnocytophaga spp., 1.3 × 10 6 vs 6.8 × 10 4 ; F.periodonticum , 2 × 10 6 vs 10 6 ; S.noxia , 6 × 10 5 vs 2 × 10 5 ; H.alvei , 8 × 10 5 vs 9 × 10 4 ; and Neisseria spp., 2 × 10 5 vs 10 6 ), day 120 ( V.parvula , 8 × 10 5 vs 3 × 10 5 ; S.noxia , 2 × 10 6 vs 0; and T.socranskii , 3 × 10 5 vs 8 × 10 4 ), and day 180 ( S.enterica subsp. enterica serovar Typhi, 8 × 10 6 vs 2 × 10 6 ) (p<0.05). Implants showed significant increases over time in the levels of F.nucleatum , Gemella spp., H.pylori , P.micra , S.aureus , S.liquefaciens , and T.forsythia (p<0.05). LRA found that dental implants were negatively correlated with high levels of S. noxia and V. parvula (ß=-0.5 to -0.3; p<0.05). CONCLUSIONS: Early submucosal microbiota is diverse and only a few species differ between teeth and implants in the same individual. Only 7 days after implant installation, a rich microbiota can be found in the peri-implant site. After six months of evaluation, teeth and implants show similar prevalence and levels of the target species, including known and new periodontopathic species.
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Implantes Dentários , Helicobacter pylori , Microbiota , Humanos , Biofilmes , DNARESUMO
The dysbiotic biofilm of periodontitis may function as a reservoir for opportunistic human pathogens of clinical relevance. This study explored the virulence and antimicrobial susceptibility of staphylococci isolated from the subgingival biofilm of individuals with different periodontal conditions. Subgingival biofilm was obtained from 142 individuals with periodontal health, 101 with gingivitis and 302 with periodontitis, and cultivated on selective media. Isolated strains were identified by mass spectrometry. Antimicrobial susceptibility was determined by disk diffusion. The mecA and virulence genes were surveyed by PCR. Differences among groups regarding species, virulence and antimicrobial resistance were examined by Chi-square, Kruskal-Wallis or Mann-Whitney tests. The overall prevalence of subgingival staphylococci was 46%, especially in severe periodontitis (> 60%; p < 0.01). S. epidermidis (59%) and S. aureus (22%) were the predominant species across groups. S. condimenti, S. hominis, S. simulans and S. xylosus were identified only in periodontitis. High rates of resistance/reduced sensitivity were found for penicillin (60%), amoxicillin (55%) and azithromycin (37%), but multidrug resistance was observed in 12% of the isolates. Over 70% of the mecA + strains in periodontitis were isolated from severe disease. Higher detection rates of fnB + isolates were observed in periodontitis compared to health and gingivitis, whereas luxF/luxS-pvl + strains were associated with sites with deep pockets and attachment loss (p < 0.05). Penicillin-resistant staphylococci is highly prevalent in the subgingival biofilm regardless of the periodontal status. Strains carrying virulence genes related to tissue adhesion/invasion, inflammation and cytotoxicity support the pathogenic potential of these opportunists in the periodontal microenvironment.
