Este trabalho teve como objetivo comparar parâmetros nutricionais com presença de cárie e condição clínica periodontal entre grupos de adolescentes com e sem obesidade atendidos nas Clínicas de Nutrição e Odontologia da Faculdade São Lucas, Porto Velho- RO. O estudo foi transversal, do tipo caso- controle. Foram incluídos indivíduos entre dez e 19 anos de idade, de ambos os gêneros, previamente avaliados quanto ao estado nutricional (Índice de massa corporal IMC de peso para estatura, soma das dobras cutâneas triciptal e subescapular e inquérito de freqüência alimentar), foram alocados nos seguintes grupos: eutróficos (entre percentil 15 e 85 para IMC) e obeso (acima do percentil 85 para IMC e dobras cutâneas), sendo 18 indivíduos em cada grupo. Foram determinados o CPO-D, os índices de controle de placa e de sangramento gengival bem como valores de profundidade de sondagem e nível clínico de inserção em toda a boca. Os resultados apresentaram que a obesidade não foi fator diferencial com relação ao índice CPO-D, e que quanto maior o índice CPO-D, menor foi a ingestão de vegetais e maior o consumo de doces. A obesidade também não foi diferencial na ocorrência de periodontite e não houve relação entre a ocorrência de periodontite e os valores dos ICP e ISG. Já o padrão de ingestão alimentar entre os adolescentes positivos e negativos para periodontite demonstra que os grupos têm ingestão semelhante de proteínas e carboidratos complexos, porém em relação à ingestão de vegetais e doces (carboidratos simples), ocorre variação importante. O grupo positivo para periodontite faz ingestão bem menor de vegetais e maior de doces do que o grupo negativo para a periodontia. Conclui-se que não houve relação entre obesidade e doença periodontal, assim com não houve relação do ICP e ISG com a periodontite, que a doença periodontal foi mais presente em jovens com idade a partir de 15 anos; houve uma relação dignificante entre a baixa ingestão de vegetais e alta ingestão de doces (carboidratos simples) tanto com a o quadro clínico de periodontite, como para um alto índice CPO-D e que A orientação nutricional para uma alimentação saudável, medidas de higiene oral adequadas podem prevenir o aparecimento ou o agravamento das doenças bucais. / This search had as an objective to compare nutritionals parameters with caries presence and periodental clinicals condition among teens groups and without obesity taken care in the Nutritions Clinics and Dentistry at São Lucass college in Porto Velho-Ro. The study was transversal, which means that each case has been controlled. They had been put individuals between ten to 19 years old in both kind, previously evaluated how much to the nutritional state (IMC of weight for each stature, the add of the cutaneous triciptal and to subscapular and alimentary frequencys inquiry), they had been placed in the following groups: eutróficos (between percentile 15 to 85 for IMC) and obese (above of percentile 85 for IMC and cutaneous folds), being 18 individuals in each group. The CPO-D, the indices of teeths matters and gingival bleed as well as values of depth of sounding and clinical level of insertion in all the mouth. The results had presented that the obesity was not the main differential related to index CPO-D, and that the bigger the CPO-D, less was the ingestion of vegetable ingestion and the biggest absorption of candy. The obesity also was not the main differential in the periodontitis occurrence and it did not have relation to the occurrence of periodontitis and the values of ICP and ISG. But the standard of alimentary ingestion between the positive and negative adolescents for periodontite demonstrates that the groups have similar protein ingestion and complex carbohydrate, however in relation to the ingestion of vegetables and candies (simple carbohydrate), it occurs important variation. The positive group for periodontitis ingest less vegetable and much candies than the other group, the negative one.Which can be concluded that it did not have relation between obesity and periodontal illness, also did not have relation of ICP and ISG with the periodontitis, and the periodontal illness was more present in teens from15 years old; it had a significant related to a low vegetable ingestion and a high candy ingestion (simple carbohydrate) in such a clinical chart of periodontitis, as for one high index CPO-D and that the nutritional orientation for a healthful feeding, and verbal hygiene can prevent the appearance or the aggravation of the buccal illnesses.

