RESUMO
INTRODUCTION: The association of the periodontium with the fixed prosthesis is the basis of prosthetic rehabilitation. This prospective case series aimed to evaluate periodontal health through the relation between periodontal/peri-implant disease progression and the use of fixed partial dentures (FPDs). METHODS: Probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) on either teeth or implants were evaluated at up to 25-year follow-up and compared with the baseline. Statistical analysis was performed using the Kaplan-Meier test (p⟨0.05). RESULTS: The prospective evaluation showed that the patients maintained adequate periodontal health. Failure (severe periodontal stages) occurred in 12.5% of patients. The survival rate for 107 teeth/implants was 80.48%. The comparisons for clinical parameters revealed no statistically significant difference (p⟩ 0.05). At T1, the measurements for anterior and posterior regions, respectively, were PD =2.7mm and 3.1mm; CAL= 3.3mm and 3.6mm; GI=0.5 (both regions); and PI=0.79 and 0.62. Periodontal/peri-implant disease progression did not relate to the use of prostheses. CONCLUSIONS: Patients with more frequent follow-up appointments and lower GI and PI showed periodontal health for longer periods. Patients with different oral hygiene levels present different periodontal disease progression. Periodic hygiene control and motivation are vital factors for extensive oral rehabilitation success.
Assuntos
Implantes Dentários , Peri-Implantite , Doenças Periodontais , Humanos , Implantes Dentários/efeitos adversos , Doenças Periodontais/induzido quimicamente , Prótese Parcial Fixa , SeguimentosRESUMO
The purpose of this article is to discuss the clinical management and behavior during periodontal treatment in two patients with fragile X syndrome (FXS) using alternative communication with pictures (ACP). Both patients had a history of previous dental care only possible under general anesthesia. The ACP was used to anticipate the activities to be carried out, promoting ambiance, improving the professional-patient communication, and decreasing the stress of the patient. It was possible to carry out outpatient care without oral sedation and containment/physical restraint in both patients, being surpassed the communicative and behavioral difficulties. These case reports allow us to re-think dental care under general anesthesia or other invasive methods for patients with FXS. Therefore, the ACP is an important mediator tool that can facilitate the insertion and the management of patients with FXS, allowing the dental care outpatient clinic to promote oral health and quality of life for these patients, improving adherence to periodontal treatment and the periodontal maintenance for oral hygiene.
RESUMO
La periodontitis es una enfermedad inflamatoria, crónica que afecta a los tejidos de soporte de los dientes y puede repercutir en la salud general, afectando la calidad de vida del paciente. La enfermedad de Alzheimer es una condición neurodegenerativa y progresiva que va disminuyendo la memoria, el lenguaje y aprendizaje de los pacientes. El objetivo de la investigación es realizar una revisión bibliográfica para comprender la posible vinculación entre la periodontitis y el Alzheimer. Los microorganismos periodontopatógenos producen una respuesta inflamatoria que, por vía sistémica, puede desencadenar un mecanismo inflamatorio dentro del sistema nervioso central. La respuesta del hospedero es liberar gran cantidad de moléculas proinflamatorias que comprometen la barrera hematoencefálica sobreestimulando a las células microgliales, esto conduce a la destrucción de neuronas vitales y al mantenimiento de la inflamación crónica que contribuye a la progresión del Alzheimer. Por otra parte, la periodontitis puede favorecer la formación de placas ateromatosas que afectan la integridad vascular siendo éste un factor a considerar en el desarrollo de la patología cerebrovascular. A pesar que son pocos los estudios clínicos experimentales, ya se puede sugerir la correlación entre ambas enfermedades (AU)
Periodontitis is a chronic inflammatory disease that affects the supporting tissues of teeth, affecting the systemic health and quality of life of the patient. Alzheimer's disease is a neurodegenerative and progressive condition that decreases memory, speech and learning of patients. The objective of this literature review was to report the possible link between periodontitis and Alzheimer's disease. Periodontopathogens produce an inflammatory response that, systemically, can trigger an inflammatory mechanism within the central nervous system. Due to this attack, the host releases a great quantity of proinflammatory molecules that compromise the blood-brain barrier by over- stimulation microglial cells, this produces destruction of vital neurons and maintenance the chronic inflammation in CNS and that contribute to the progression of Alzheimer's disease. On the other hand, periodontitis can favor the formation of atheromatous plaques that affect vascular integrity, being a factor to consider in the development of the cerebrovascular disease. Although there are few experimental clinical studies, the correlation between both diseases can already be suggested (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Periodontite/complicações , Periodontite/prevenção & controle , Doença de Alzheimer/etiologia , Transtornos Cerebrovasculares , Doença Crônica , Mediadores da Inflamação/fisiologia , Placa Dentária/prevenção & controle , ManutençãoRESUMO