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Gengivite , Periodontite , Humanos , Staphylococcus , Antibacterianos/farmacologia , Staphylococcus aureus , Virulência/genética , Farmacorresistência Bacteriana , Amoxicilina , Staphylococcus epidermidis , Testes de Sensibilidade MicrobianaRESUMO
Abstract Objectives To evaluate the colonization dynamics of subgingival microbiota established over six months around newly installed dental implants in periodontally healthy individuals, compared with their corresponding teeth. Methodology Seventeen healthy individuals assigned to receive single dental implants participated in the study. Subgingival biofilm was sampled from all implant sites and contralateral/ antagonist teeth on days 7, 30, 90, and 180 after implant installation. Microbiological analysis was performed using the Checkerboard DNA-DNA hybridization technique for detection of classical oral taxa and non-oral microorganisms. Significant differences were estimated by Mann-Whitney and Friedman tests, while associations between implants/teeth and target species levels were assessed by linear regression analysis (LRA). Significance level was set at 5%. Results Levels of some species were significantly higher in teeth compared to implants, respectively, at day 7 ( V.parvula , 6 × 10 5 vs 3 × 105 ; Milleri streptococci , 2 × 10 6 vs 6 × 10 5 ; Capnocytophaga spp., 2 × 10 6 vs 9 × 10 5 ; E.corrodens , 2 × 10 6 vs 5 × 10 5 ; N. mucosa , 2 × 10 6 vs 5 × 10 5 ; S.noxia , 2 × 10 6 vs 3 × 10 5 ; T.socranskii , 2 × 10 6 vs 5 × 10 5 ; H.alvei , 4 × 10 5 vs 2 × 10 5 ; and Neisseria spp., 6 × 10 5 vs 4 × 10 4 ), day 30 ( V.parvula , 5 × 10 5 vs 10 5 ; Capnocytophaga spp., 1.3 × 10 6 vs 6.8 × 10 4 ; F.periodonticum , 2 × 10 6 vs 10 6 ; S.noxia , 6 × 10 5 vs 2 × 10 5 ; H.alvei , 8 × 10 5 vs 9 × 10 4 ; and Neisseria spp., 2 × 10 5 vs 10 6 ), day 120 ( V.parvula , 8 × 10 5 vs 3 × 10 5 ; S.noxia , 2 × 10 6 vs 0; and T.socranskii , 3 × 10 5 vs 8 × 10 4 ), and day 180 ( S.enterica subsp. enterica serovar Typhi, 8 × 10 6 vs 2 × 10 6 ) (p<0.05). Implants showed significant increases over time in the levels of F.nucleatum , Gemella spp., H.pylori , P.micra , S.aureus , S.liquefaciens , and T.forsythia (p<0.05). LRA found that dental implants were negatively correlated with high levels of S. noxia and V. parvula (β=-0.5 to -0.3; p<0.05). Conclusions Early submucosal microbiota is diverse and only a few species differ between teeth and implants in the same individual. Only 7 days after implant installation, a rich microbiota can be found in the peri-implant site. After six months of evaluation, teeth and implants show similar prevalence and levels of the target species, including known and new periodontopathic species.
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Objetivo: Avaliar a frequência de hipertensão arterial sistêmica e sua associação com parâmetros periodontais e do índice de dentes cariados, perdidos, obturados (CPOD) em indivíduos atendidos na clínica do Curso de Odontologia da Unigranrio. Materiais e métodos: Noventa e cinco indivíduos de ambos os sexos foram incluídos no estudo entre março e maio de 2021. Os participantes responderam a questionários anamnésicos, tiveram sua pressão arterial sistêmica aferida e foram examinados para obtenção do índice CPOD e de parâmetros periodontais. Resultados: A frequência de hipertensão arterial sistêmica na população estudada foi 23,15%. Em pacientes com periodontite, essa prevalência foi 27%, e, em pacientes com gengivite, 19%. Pacientes com periodontite tiveram médias superiores de pressão arterial sistólica (PAS) e diastólica (PAD) comparado ao grupo com gengivite (p<0,0001). Foram identificadas correlações significativas positivas entre PAS e bolsas periodontais moderadas (rho=0,356) e profundas (rho=0,342), perda de inserção avançada (rho=0,538), CPOD (rho=0,365) e quantidade de dentes ausentes (rho=0,477), p < 0,001. A PAD apresentou correlações significativas (p < 0,001) positivas com bolsas periodontais moderadas (rho=0,331) e profundas (rho=0,283), perda de inserção avançada (rho=0,465), CPOD (rho=0,361) e dentes ausentes (rho=0,348). Conclusões: A frequência de hipertensão arterial sistêmica autorrelatada é relativamente alta na população estudada e, em especialmente, dentre as pessoas com periodontite. Pressão arterial sistólica e diastólica são correlacionadas positivamente com parâmetros periodontais indicadores de severidade de doença, assim como piores escores do CPOD.
