Background: Conflicting evidence of an association between alcohol consumption and periodontal disease has been suggested in the literature. The aim of the present study was to investigate the impact of alcohol consumption on periodontal attachment loss (PAL) over a period of 5-years. Methods: A multistage probability sampling strategy was used to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. Five hundred sixty one individuals (238 males and 323 females) that were 19-65 years-old, had no medical history of diabetes and at least 6 teeth were included. Participants were clinically examined and interviewed in 2001 and 2006. Alcohol consumption was assessed by asking participants about the usual number of drinks consumed in a week. Standard formulas were used to calculate the amount of pure alcohol consumed per day in grams. Drinkers were categorized into occasional (<3g/day) and regular drinkers (≥3g/day). Individuals showing ≥4 teeth with proximal PAL ≥3 mm over the 5-years follow-up period were classified as having disease progression. Linear models were used to estimate the relative risk. Results: Male regular drinkers had higher risk of having PAL progression than never-drinkers. After adjusting for important co-factors regular drinkers had 1% increased risk per grams/day of pure alcohol consumption (RR: 1.01, 95%CI 1.00-1.02), which means between 5 to 7% increased risk per drink per day. Male occasional drinkers were not at higher risk of having disease progression. No association between alcohol consumption and periodontitis was observed for females. Conclusion: Alcohol consumption increased the risk of PAL progression in male regular drinkers. The impact of alcohol cessation initiatives on the periodontal health should be evaluated.

Objetivo: Comparar dois métodos de aferição da perda de inserção clínica (PI) em pacientes periodontais. Materiais e métodos: Setenta e cinco exames (50,9 ± 8,02 anos, 72,2% mulheres e 49,4% não-fumantes), realizados por examinadores calibrados, com registro do Índice de placa visível (IPV), Índice de Sangramento gengival (ISG), Profundidade de Sondagem (PS), Sangramento à Sondagem (SS), Perda de Inserção Clínica aferida pelo método direto (PID) e Recessão Gengival (RG), em 6 sítios/dente, foram utilizados. Valores para PII (método indireto) resultaram do somatório da PS e RG dos sítios RG+ (sítios com recessão gengival). A PID foi considerada como referência. Os dados foram analisados por “clusters”. A dependência dos dados foi observada em níveis hierárquicos: indivíduo/exame, dente e sítio. Para a comparação entre PID e PII gerou-se o valor de d (diferença entre os métodos). Modelos multivariados foram aplicados para investigar o comportamento das demais variáveis em relação à estimação da PI. O Gráfico de Bland-Altman foi gerado para verificar a distribuição da concordância entre os métodos. Resultados: A média de PID (3,96±2,07) foi significativamente menor que a observada para PII (4,47±2,03). Portanto, o valor de d foi de 0,513±1,23. A análise multivariada revelou que ISG, SS, PS e o fato de ser sítio interproximal exerceram influência significativa nas aferições de PII em relação à PID (p≤0,05). A cada milímetro a mais de PS, a PII aumenta em até 0,38mm. Conclusão: Considerando-se a superestimação do dano periodontal determinada pelo método indireto, sugere-se que a PID seja preferível para a realização de exames periodontais, como uma forma de minimizar vieses de aferição. / Objective: This observational study sought to compare two methods for determination of clinical attachment loss (CAL) in periodontal evaluation. Materials and methods: The sample comprised 75 exams from periodontal patients (50.9±8.02 years; 72,2% female; 49.4% nonsmokers). Visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), and gingival recession (GR) were assessed at six sites per tooth. Direct clinical attachment level (CALD) measurements were obtained by measuring the distance between the CEJ and the most apical of probe penetration in the gingival sulcus/periodontal pocket. Indirect clinical attachment level (CALI) was calculated by adding the PD and GR measurements of sites with gingival recession (GR+). These measurements were obtained by three calibrated raters. Means were calculated for each indicator. Data were assessed by cluster analysis. Data dependence was observed at the following hierarchical levels: patient/examination, tooth, and site. The methods were compared by means of the difference (d) between CALD and CALI values. Univariate and multivariate mixed models were then applied. A Bland–Altman plot was generated to ascertain the distribution of agreement between the two methods for CAL determination. Results: The mean CALD and CALI values were 3.96±2.07and 4.47±2.03, respectively. Therefore, the indirect method overestimated CAL (d=0.513±1.23). On multivariate analysis, GBI, BOP, PD, and interproximal site location had a significant influence on CALI measurements as compared with CALD (p ≤ 0.05). With each additional 1 mm in PD, CALI increased by up to 0.38 mm. Conclusion: Given the extent to which periodontal damage is overestimated by the indirect method, we suggest that the directly measured clinical attachment level is preferable for periodontal examination, so as to minimize measurement bias.