O diabetes mellitus (DM) é caracterizado por uma deficiência no transporte de glicose da corrente sanguínea para o interior da célula, elevando os níveis de glicose no sangue. Isso ocorre pela deficiência e até mesmo resistência à insulina, e é controlada por agentes hipoglicêmicos orais e/ou dieta, associada a exercícios físicos. É classificada em tipo I e II, sendo que o segundo é a forma mais comum da doença e tem a idade como um dos fatores predisponentes. O periodonto é formado por estruturas de suporte e proteção ao elemento dentário e seu aspecto de saúde tem uma importância significante na cavidade bucal. A doença periodontal (DP) é um processo inflamatório crônico caracterizado por inflamação do tecido gengival e/ou perda de estruturas que compõem o periodonto, causando danos à estrutura dentária ou até perda do dente. É reconhecida como a sexta maior complicação do diabetes. Esse estudo teve como objetivo comparar as alterações periodontais em indivíduos diabéticos tipo II e não diabéticos residentes no município de Araguaína Tocantins (TO). Para isso, foram examinados 34 pacientes divididos em dois grupos: diabéticos e não diabéticos, que foram submetidos a exames periodontais para determinar a Profundidade de Sondagem (PS), Perda de Inserção Clínica (PIC), Índice Gengival (IG), Índice de Placa (IP), Índice de Higiene Oral (IHO) e exames laboratoriais para os diabéticos tipo II. Para a análise estatística foi usado o teste t no intuito de obter as correlações dos índices entre os diabéticos e o teste U para analisar as alterações periodontais entre os grupos. Foram encontrados PIC e IHO maiores em diabéticos, sendo os demais índices maiores no grupo dos não diabéticos. Só IP não apresentou diferença estatística significante (p>0,05). Também foi verificada uma correlação entre IP e IG, não ocorrendo entre os demais índices. Concluiu-se que os diabéticos têm doença periodontal mais severa que os não diabéticos. / Diabetes Melitus (DM) is characterized by a deficiency in the glicose transport from the blood stream to the inside of cells, raising the glicose leves in the blood. This occurs due to the deficiency or even resistance to insulin, and it is controlled by oral hypoglicemic agents and/or diet, associated with physical exercises. It is classified in types I and II, in such a way the second type in the most common and its predisponent factor is age. The periodonto is made of structures that support and protect the dental element and its health aspect has a significant importance to the bucal cavity. The periodontal disease (PD) is a chronic inflammatory process characterized by inflammation of the gingival tissue and /or loss of structures that compose the periodonto, causing damage to the dental structure or even loss of teeth. Its known as the sixth biggest complication derived from diabetes. This work had the purpose of comparing periodontal modifications in diabetic type II and non diabetic patients who lived in Araguaína Tocantins (TO). Therefore, 34 patients were examined and separated in two groups with PD: diabetics and non diabetics. They were submitted to periodontal examination in order to measure the Depth Proof (PPD), Clinical Attachment Loss (CAL), Gingival Index (GI), Plaque Index (PII), Oral Hygiene Index (OHI) indices. Also, laboratorial tests were made for type II - diabetic patients. The statistical analysis was made using the t-test to obtain the indices of correlation in diabetic group and the u-test to evaluate periodontal modifications between the groups. The CAL and the indices were higher in diabetic group and the other indices were higher in non diabetic group. Only the PII index show no significant statistic difference (p>0,05). It was also verified a correlation between PII and GI indices, yet it was not true in other indices. It was possible the conclude that the diabetics have more severe periodontal disease than the non diabetics.

Porphyromonas gingivalis produces proteases capable of degrading cytokines, host heme proteins, and some antimicrobial peptides. In this work, I show that P. gingivalis culture supernatants fully or partially degrade human neutrophil peptide alpha-defensins and human beta-defensins after 30 minutes. This observation suggests that proteases from P. gingivalis degrade defensins and this activity could abrogate defensin-related innate immune functions.