Aim: The study evaluated the prevalence of systemic arterial hypertension and its association with periodontal parameters and decayed-missing-filled teeth (DMFT) index in individuals treated in a Dental School clinic. Material and methods: Ninety-five individuals of both genders were included in the study in the period between March and May 2021. All participants answered anamnestic questionaries, had their systemic blood pressure measured, and were examined to obtain the DMFT and periodontal parameters. Results: The prevalence of systemic arterial hypertension in the study population was 23.15%. In periodontitis individuals, that prevalence was 27%, and, in gingivitis patients, 19%. Patients with periodontitis have higher mean systolic (SBP) and diastolic (DBP) blood pressure compared with gingivitis individuals (p<0.0001). Significant positive correlations were found between SBP and moderate (rho=0.356) and deep (rho=0.342) periodontal pockets, severe attachment loss (rho=0.538), DMFT (rho=0.365), and amount of missing teeth (rho=0.477), p ? 0.001. The DBP showed significant (p?0.001) positive correlations with moderate (rho=0.331) and (rho=0.283) deep periodontal pockets, severe attachment loss (rho=0.465), DMFT (rho=0.361), and missing teeth (rho=0.348). Conclusions: The prevalence of systemic arterial hypertension is relatively high in the study population and, in particular, among individuals with periodontitis. Systolic and diastolic blood pressure are positively correlated with periodontal parameters that indicate the severity of disease, as well as with worse DMFT scores.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Periodontite/complicações , Índice CPO , Gengivite/complicações , Hipertensão/complicações , Periodontite/diagnóstico , Periodontite/epidemiologia , Fatores de Risco , Fatores Etários , Distribuição por Idade e Sexo , Gengivite/diagnóstico , Gengivite/epidemiologiaRESUMO
BACKGROUND: This study analyzed the levels of a specific group of periodontal health/disease-related oral bacteria in the subgingival biofilm of young adults with overweight (OW) and obesity (OB), and no destructive periodontal disease. METHODS: Full-mouth periodontal assessment and subgingival biofilm sampling were performed in individuals with normal weight (NW) (BMI [body mass index] ≥18.5 to ≤24.9 kg/m2 ; n = 29), OW (BMI ≥25 to ≤29.9 kg/m2 ; n = 26), or OB (BMI ≥30 kg/m2 ; n = 22). BMI, waist (WC) and hip (HC) circumferences, and waist-hip ratio (WHR) were established for every individual. Biofilm samples were analyzed by checkerboard. Spearman coefficient, linear, and logistic regression analyses were obtained. RESULTS: Gingivitis was detected in 45% NW, 65% OW, and 73% OB individuals. NW patients presented significantly less calculus and supragingival biofilm than OB. OW, and OB individuals had significantly higher levels of Porphyromonas gingivalis and Tannerella forsythia than NW patients (P <0.05). Treponema denticola correlated with BMI (rho = 0.31), WC (rho = 0.28), and HC (rho = 0.29), P≤0.01. Linear regression analysis showed significant (P <0.05) positive associations between BMI, WC, HC, and WHR indicators and Prevotella spp., Lactobacillus spp., V. parvula, and A. actinomycetemcomitans (Aa); negative associations were found between Capnocytophaga spp., WC, and HC (ß = -0.29 and ß = -0.37, respectively; P <0.01). However, the interaction of Prevotella spp. and T. forsythia decreased the likelihood of an individual to be diagnosed as OW/OB (OR 0.183 [95% CI, 0.062-0.540]). CONCLUSIONS: Few periodontal pathogens differed in levels between NW and OW/OB individuals without destructive periodontal disease. Moreover, Aa, T. denticola, and Prevotella spp. were associated with clinical parameters of obesity.
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Microbiota , Doenças Periodontais , Aggregatibacter actinomycetemcomitans , Humanos , Obesidade/complicações , Porphyromonas gingivalis , Treponema denticola , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to evaluate the dentists' knowledge and practice regarding HIV positive individuals' oral care in Rio de Janeiro State. METHODS: Dentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests. RESULTS: From the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: "Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?" (p = 0.044), and "Do the negative HIV tests surely indicate that the persons are free of viruses?" (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001). CONCLUSION: Most dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.