Background and Aims: There is little information about the epidemiology and risk factors of periodontal diseases in Latin America in general, and Brazil in particular. The principal aims of this study were to: 1) describe the prevalence and severity of periodontal attachment loss and gingival recession, and to assess the contribution of demographic, behavioral, and environmental exposures to the occurrence of periodontal disease outcomes in a sample representative of the urban population in the state of Rio Grande do Sul in south Brazil; and 2) report the epidemiology and risk indicators of aggressive periodontitis in this population. Methods: A representative sample consisting of 1,586 subjects 14-103 years of age (mean 38 y) and comprising 45.3% males and 54.7% females was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and underwent a full-mouth, six sites per tooth clinical examination in a mobile examination center. Results: Moderate and severe clinical attachment loss and gingival recession were widespread among adults in this population. The prevalence and extent of attachment loss ³5 and ³7 mm were 79% and 52% subjects, and 36% and 16% teeth; and for gingival recession ³3 mm and ³5 mm were 52% and 22% subjects, and 17% and 6% teeth, respectively. Aggressive periodontitis was diagnosed in 5.5% of subjects, which is significantly higher than the reported prevalence in most other populations. Among the main risk indicators for chronic as well as aggressive destructive periodontal diseases were: older age, low socioeconomic status, dental calculus, and smoking. Cigarette smoking accounted for an important part of periodontal disease burden, particularly in adults, and should be considered an important target in any prevention strategy aimed at reducing the burden of periodontal diseases. Partial recording methods consistently underestimated the prevalence of attachment loss in the population, and the extent of underestimation was dependent on the type of system used and the threshold of attachment loss. Conclusions: Destructive periodontal diseases are prevalent in this Brazilian population. Suitable disease prevention and health promotion programs should be established to improve the periodontal health in this population.

Objetivo: Comparar dois métodos de aferição da perda de inserção clínica (PI) em pacientes periodontais. Materiais e métodos: Setenta e cinco exames (50,9 ± 8,02 anos, 72,2% mulheres e 49,4% não-fumantes), realizados por examinadores calibrados, com registro do Índice de placa visível (IPV), Índice de Sangramento gengival (ISG), Profundidade de Sondagem (PS), Sangramento à Sondagem (SS), Perda de Inserção Clínica aferida pelo método direto (PID) e Recessão Gengival (RG), em 6 sítios/dente, foram utilizados. Valores para PII (método indireto) resultaram do somatório da PS e RG dos sítios RG+ (sítios com recessão gengival). A PID foi considerada como referência. Os dados foram analisados por “clusters”. A dependência dos dados foi observada em níveis hierárquicos: indivíduo/exame, dente e sítio. Para a comparação entre PID e PII gerou-se o valor de d (diferença entre os métodos). Modelos multivariados foram aplicados para investigar o comportamento das demais variáveis em relação à estimação da PI. O Gráfico de Bland-Altman foi gerado para verificar a distribuição da concordância entre os métodos. Resultados: A média de PID (3,96±2,07) foi significativamente menor que a observada para PII (4,47±2,03). Portanto, o valor de d foi de 0,513±1,23. A análise multivariada revelou que ISG, SS, PS e o fato de ser sítio interproximal exerceram influência significativa nas aferições de PII em relação à PID (p≤0,05). A cada milímetro a mais de PS, a PII aumenta em até 0,38mm. Conclusão: Considerando-se a superestimação do dano periodontal determinada pelo método indireto, sugere-se que a PID seja preferível para a realização de exames periodontais, como uma forma de minimizar vieses de aferição. / Objective: This observational study sought to compare two methods for determination of clinical attachment loss (CAL) in periodontal evaluation. Materials and methods: The sample comprised 75 exams from periodontal patients (50.9±8.02 years; 72,2% female; 49.4% nonsmokers). Visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), and gingival recession (GR) were assessed at six sites per tooth. Direct clinical attachment level (CALD) measurements were obtained by measuring the distance between the CEJ and the most apical of probe penetration in the gingival sulcus/periodontal pocket. Indirect clinical attachment level (CALI) was calculated by adding the PD and GR measurements of sites with gingival recession (GR+). These measurements were obtained by three calibrated raters. Means were calculated for each indicator. Data were assessed by cluster analysis. Data dependence was observed at the following hierarchical levels: patient/examination, tooth, and site. The methods were compared by means of the difference (d) between CALD and CALI values. Univariate and multivariate mixed models were then applied. A Bland–Altman plot was generated to ascertain the distribution of agreement between the two methods for CAL determination. Results: The mean CALD and CALI values were 3.96±2.07and 4.47±2.03, respectively. Therefore, the indirect method overestimated CAL (d=0.513±1.23). On multivariate analysis, GBI, BOP, PD, and interproximal site location had a significant influence on CALI measurements as compared with CALD (p ≤ 0.05). With each additional 1 mm in PD, CALI increased by up to 0.38 mm. Conclusion: Given the extent to which periodontal damage is overestimated by the indirect method, we suggest that the directly measured clinical attachment level is preferable for periodontal examination, so as to minimize measurement bias.

