Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Gingival abrasions resulting from brushing are reversible epithelial lesions, presenting a superficial or exposed tissue. These lesions have been considered subrogated outcome of gingival recession, although the mechanisms by which gingival abrasion result in apical migration of the junctional epithelium, bone loss, gum recession and consequently, have not yet been known. The aim of this study was to evaluate the effect of the type of filament of soft bristle brushes (round and tapered), and the presence dentifrice. Gingival abrasion is the primary endpoint and secondary is the ability to remove plaque. The experimental design was crossed. Thirty-nine patients with gingival health abstained from oral hygiene for 72 hours. The following contralateral quadrants were randomized to be brushed with a toothbrush rounded or tapered filaments, each quadrant for 30 seconds, totaling to two minutes. In the first period was used fluoridated toothpaste, brushing the second period was performed with water only. "Washout" of a week between the periods will be held. Evaluation of Stained Plaque and gingival abrasion were performed before and after brushing. The results of this study demonstrated that both bristle brushes soft, rounded or conical, were effective in removing plaque (p <0.05), and promoted significantly more gingival abrasion injuries comparing the baseline period and after brushing (p <0.05), but no statistically significant difference between the brushes evaluated. The use of the dentifrice contributed to greater removal of plaque (p> 0.05) and increased number of injuries abrasion gum (p <0.05), most of the sites evaluated. The rounded brush filament showed higher levels of gingival abrasion injury, but was more effective at removing plaque stained. Both brushes used in the study were effective and safe. / Abrasões gengivais decorrentes de escovação são lesões epiteliais reversíveis, apresentando-se de forma superficial ou com exposição do tecido conjuntivo. Essas lesões têm sido consideradas desfecho sub-rogado de recessão gengival, embora os mecanismos pelos quais a abrasão gengival resultaria em migração apical do epitélio juncional, perda óssea, e consequente recessão gengival, não tenham sido ainda entendidos. O objetivo deste estudo foi avaliar o efeito do tipo de acabamento das cerdas de escovas macias (arredondado e cônico), e da presença dentifrício tendo como desfecho primário a abrasão gengival e secundário a remoção de placa. O desenho experimental utilizado foi cruzado, randomizado e cego. Trinta e nove pacientes com saúde gengival absteram-se de higiene bucal por 72 horas. A seguir, tiveram os quadrantes contralaterais randomizados para serem escovados com uma escova de filamentos arredondados e cônicos, durante 30 segundos cada quadrante, totalizando-se dois minutos. No primeiro período foi utilizado dentifrício fluoretado, no segundo período a escovação foi realizada apenas com água. Washout de uma semana entre os períodos foi realizado. Avaliações de Placa Corada e Abrasão Gengival foram realizadas pré e pós escovação. Os resultados do presente estudo demonstraram que o tipo de acabamento de cerdas de escovas macias, arredondadas ou cônicas, não influenciou na remoção de placa e abrasão gengival (p>0,05). O uso do dentifrício contribuiu para maior remoção de placa (p>0,05) e maior número de lesões de abrasão gengival (p<0,05), na maioria dos sítios avaliados. Os resultados do presente estudo demonstraram que ambas as cerdas de escovas macias, arredondadas ou cônicas, foram eficazes na remoção de placa (p<0,05), e promoveram significativamente mais lesões de abrasão gengival comparando-se no período baseline e pós escovação (p<0,05), porém não houve diferença estatisticamente significante entre as escovas avaliadas. O uso do dentifrício contribuiu para maior remoção de placa (p>0,05) e maior número de lesões de abrasão gengival (p<0,05), na maioria dos sítios avaliados. A escova de filamento arredondado mostrou maiores índices de lesão de abrasão gengival, porém foi mais eficaz na remoção de placa corada. Ambas as escovas utilizadas no estudo foram eficazes e seguras.

La morphogenèse crâniofaciale chez les vertébrés est un phénomène important, strictement régulé dans l’espace et dans le temps. Elle est basée sur une série complexe d'événements moléculaires et morphogénétiques qui implique un réseau interactionnel de gènes et de facteurs de transcriptions, tels les homéoboîtes. La crête neurale (CN) est au cœur de ce processus. Cette dernière fournit la principale source du mésenchyme crâniofacial. Cette population de cellules embryonnaires transitoires va subir une transition épithélio-mésenchymateuse et migrer en plusieurs vagues vers des sites prédéfinis puis se différencier en divers types cellulaires. La CN est à l’origine de plusieurs structures : une grande partie du squelette facial dont le maxillaire, la mandibule, l’os alvéolaire qui entoure les dents ainsi qu’une partie des tissus conjonctifs crâniofaciaux. Les cellules issues des CN sont pluripotentes et offrent un espoir en régénération osseuse et cartilagineuse. Ces caractéristiques ont généré un intérêt particulier des chercheurs pour les utiliser en thérapie cellulaire afin de réparer les défauts osseux des mâchoires. Parmi les tissus crâniofaciaux, nous avons choisi d’étudier plus avant la gencive et les cellules gingivales car leur accès est le plus facile et leurs capacités de différenciation autorisent l’observation d’autres phénotypes cellulaires.La gencive est un tissu kératinisé qui entoure les dents et recouvre l’os alvéolaire. Ce tissu est composé principalement de fibroblastes gingivaux (GFs). Parmi ces cellules, se trouvent des cellules souches gingivales (GSCs) caractérisées par leur auto-renouvellement et leur multipotence. Les GSCs sont facilement recueillies chez les patients adultes, elles montrent une plasticité importante et une activité immunomodulatrice qui en font un outil de choix pour la thérapie cellulaire. De plus, la biopsie se fait sans douleur et n’entraîne ni cicatrice ni problème fonctionnel.La première partie de mon travail de doctorat avait pour objectif d’évaluer le rôle de Msx1 dans la morphogenèse crâniofaciale et par la suite d’analyser l’os alvéolaire après une extraction dentaire afin d’analyser