Magister Chirurgiae Dentium (MChD) / Periodontal disease is one of the most common diseases worldwide. Periodontal treatment aims to prevent disease progression and restore functional and aesthetic dentition. The purpose of studying periodontal treatment outcome is to assess treatment efficacy. Treatment outcome of periodontal disease is affected by multiple patient-related factors, the type of treatment provided, and the expertise of the clinician.

Type 2 diabetes is epidemic in the American Indian population. One problem health care providers face when working with the American Indian population is communicating about secondary complications, such as periodontal disease. From a public health standpoint, periodontal disease prevention is important not only to prevent unnecessary oral pain and tooth loss, but also to prevent other more serious systemic problems from occurring such as cardiovascular disease, strokes, and bacterial pneumonia. The purpose of this qualitative study was to examine the communication efforts of health care providers and understand if and how they discuss periodontal disease with their American Indian patients with type 2 diabetes. Structured interviews were conducted with health care providers at an American Indian community clinic using questions based on the model of communication competence. Data analysis consisted of an analysis of the interview transcripts looking for concepts, themes, and events to see if discussion of periodontal disease is occurring at diabetic visits. Results of the study showed that although all the providers knew about the link between diabetes and periodontal disease risk, not all the providers were discussing the risk with their patients, and time, perceived health literacy, and other priorities all played a role in the lack of communication. This finding has the potential to influence positive social change by being an impetus for change in current diabetic patient care policies in the areas of communication and education regarding American Indian patients with diabetes about periodontal disease risk.

Indiana University-Purdue University Indianapolis (IUPUI) Indiana University School of Dentistry / Background: Pre-eclampsia a potentially life threatening hypertensive disorder occurring in 3-14% of pregnancies. Its etiology is multifactorial involving the placenta. The only “cure” that currently exists is the delivery of the baby, which is often pre-term. There is no early pregnancy screening test to recognize those at risk. Recently, an altered immune-inflammatory responses at the placental level in response to infectious agents (eg., periodontal pathogens) have been proposed to be etiological for this pregnancy complication. A new class of Pattern Recognition Receptors called Peptidoglycan Recognition Proteins (PGRPs) constituting 4 distinct molecules PGRP 1-4 is emerging as a key player in modulating host responses to peptidoglycan and its breakdown products. A critical knowledge gap exists on the role of PGRPs in the innate immune responses that occur at the maternal-fetal interface in response to pathogens and their components that may be present in maternal circulation secondary to chronic infections. Aim: The aim of this pilot study is to investigate the expression PGRPs in the placenta of pre-eclamptic women. The overall goal is to better understand the association of periodontal disease and adverse pregnancy outcomes. Methods and Materials: This case control study consisted of subjects with: (1) normal term pregnancies (n=7) (2) pre-eclampsia (n=7). Preeclampsia was defined as hypertension (systolic blood pressure of ≥ 140 mm Hg or diastolic blood pressure of ≥ 90 mm Hg on at least 2 occasions, 4 hours to 1 week apart) and proteinuria (≥ 300 mg in a 24-hour urine collection or one dipstick measurement of ≥ 2+). A real time quantitative PCR array was used to analyze the relative mRNA expression of TLR2, TLR4, NOD1, NOD2, PGRP1, PGRP2, PGRP3, and PGRP4. Immunohistochemistry was performed to determine the cell type(s) expressing the PGRP proteins in the placental tissue. Summary statistics (mean, standard deviation, range, 95% confidence interval for the mean) were calculated for PGRP 1-4 expression for each group. Results and conclusions: The PCR data showed the expression of PGRPs 1, 3 and 4 in the placental samples. There was an up-regulation of PGRP-1 (1.4 fold) and down regulation of PGRP-3 (1.3 fold) and PGRP-4 (1.6 fold). TLR2, TLR4 and NOD2 mRNA were also elevated in the placental samples. Immunohistochemistry demonstrated positive staining for PGRPs 3 and 4 in the trophoblasts. The results from this novel research could lead to development of salivary and/or plasmatic biomarkers for early detection of PE and warrants further investigation.