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Relações Dentista-Paciente , Odontólogos/psicologia , Infecções por HIV/complicações , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Saúde Bucal , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Idoso , Brasil , Criança , Assistência Odontológica para Doentes Crônicos , Feminino , Infecções por HIV/transmissão , Humanos , Controle de Infecções Dentárias , Masculino , Doenças da Boca/diagnóstico , Doenças da Boca/etiologia , Prática Profissional , Inquéritos e Questionários , Precauções UniversaisRESUMO
Existe uma conexão entre a saúde bucal e a saúde sistêmica, principalmente no caso de paciente portadores de doenças periodontais. Objetivo: O objetivo deste estudo é avaliar o conhecimento de médicos, que trabalham no Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias, sobre a relação entre doenças periodontais e doenças sistêmicas. Metodologia: Questionários com 13 perguntas, que incluem questões sobre a relação entre as doenças orais e as metabólicas foram aplicados a 50 médicos que trabalham no Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias. Os participantes foram grupados em até 8 anos de formado (n = 26) e mais de 8 anos de formado (n = 24). Os dados foram testados pelos testes Mann-Whitney e do Qui-quadrado, ao nível de significância a 5%. Resultados: A grande maioria dos participantes, independentemente do grupo, já referiu paciente ao cirurgião-dentista, e o principal motivo foi a presença de lesão intra-oral. Maior parte dos respondentes apontou o sangramento gengival como sintoma primário da doença periodontal. Além disso, quase 100% dos participantes apontou existir relação entre doença periodontal e doenças sistêmicas, sendo doença cardiovascular a mais frequentemente citada. O principal meio de obtenção de informação sobre o assunto citado foram livros e periódicos. Conclusão: A grande maioria dos médicos, participantes do presente estudo, está ciente da relação existente entre doenças periodontais e doenças sistêmicas, principalmente, as doenças cardiovasculares. Isto foi evidenciado pela alta taxa de encaminhamento dos pacientes a dentistas e o conhecimento sobre os sinais clínicos da doença periodontal.
There is a connection between oral and systemic health, especially concerning patients with periodontal diseases. Aim: The objective of this study was to evaluate the knowledge of physicians working at the Adão Pereira Nunes Hospital, Saracuruna, Duque de Caxias, on the relationship between periodontal and systemic diseases. Methodology: Questionnaires with 13 questions, which include questions about the relationship between oral and metabolic diseases, were applied to 50 physicians working at Hospital Adão Pereira Nunes, Saracuruna, Duque de Caxias. Participants were distributed to 2 groups, according with years of graduation (up to 8 years, n = 26; and over 8 years, n = 24). Data were tested for significant differences by Mann-Whitney and Chi-square tests, at a significance level of 5%. Results: The majority of the participants, regardless of the group, referred patients to the dentist, and the main reason was the presence of intra-oral lesions. Most respondents pointed to gingival bleeding as a primary symptom of periodontal disease. Almost 100% of the participants indicated a relationship between periodontal disease and systemic diseases; moreover, cardiovascular disease was the most frequently cited. Books and scientific periodicals were the main source of obtaining information on the matter. Conclusion: The great majority of participants physicians are aware of the relationship between periodontal diseases and systemic diseases, mainly cardiovascular diseases. This was evidenced by the high referral rate of patients to dentists and the knowledge about the clinical signs of periodontal disease.
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Humanos , Masculino , Feminino , Doenças Periodontais , Médicos , Odontólogos , Doença Hepática Induzida por Substâncias e DrogasRESUMO
OBJECTIVE: In this study, we hypothesized that in the absence of oral hygiene, re-growth of the climax microbial communities of supra and subgingival biofilm happens in a faster and more intense fashion in individuals with chronic periodontitis (CP) compared to periodontally healthy controls (PH). DESIGN: Thirty patients (PH=15 and CP=15) received professional supragingival prophylaxis, and were asked to refrain from oral hygiene for 7days. Supra and subgingival biofilm samples and GCF were collected from randomly selected quadrants at baseline (before prophylaxis), immediately after prophylaxis, 2h, 6h, 24h, and 7days after prophylaxis. The composition of the biofilm was determined by the checkerboard method. RESULTS: All subjects developed gingivitis at the end of 7days without oral hygiene. GCF mean volumes were significantly higher in CP than PH patients at baseline, but they started decreasing 2h after prophylaxis, returning to baseline levels after 24h in both groups. Significant increases in mean counts for most of the species evaluated were observed in both groups and biofilms over time (p<0.05). Few hours after prophylaxis, a more marked reduction in microbial counts happened in the supragingival biofilm of the CP group, and re-development of biofilm started later than in the PH group. At 7days, no differences were seen between groups. Significant differences in kinetics of re-colonization between groups were observed only in the subgingival biofilm for T. denticola and F. nucleatum ss vicentii (increased in the CP), and N. mucosa (increased in the PH group; p<0.05). CONCLUSIONS: Biofilm re-development was very similar between CP and PH individuals, although microbial re-growth occurred few hours earlier in PH than PC. Only 3 species in the subgingival biofilm differed in re-colonization between groups. Thus, we reject the hypothesis that re-colonization of biofilm in CP patients is more intense and faster than in individuals with PH.