Orientador: Daniela Leal Zandim-Barcelos / Resumo: A movimentação dentária ortodôntica em pacientes adultos com histórico de doença periodontal requer um planejamento complexo, devido à reabsorção óssea, e a dificuldade de se obter uma ancoragem satisfatória por consequência da perda de elementos dentários. O objetivo deste trabalho foi avaliar as alterações longitudinais no perfil microbiológico e nos parâmetros clínicos periodontais de incisivos centrais superiores com periodonto reduzido durante e após término do movimento de intrusão dentária. Vinte pacientes com doença periodontal foram selecionados de acordo com os critérios do estudo. Estes pacientes deveriam apresentar incisivos centrais superiores vestibularizados e extruídos com perda de inserção ≥ 5 mm e indicação de intrusão dentária. Todos os sítios com atividade de doença periodontal receberam raspagem e alisamento radicular (RAR) e para o tratamento ortodôntico ser iniciado, os incisivos centrais superiores deveriam apresentar estabilidade no nível clínico de inserção após 90 dias do término do tratamento periodontal ativo. Os parâmetros clínicos Índice de placa (IP), Índice Gengival (IG), profundidade de sondagem (PS), nível clínico de inserção (NCI), recessão gengival (RG), sangramento à sondagem (SS) e tamanho de coroa clínica (TCC) foram avaliados antes do procedimento de RAR, no início do movimento de intrusão (T1- Baseline), durante o movimento de intrusão (90 e 180 dias), imediatamente após o término da intrusão ortodôntica (T2), 90 e 180 dias após o tér... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Orthodontic tooth movement in adult patients with a history of periodontal disease requires complex planning, due to bone resorption, and the difficulty of achieving satisfactory anchorage as a result of loss of dental elements. The objective of this study was to evaluate longitudinal changes in microbiology and clinical periodontal parameters of upper central incisors, in patients with reduced periodontium, before, during and after orthodontic intrusion. Twenty patients with periodontal disease were selected according to the study criteria. These patients should have vestibularized and extruded upper central incisors with insertion loss ≥ 5 mm and indication of dental intrusion. All sites with activity of periodontal disease received scaling and root planing (RAR) and for orthodontic treatment to be started, the upper central incisors should have stability in the clinical level of insertion after 90 days of the end of active periodontal treatment. Clinical parameters Plaque index (PI), Gingival index (GI), probing depth (PD), clinical level of insertion (CLI), gingival recession (GR), probing bleeding (PB) and clinical crown size (CCS) were evaluated before the RAR procedure, at the beginning of the intrusion movement (T1- Baseline), during the intrusion movement (90 and 180 days), immediately after the end of the orthodontic intrusion (T2), 90 and 180 days after the end of the intrusion treatment. Sample collections of gingival crevicular fluid (GFC) were performed during t... (Complete abstract click electronic access below) / Mestre

The focus of this thesis was to study an action that humans perform regularly, namely, to hold a morsel between the teeth and split it into smaller pieces. Three different issues related to this biting behavior were addressed:  (1) the effect of redu­c­ed perio­dontal tissues on food holding and splitting behavior; (2) the behavioral conse­quences of performing different bite tasks with different functional requirements, i.e., to split a peanut half resting on a piece of chocolate or to split both the peanut and the chocolate; and (3) the reflex modulations resul­ting from such a change in the intended bite action. The main conclusions from the experi­mental studies were the following: First, perio­dontitis, an inflam­matory disease that destroys the peri­o­dontal ligaments and the embedded perio­dontal mechanoreceptors, causes significant impairments in the masticatory abili­ty: the manipulative bite forces when holding a morsel are elevated compared to a matched control population and the bite force development prior to food split is altered. These changes are likely due to a combination of reduced sensory informa­tion from the damaged ligaments and to changes in the bite stra­tegy secon­d­ary to the unstable oral situation. Second, people exploit the anatomy of jaw-closing muscles to regulate the amount of bite force that dissipates following a sudden unloading of the jaw. Such control is necessary because without mechanisms that quickly halt jaw-closing movements after sudden unloading, the impact forces when the teeth