Indiana University-Purdue University Indianapolis (IUPUI) / Periodontal disease (PD) affects 42% of US population resulting in compromised quality of life, the potential for tooth loss and influence on overall health. Despite significant understanding of PD etiology, limited longitudinal studies have investigated PD change in response to various treatments. A major barrier is the difficulty of conducting randomized controlled trials with adequate numbers of patients over a longer time. Electronic dental record (EDR) data offer the opportunity to study outcomes following various periodontal treatments. However, using EDR data for research has challenges including quality and missing data. In this dissertation, I studied a cohort of patients with PD from EDR to monitor their disease status over time. I studied retrospectively 28,908 patients who received comprehensive oral evaluation at the Indiana University School of Dentistry between January 1st-2009 and December 31st-2014. Using natural language processing and automated approaches, we 1) determined PD diagnoses from periodontal charting based on case definitions for surveillance studies, 2) extracted clinician-recorded diagnoses from clinical notes, 3) determined the number of patients with disease improvement or progression over time from EDR data. We found 100% completeness for age, sex; 72% for race; 80% for periodontal charting findings; and 47% for clinician-recorded diagnoses. The number of visits ranged from 1-14 with an average of two visits. From diagnoses obtained from findings, 37% of patients had gingivitis, 55% had moderate periodontitis, and 28% had severe periodontitis. In clinician-recorded diagnoses, 50% patients had gingivitis, 18% had mild, 14% had moderate, and 4% had severe periodontitis. The concordance between periodontal charting-generated and clinician-recorded diagnoses was 47%. The results indicate that case definitions for PD are underestimating gingivitis and overestimating the prevalence of periodontitis. Expert review of findings identified clinicians relying on visual assessment and radiographic findings in addition to the case definition criteria to document PD diagnosis. / 2021-08-10

BACKGROUND: There is a dearth of studies on the association between diabetes mellitus (DM) and the risk of developing oral health complications in nonsmokers. Recent studies have presented a strong link between smoking and increased risk of periodontal disease in patients with T2DM. This study attempts to look at the risk of developing caries and poor oral health in nonsmokers who also have DM. Male and female subjects from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2017-2018 study who were 21+ years at the time of entering the study were included. The exposures are DM and smoking, and the outcome is oral health. HYPOTHESIS: DM-IFG will increase the risk of developing dental caries and tooth loss, thus lowering the quality of oral health in smokers compared to nonsmokers. METHODS: DM was defined as either the self-report of a doctor’s diagnosis of DM or a fasting glucose level of 126mg/dL or higher, or both. IFG was defined as a level of fasting glucose between 100mg/dL and 126mg/dL, as well as being informed by a medical doctor about having borderline DM. Subjects with IFG or DM were further combined into a DM-IFG group. Each subject’s status was classified on the basis of both DM-IFG status and smoking status, yielding four exposure groups: (1) no DM-IFG/non-smokers, (2) no DM-IFG/smokers, (3) DM-IFG/non-smokers, and (4) DM-IFG/smokers. Oral health outcomes were defined as a percent of missing teeth (due to dental health issues), percent of teeth with dental caries, and percent of teeth either missing or with caries. The primary statistical analysis for association between DM-IFG and smoking exposures and oral health outcomes was multivariable logistic regression. Adjusted models controlled for covariates such age, gender, Body Mass Index (BMI), education level, minutes of sedentary activity, race, HR, and percent of calories from fat intake. RESULTS: Overall, the prevalence of having 25% or more of teeth with dental caries was similar in those with and without DM-IFG (50.9% vs. 49.9%, respectively) and, surprisingly, was with higher among non-smokers than smokers (51.9% vs. 42.1%, respectively. Those with DM-IFG had a prevalence of missing teeth due