Abstract: oral health is an integral part of an individual's general health, interfering with all dimensions of life: functional, aesthetic, psychological, social, physical, nutritional, and even psychosocial. hence oral health is directly related to quality of life. periodontitis is one of the most prevalent oral diseases and one of the major causes of tooth loss, impacting negatively on self-reported individuals' quality of life. periodontal maintenance therapy aims to effectively minimize the recurrence of periodontal disease, as well as the incidence of tooth loss. in periodontal literature, studies associated with quality of life indicators, presented in the form of questionnaires aimed at measuring the impact of periodontitis and tooth loss on self-reported individual's quality of life, highlight the "oral impacts on daily performance" (OIDP) and "oral health impact profile" (OHIP). as such, this study presents a critical review of the literature and describes the impact of periodontal disease and tooth loss on the quality of life of patients undergoing periodontal maintenance therapy.
Assuntos
Humanos , Periodontite/terapia , Qualidade de Vida , Saúde Bucal , Perda de Dente/psicologia , Doenças Periodontais , Cooperação do PacienteRESUMO
BACKGROUND AND OBJECTIVE: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years. METHODS: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. RESULTS: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. CONCLUSION: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT.
Assuntos
Periodontite Crônica/prevenção & controle , Perda de Dente/etiologia , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Cárie Dentária/complicações , Índice de Placa Dentária , Feminino , Seguimentos , Defeitos da Furca/classificação , Hemorragia Gengival/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Perda da Inserção Periodontal/classificação , Bolsa Periodontal/classificação , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fumar , Fraturas dos Dentes/complicações , Mobilidade Dentária/complicações , Raiz Dentária/lesões , Dente não Vital/complicações , Adulto JovemRESUMO
Através da manutenção, é possível atingir os objetivos de prevenir ou reduzir a recorrência e a progressão da doença periodontal, diminuir a incidência de perda de dentes e aumentar a probabilidade de diagnosticar e tratar outras doenças ou condições sistêmicas encontradas na cavidade bucal.Contudo, apenas uma pequena parcela da população pratica corretamente seus auto cuidados eretorna para as sessões de manutenção na frequência estabelecida. O aumento da cooperação está intrinsecamente relacionado ao empenho do profissional em identificar, logo de início, pacientes não-colaboradores, adotando métodos individualizados. Considerando que a manutenção é parte essencial do tratamento periodontal, esta revisão de literatura tem o propósito de avaliar a saúde do periodonto após tratamento ativo, traçar o perfil dos pacientes colaboradores, identificar os fatores dificultosos e estabelecer as condutas para obtenção da cooperação consciente, de modo a fornecer subsídios para o sucesso da relação profissional-paciente.
With the periodontal maintenance it is possible to reach the goals to prevent or to reduce the recurrenceand progression of periodontal disease, to diminish the incidence of teeth loss and to increasethe probability to diagnosis and to treat, in proper intervals, other illnesses or systemic conditionsfound in the oral cavity. However, only a small piece of the population practices its self-care correctlyand returns for the recall in the scheduled frequency. The increase of the cooperation is relatedintrinsically to the persistence of the professional in identifying, in the beginning, non collaboratorpatients. Considering periodontal maintenance as an essential part of the therapy, the aim of the literaturereview was to evaluate its importance in order to preserve periodontal health after the activetreatment, to know the prevalence and the features of the patients who cooperate with this phase ofthe treatment, to identify the factors that they make the maintenance difficult and to establish themost efficient behaviors for compliance with the purpose of achieving success for the relationship between professional and patient.