collide could otherwise damage both the teeth and related soft tissues. Splitting a piece of chocolate, for instance, regularly requires &gt;100N of bite force and the jaws collide within 5 ms of a split. On the other hand, when biting through heterogeneous food, the bite force needs to be kept high until the whole morsel is split. The required regulation is achieved by differen­tial­ly engaging parts of the masseter muscles along the anteroposterior axis of the jaw to exploit differences between muscle portions in their bite force generating capa­ci­ty and muscle shortening velocity. Finally, the reflex evoked by suddenly unloading the jaw—apparent only after the initial bite force dissipation—is modulated according to the bite intention. That is, when the intention is to bite through food items with multiple layers, the reflex response in the jaw opening muscles following a split is small, thus minimizing the bite force reduction. In contrast, when the intention is to rapidly decrease the bite force once a split has occurred, the reflex response is high. This pattern of reflex modulation is functionally beneficial when biting through heterogeneous food in a smooth manner. The presented studies show the significance of integrating cogni­tive, physiological and anatomical aspects when attempting to understand human masticatory control.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis--University of Oklahoma. / Bibliography: leaves 63-70.

O objetivo desta tese foi estimar a progressão de perda de inserção periodontal (PI) após 5 anos de acompanhamento e estudar fatores de risco para a sua ocorrência em uma amostra urbana do sul do Brasil. O Estudo de Porto Alegre teve início em 2001 com a constituição de uma amostra representativa da região metropolitana obtida por uma amostragem probabilística proporcional estratificada de múltiplo-estágio. A amostra inicial constituiu-se de 1465 indivíduos dentados e 121 desdentados (14-103 anos de idade; média 37,9 anos, desvio padrão 13,3). Em 2006, 697 (47,6%) indivíduos dentados (294 homens e 403 mulheres) e 48 desdentados participaram novamente. Dados demográficos, comportamentais e socioeconômicos foram coletados através de um questionário estruturado. PI foi obtida em seis sítios de todos dentes, por periodontistas calibrados. Duas análises foram realizadas, uma para estimar a ocorrência da progressão de PI proximal, e outra para estimar a associação de fatores de risco para progressão de PI. Do total, 56,0% e 36,2% dos indivíduos apresentaram progressão de PI ≥3mm em 2+ e 4+ dentes, respectivamente. Em geral, a extensão da progressão foi localizada, com média de 3,76 dentes com progressão ≥3mm. A média de progressão de PI foi 0,3mm/ano, sendo que 67% dos indivíduos apresentaram taxa de progressão moderada (>0,1mm/ano a ≤0,5mm/ano), 16,9% leve/nenhuma progressão (≤0,1mm/ano) e 16,1% rápida progressão (>0,5mm/ano). A progressão de PI aumentou estatisticamente com a idade e foi significativamente maior nos homens. Na análise multivariável pode-se observar que: indivíduos de 30-49 e 50+ anos tiveram risco duas vezes maior do que indivíduos com <30 anos; baixa educação aumentou o risco de progressão em 53%; homens nunca-fumantes tiveram risco aumentado em 33% comparados a mulheres nunca-fumantes; entre os fumantes, o risco aumentou em 8% para homens e em 21% para mulheres a cada 10 maços-ano. Pode-se concluir que uma grande proporção desta amostra urbana brasileira apresentou progressão de PI. Idade, gênero, educação e fumo foram encontrados como fatores de risco independentes para progressão de PI. Medidas de promoção de saúde devem ser estabelecidas para diminuir a ocorrência e progressão das doenças periodontais destrutivas nessa população. / The aim of this thesis was to estimate the occurrence of progression of periodontal attachment loss (PAL) and determine its risk factors in an urban sample from South Brazil. The “Porto Alegre Study” started in 2001 and was an epidemiological survey with a representative sample of the Porto Alegre metropolitan area obtained by a multistage probability sampling. At baseline, the sample comprised 1465 dentate and 121 edentulous individuals (mean age: 37.9 years, standard deviation:13.3). After 5 years, 697 (47.6%) dentate (294 males and 403 females) and 48 edentulous subjects were re-evaluated. Demographics, behavioral and socioeconomic data were collected using a structured questionnaire. PAL was obtained in six sites of all teeth present by calibrated periodontists. Two analyses were performed, one aiming at estimating the occurrence of PAL progression, and another aiming at determining risk factors for PAL progression. Overall, 56.0% and 36.2% of the