to dental causes (≥ 15% missing) of 43.2% compared with a prevalence of 28.6% among those without DM-IFG. Since the majority of missing teeth were likely to be due to caries as well, the final outcome for these analyses consists of participants with either missing teeth or carious remaining teeth. Here, we found that 55.8% of those with DM-IFG had 40% of more of teeth missing vs. 44.8% of those without DM-IFG (p<0.0001). Similarly, 52.1% of smokers vs. 48.8% of non-smokers had more missing or carious teeth (p=0.1587). In the multivariable models, adjusting for age, race, HR, and percent of calories from fat, these analyses showed that DM-IFG alone (among non-smokers) was associated with a 1.42-fold increased risk of missing teeth while smoking along was associated with a 2.86-fold increased risk. The combined effects of the two factors were even stronger. Those who smoked cigarettes and who had DM-IFG (compared with those who did not smoke and had no DM-IFG) had a 3.88-fold increased risk of have 15% or more of their teeth missing due to dental health issues. Lastly, I examined these same effects on the risk of having either missing teeth or dental caries. In these analyses, smokers without DM-IFG had a 67% higher risk (95% CI: 1.27-2.19) of have 40% or more of their teeth missing or with caries while non-smokers with DM-IFG had no excess risk. Finally, those with DM-IFG who also smoked cigarettes had a 52% increased risk (95% CI: 1.08-2.14) of have 40% or more of their teeth missing or with caries compared with non-smokers who did not have DM-IFG. CONCLUSION: These results suggest that smoking was a more important risk factor for having missing teeth or dental caries than was DM or IFG.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19362号 / 医博第4039号 / 新制||医||1011(附属図書館) / 32376 / 新制||医||1011 / 京都大学大学院医学研究科医学専攻 / (主査)教授 横出 正之, 教授 佐藤 俊哉, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Aim: The aim of the study was to systematically review the evidence from clinical intervention trials evaluating the effect of periodontal treatment (PT) on surrogate markers on individuals diagnosed with periodontal disease (PD) and atherosclerotic cardiovascular disease (ACVD). The systematic review was based on quantitative literature. Method: A electronic search for relevant articles published between October 2012- October 2022 was carried out in the following databases: PubMed, Cochrane Library, and Web of Science. Results: The systematic search identified 686 articles, after the title and abstract screening 14 articles were read in full-text, 7 articles underwent risk of bias assessment, 1 was excluded due to high risk of bias and 6 articles were ultimately included. The results found that PT led to decreased levels of inflammatory biomarkers and surrogate markers of ACVD, improved periodontal parameters and endothelial function, and reduced levels of periodontopathogens. Conclusion: The findings indicate that PT can potentially benefit atherosclerosis by managing and improving its risk factors. As demonstrated by the small sample size further research is needed to fully determine the effects of PT on atherosclerosis. / Syfte: Studiens syfte var att systematiskt granska evidensen från kliniska interventionsstudier som utvärderade effekten av parodontal behandling på surrogatmarkörer på individer diagnostiserade med parodontit och aterosklerotisk hjärt-kärlsjukdom (ACVD). Den systematiska litteraturöversikten baserades på kvantitativ litteratur. Metod: En elektronisk sökning för relevanta artiklar som publicerades mellan oktober 2012 och oktober 2022 gjordes i följande databaser: PubMed, Cochrane Library och Web of Science. Resultat: Sökningen identifierade 686 artiklar, varav 14 lästes i fulltext, 7 artiklar bedömdes för risk av snedvridning, 1 var exkluderad på grund av hög risk för snedvridning och slutligen inkluderades 6 vetenskapliga studier med kvantitativ ansats. Studierna fann att parodontal behandling ledde till minskade nivåer av inflammatoriska biomarkörer och surrogatmarkörer, förbättrade parodontala parametrar och endotelfunktion samt minskade nivåer av parodontala bakterier. Slutsats: Fynden indikerar att parodontal behandling potentiellt kan gynna åderförkalkning genom att hantera och förbättra dess riskfaktorer. Vidare forskning behövs för att fullständigt bestämma effekterna av parodontal behandling på ateroskleros.