Assuntos
Doenças Periodontais/prevenção & controle , Doenças Periodontais/terapia , Relações Dentista-PacienteRESUMO
O objetivo do estudo foi mensurar as alterações na quantidade do volume de fluido gengival (FG) dos dentes submetidos à movimentação ortodôntica, em adultos com periodontite crônica na fase de manutenção periodontal. O FG foi coletado com uma tira de papel absorvente padrão das áreas de pressão dos dentes de 10 pacientes (sete homens e três mulheres) e medido em microlitro no Periotron em seis dias distintos (dia -7, dia 0, dia 1, dia 7, dia 14 e dia 21). Os pacientes foram submetidos a um rigoroso programa de controle de placa. O teste de Wilcoxon foi aplicado para comparar os dados obtidos. Os resultados mostraram que o controle de placa efetivo baixou a quantidade de FG do dia -7 para o dia 0, e em seguida houve uma elevação do FG até o dia 7 por conta do início da movimentação ortodôntica, e uma nova queda do dia 7 até o 21. O maior volume de FG foi encontrado no dia 7, uma semana após o início da movimentação. O menor volume no dia 0. Concluindo, a movimentação ortodôntica aumentou o volume de FG do dia 0 até o dia 7.
The aim of this study was to measure the alterations in the amount of gingival crevicular fluid (GCF) of teeth during orthodontic tooth movement in adults with chronic periodontitis under a periodontal maintenance program. The GCF was collected with paper stripes from pression sides of teeth in 10 patients (7 males and 3 females) and measured in microlitres on Periotron in six distinct periods of time (day -7, day 0, day 1, day 7, day 14, day 21). Patients were under supervised program of plaque control. Wilcoxon test was applied to compare the data. The results shown that the effective plaque control reduces the amount of GCF from day -7 to day 0, followed by an elevation until day 7 after the beginning of orthodontic tooth movement and a new reduce from day 7 to 21. The highest amount of GCF was found on day 7, one week after the beginning of tooth movement, while the smallest found on day 0.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Líquido do Sulco Gengival , Técnicas de Movimentação Dentária , Periodontite Crônica/terapia , Brasil , Gengiva , Estatísticas não ParamétricasRESUMO
Neste estudo observacional longitudinal prospectivo, foram avaliados os parâmetros clínicos de 2257 sítios de 16 pacientes não fumantes em manutenção periodontal, através de sondagem computadorizada. Estes pacientes, tratados de periodontite crônica de moderada a severa, receberam manutenção periodontal trimestralmente durante dois anos. Na consulta inicial e aos 3, 6, 9, 12, 18 e 24 meses foram registrados, em seis sítios por dente, os parâmetros clínicos profundidade clínica de sondagem (PCS), retração gengival, nível clínico de inserção (NCI), sangramento e supuração à sondagem e presença de placa, além da mobilidade dentária. A mensuração e registro automatizado destas medidas foram realizados com precisão de 0,2 mm, sob pressão constante de 20 g. Todos os exames foram realizados pelo mesmo examinador, treinado e calibrado. Os sítios monitorados apresentaram, no período avaliado, redução de bolsa e ganho clínico de inserção significativos (p<0,00001). Considerando diferenças maiores do que 1 mm entre o NCI aos 24 meses e no exame inicial, 4,52% dos sítios apresentaram perda de inserção. O modelo multinível de regressão logística mostrou que, quanto menores o NCI e a PCS inicial do sítio, maiores seriam suas chances de perder inserção. Sítios com maiores frequências de presença de placa ou de sangramento à sondagem, bem como sítios proximais e em dentes com mobilidade, também tiveram maiores chances de perda de inserção. Sítios de alguns grupos dentários também apresentaram maiores chances deste desfecho. O reduzido número de sítios com perda de inserção e a melhora nos parâmetros clínicos detectados neste estudo demonstraram a importância de um programa de manutenção periodontal bem realizado e supervisionado, com intervalos regulares de três meses, na manutenção da saúde periodontal obtida com o tratamento.