subjects presented PAL progression ≥3mm in 2+ and 4+ teeth, respectively. In general, extent of progression was localized with 3.76 teeth presenting PAL progression ≥3mm. Overall mean PAL progression was 0.3mm/year. When subjects were categorized according to the mean annual PAL progression, 67.0% of subjects showed a moderate progression rate (>0.1mm/year to ≤0.5mm/year), whereas 16.1% were deemed as having no/ slight (≤0.1mm/year) and 16.9% as rapid progression (>0.5mm/year) rates. PAL progression increased significantly with age and was statistically higher among males. The multivariable model showed that: 30-49 and 50+ years-old individuals had approximately two times higher risk than <30 year-olds; low education increased the risk of PAL progression by 53%; among never-smokers, males were 33% more likely to experience PAL progression than females, while the risk increased by 8% for smoker males and by 21% for smoker females per 10 packyears of lifetime smoking exposure. It can be concluded that a large proportion of this urban Brazilian sample was affected by PAL progression underscoring the need for health promotion initiatives aiming at preventing progression of destructive periodontal disease. Age, gender, education and smoking were found to be independent risk factors for PAL progression.

Periodontal diseases are highly prevalent and one of the most significant causes of tooth loss in the world, which is associated with functional, psychological, social and aesthetic impacts. The aim of this study was to evaluate the area of remaining periodontal ligament (ALPR) on extracted teeth collected in the public health care service to Santa Maria - RS. 725 teeth extracted teeth in five month period were collected, 414 were stained with hematoxylin 5% and analyzed with 7.5X increase in stereomicroscope to measure the ALPR. Chips containing reasons of extraction, age and gender of patients were record by dentists who performed the procedures. Descriptive analysis was calculated for demographic parameters, types of teeth extracted and reasons for extraction. Percentage of ALPR was determined for each tooth. Comparisons of ALPR area and total area between teeth extracted for periodontal reasons and other reasons were performed. Teeth extracted for periodontal reason were stratified cutoff points (25.40 and 50%) regarding the amount of remansecente periodontal ligament. ALPR extracted teeth by periodontal reason was extracted from 34.86% and 79.56% for other reasons (p = 0.00). Periodontal disease is the main reason reported for extraction (36.4%), followed by residual roots (21.4%). Upper molar (18.5%) and lower molar (44.5%) had the highest percentage of extraction for periodontal reasons and others, respectively. We conclude that, through an appropriate periodontal treatment and preventive periodic maintenance, a significant portion of the extracted teeth for periodontal reason could have been kept in comfort and function throughout life. / Doenças periodontais são altamente prevalentes e uma das causas mais expressivas de perdas dentárias no mundo, o que está associado a impactos funcionais, psicológicos, sociais e estéticos. O objetivo deste estudo foi avaliar a área de ligamento periodontal remanescente (ALPR) em dentes extraídos recolhidos no serviço de atendimento público de saúde de Santa Maria - RS. Foram coletados 725 dentes extraídos no período de cinco meses, 414 foram corados com hematoxilina 5% e analisados com aumento de 7,5X em estereomicroscópio para mensurar a ALPR. Fichas contendo motivo da extração, idade e gênero dos pacientes foram preenchidas pelos dentistas que realizaram os procedimentos. Análise descritiva foi calculada para parâmetros demográficos, motivos de exodontia e tipos de dentes extraídos. Percentual da ALPR foi determinado para cada dente. Comparações da ALPR por superfície e ALPR total entre os dentes extraídos por motivo periodontal e outros motivos foram realizadas. Dentes extraídos por razão periodontal foram estratificados em pontos de corte (25,40 e 50%) referentes à quantidade de ligamento periodontal remansecente. ALPR de dentes extraídos por motivo periodontal foi 34,86% e extraídos por outras razões 79,56% (p=0,00). Doença periodontal foi a principal razão relatada de exodontia (36,4%), seguida de raízes residuais (21,4%). Molares superiores (18,5%) e molares inferiores (44,5%) tiveram as maiores porcentagens de exodontia por motivo periodontal e outros, respectivamente. Concluímos que, através de um tratamento periodontal adequado e manutenção periódica preventiva, uma parcela expressiva dos dentes extraídos por razão periodontal poderia ter sido mantida em conforto e função ao longo da vida.