In this prospective longitudinal observational study, the periodontal clinical parameters of 2257 sites of 16 non-smoking patients under maintenance were evaluated by computerized periodontal probing. These patients, who had been treated of moderate to severe chronic periodontitis, received periodontal maintenance every third month over two years. At baseline and at 3, 6, 9, 12, 18 and 24 months, the clinical parameters Probing Depth (PD), gingival recession, Clinical Attachment Level (CAL), bleeding and suppuration on probing and plaque presence, besides tooth mobility, were record at six sites per tooth. The measurement and automated recording of these measures was performed with resolution of 0.2 mm, under constant force of 20g. All examinations and measures were performed by the same trained and calibrated examiner. The monitored sites showed, in the evaluated period, significant (p<0.00001) pocket reduction and clinical attachment gain. When differences between the CAL at 24 months and at baseline greater than 1 mm were considered, 4.52% of the sites showed attachment loss. The multilevel logistic model showed that, the smaller the site NCI and PCS baseline values, the bigger its odds of loss attachment. Sites with higher frequencies of plaque presence or bleeding on probing, as well as proximal sites and sites in mobility teeth, showed bigger odds of attachment loss too. Sites in some tooth groups showed bigger odds of this outcome too. The reduced number of sites with attachment loss and the detected attachment gain in this trial demonstrated the importance of a well performed and supervised periodontal maintenance program, with regular intervals of three months, in the maintenance of the periodontal health obtained after treatment.
Assuntos
Humanos , Masculino , Feminino , Periodontia , Periodontite Crônica/diagnósticoRESUMO
Este estudo de coorte aberto prospectivo teve como objetivo avaliar a progressão da periodontite, a influência de variáveis preditoras de risco e avaliar a incidência e motivos para a ocorrência de perda dentária (PD) em indivíduos inseridos num programa de terapia de manutenção periodontal (TMP) em ambiente universitário. Metodologia: 250 indivíduos com diagnóstico de periodontite crônica moderadaavançada, que finalizaram terapia periodontal ativa foram recrutados na Faculdade de Odontologia da Universidade Federal de Minas Gerais, Brasil. Todos foram submetidos a um exame clínico periodontal completo (TMP1) e a uma coleta de variáveis sociais, demográficas e biológicas de interesse. Avaliou-se o grau de cooperação destes indivíduos (cooperadores, cooperadores irregulares e não cooperadores) quanto à adesão ao programa de TMP em re-chamadas trimestrais (TMP2, TMP3 e TMP4) pelo período de 12 meses. Assim, 150 indivíduos considerados cooperadores completos (60%) foram elegíveis para esta pesquisa. Em todas as re-chamadas foram coletados os seguintes dados: índice de placa (IP), sangramento a sondagem (SS), profundidade de sondagem (PS), níveis clínicos de inserção (NCI), supuração (S) e envolvimento de furca (EF), em todos dentes presentes (com exceção de terceiros molares). Identificou-se, pela plausibilidade biológica, quais variáveis preditoras de risco poderiam influenciar a condição clínica periodontal e a progressão da periodontite. O efeito de variáveis de interesse e confundimentofoi testado por análise univariada e regressão logística multivariada, assim como motivos e tipos de dentes perdidos. Resultados: Observou-se uma melhora considerável nos parâmetros clínicos periodontais na maioria dos indivíduos. Durante o período de monitoramento, 130 indivíduos (86,7%) tiveram estabilidade periodontal e 20 indivíduos (13,3%) apresentaram progressão de periodontite. Diabetes não foi associada à progressão de periodontite (p=0,67) e o tabagismo foi significantemente associado a maior progressão de periodontite (RC=2,7; 95% IC: 1,01-7,22). 28 indivíduos (18,66%) apresentaram perda dentária os quais somaram 47 dentes perdidos (1,4%). Os motivos e números de dentes perdidos foram respectivamente: doença periodontal (n=34; 72,3%), cárie (n=3; 6,4%), motivos protéticos (n=9; 19,2%), perfuração radicular (n=1; 2,1%). Molares apresentaram maior mortalidade dental do que não molares e homens 3 vezes mais chances de PD do que mulheres (RC=3,16; 95% IC: 1,28-7,78). Indivíduos com 10% de sítios com PS entre 4 e 6 mm apresentaram 5 vezes mais chances de PD (RC= 5,13; IC 95%: 2,04-12,09). A determinação do risco individual pelo modelo ARP (Avaliação do Risco Periodontal) resultou na classificação dos indivíduos em 02(1,3%) de baixo risco, 83 (55,3%) de moderado risco e 65 (43,4%) de alto risco àrecorrência de periodontite. Conclusões: Os programas de manutenção periodontalem ambiente universitário podem estabilizar a condição periodontal obtida apósterapia ativa e, adicionalmente, controlar e/ou minimizar a ação de variáveispreditoras de risco a progressão da periodontite. Neste estudo, a incidência de PDfoi pequena e restrita a poucos indivíduos. A adoção do modelo ARP contribui para adeterminação do risco individual dos indivíduos, permitindo que os escores de riscosejam comparados ao longo do tempo. Assim, este instrumento pode ser válido paramonitorar particularmente variáveis mutáveis de risco e auxiliar na estratégia,determinação e cooperação nos programas de TMP. A estabilidade dos tecidosperiodontais, controle de variáveis de risco e redução da PD podem ser metasalcançáveis pelos programas de TMP, refletindo a sua eficiência e propiciandomelhor qualidade de vida para indivíduos periodontalmente susceptíveis
This open prospective cohort study aimed to evaluate the progression of periodontitisand, in addition, the incidence, the reasons and the role of risk predictors on theoccurrence of tooth loss (TL) in individuals inserted in a program of periodontalmaintenance therapy (PMT) in academic environment. Methods: 250 individualsdiagnosed with moderate/advanced chronic periodontitis, that had finished activeperiodontal therapy, in the Faculty of Dentistry of the Federal University of MinasGerais, Brazil, were selected. Individuals were submitted to a complete clinicalperiodontal examination (PMT1) and collection of social, demographic and biologicalvariables of interest was performed. The degree of compliance of these individuals,(compliers, irregular compliers and non compliers) according to the adhesion to theTMP program in quarterly recalls (PMT2, PMT3 and PMT4), was evaluated during 12months period. A total of 150 individuals, that were considered complete compliers(60%), became eligible for this study. In the recall visits, the following data werecollected for all teeth (with exception of third molars): plaque index (PI), bleeding onprobing (BOP), probing depth (PD), clinical attachment level (CAL), suppuration (SU)and furcation involvement (FI). It was identified, according to the biologicalplausibility, which risk predictors could influence the periodontal clinical condition andthe progression of the periodontitis. The effect of variables of interest andconfounding was tested by univariate analysis and multivaried logistic regression, aswell as the reasons and types of teeth that were lost. Results: A considerableimprovement in periodontal clinical parameters was observed in the majority of theindividuals. During the monitoring, 130 individuals (86.7%) showed periodontalstability and 20 individuals (13.3%) presented periodontitis progression. Diabeteswas not associated with periodontitis progression (p=0.67) and, in contrast, smokingwas significantly associated with periodontitis progression (OR=2.7; 95% IC 1.01-7.22). 28 individuals (18.66%) presented TL, resulting in a total of 47 lost teeth(1.4%). The reasons and numbers of tooth loss and numbers were, respectively:periodontal disease (n=34; 72.3%), caries (n=3; 6.4%), prosthetic reasons (n=9;19.2%), root perforation (n=1; 2.1%). Molars presented greater tooth mortality thannon molars and men presented 3 times more odds of TL than women (OR=3.16;95% IC: 1.28-7.78). Additionally, individuals with 10% of sites with PD between 4 and6mm presented 5 times more odds of TL (OR= 5.13; IC 95%: 2.04 12.09). Theperiodontal risk assessment (PRA) resulted in the classification of individuals in 02(1.3%) low risk, 83 (55.3%) moderate risk and 65 (43.4%) of high-risk for recurrenceof periodontitis. Conclusions: The programmes of periodontal maintenance inacademic environment can stabilize the periodontal condition obtained after activetherapy, additionally to control and/or minimize the action of risk predictors on theprogression of periodontitis. In this study, the TL incidence was small and restrictedto few individuals. The adoption of the model PRA contributes to the determination ofrisk of individuals allowing the risk scores are compared over time. So, thisinstrument can be particularly monitoring changeable risk predictors and assisting inthe strategy, determination and compliance in the PMT programs. The stability ofperiodontal sites, the control of risk predictors and the reduction of TL can bepredictable goals for the PMT programs, reflecting its effectiveness and betterimproving quality of life for individuals susceptible to periodontitis