les mécanismes associés à ce processus et l’impact de Msx1 sur la cicatrisation osseuse.La deuxième partie de mon travail est axé sur la gencive et avait pour objectif de mettre en évidence l’origine embryologique des cellules souches orales, dont les GSCs, et de déterminer si elles proviennent des crêtes neurales, du mésoderme ou d’une mosaïque des deux. Enfin, pour appliquer nos connaissances sur l’origine embryologique des cellules souches gingivales, nous avons étudié le profil immunitaire des cellules dérivées des CN. Pour cela, nous avons déterminé la capacité phagocytaire des cellules souches gingivales murines dérivées des CN et comparé à des cellules de CN d’autres espèces vertébrées. / Craniofacial morphogenesis in vertebrates is an important phenomenon, strictly regulated in space and in time. It is based on a complex series of molecular and morphogenetic events involving an interactional network of genes and transcription factors, such as the homeobox. Neural crest (NC) is at the heart of this process. The latter provides the main source of craniofacial mesenchyme. This transient population of embryonic cells will undergo epithelial-mesenchymal transition and migrate in waves to predefined sites and to differentiate into various cell types. NC is the source of several structures: a large part of the facial skeleton including the maxillary, mandibular alveolar bone around the teeth as well as connective tissue in craniofacial portion. Cells from NC are pluripotent and offer hope for bone and cartilage regeneration. These characteristics have generated particular interest to researchers for use in cell therapy to repair bone defects of the jaw. Among the craniofacial tissues, we decided to further investigate the gums and gingival cells because their access is easier and differentiation capabilities allow observation of other cellular phenotypes.The gum is a keratinized tissue around the teeth and covers the alveolar bone. This tissue is composed mainly of populations of gingival fibroblasts (GFs). Among these populations, there are gingival stem cells (GSCs) characterized by their self-renewal and pluripotency. The GSCs are easily collected in adult patients, they show significant plasticity and immunomodulatory activity that make it a tool of choice for cell therapy. In addition, the biopsy is painless and involves neither scar nor functional problem.The first part of my PhD work was to evaluate the Msx1 role in craniofacial morphogenesis and subsequently analyse the alveolar bone after tooth extraction to analyse the mechanisms involved in this process and the impact of Msx1 on bone healing.The second part of my work focuses on the gingiva and was intended to highlight the embryological origin of oral stem cells, including GSCs and determine if they come from the neural crest, mesodermal or mosaic two. Finally, to apply our knowledge of the embryological origin of gum stem cells, we studied the immune profile derived NC cells. For this, we determined the phagocytic capacity gingival murine stem cells derived from CN and compared to cells of CN other vertebrate species.

Oral submucous fibrosis (OSF) is a debilitating irreversible fibrotic condition of the oral cavity. It is characterized by inflammation and ultimately results in trismus. Patients face difficulty in speaking, swallowing and chewing due to restricted mouth opening (trismus). This disease is also categorized as an oral premalignant disorder (OPMD). Recent reports cite a conversion rate of 10% from OSF to oral squamous cell carcinoma (OSCC). Epidemiological studies and case reports over the years have correlated the habit of chewing areca nut (Areca catechu) to the manifestation of OSF. It is a major cause of concern in the South and South East Asian parts of the world where areca nut is cultivated and routinely consumed. There are an estimated 700 million areca nut chewers around the globe with 0.5% of the population in the Indian subcontinent being affected by OSF due to this habit. Previous studies have reported differential gene expression profile and up regulation of the pro-fibrotic transforming growth factor-β (TGF-β) pathway in OSF. However, detailed molecular mechanisms for the pathogenesis of this disease are still unclear despite our knowledge about the etiological agent (areca nut) responsible for its progression. Therefore, to gain insights into the etiopathogeneses of OSF, following objectives were undertaken:  To study the gene expression changes induced by areca nut and pro-fibrotic cytokine TGF-β in primary fibroblast cells, and their implications in OSF.  To elucidate the mechanism of TGF-β signal activation in epithelial cells by areca nut. Fibroblast cells are the effectors in all fibrotic disorders. Therefore, it is essential to study the response of this cell type in fibrosis. With prior knowledge of the activation of TGF-β pathway in OSF and the etiological agent of this disease being areca nut; we wanted to study the differential gene response of fibroblasts to these two agents. For this purpose, human primary gingival fibroblasts (hGF) were used as a model system to study the global gene expression profile regulated by areca nut and/or TGF-β. hGF cells were treated with sub-cytotoxic dose of areca nut (5 µg/ml) with and without TGF-β (5 ng/ml) for 72 hours and microarray was performed. The results revealed 4666 genes being differentially regulated by areca nut in hGF cells while TGF-β regulated 1214 genes. Both of them together differentially regulated 5752 genes. 413 genes which were commonly regulated by areca nut and TGF-β were observed to have enhanced regulation with a combined treatment of areca nut, together with TGF-β. This result pointed towards the potential role of both areca nut and TGF-β in modulating fibroblast response. To further assess the role of areca nut in OSF manifestation, we first compared the transcriptome profile induced by it in epithelial cells with fibroblast cells. Areca nut was found to induce differential response in these two cell types which corroborates with the disease pathology wherein; epithelial atrophy is observed and conversely fibroblasts are proliferative. To extend these observations we compared the areca nut induced profile in epithelial cells with OSF differential profile and found that a majority of the genes regulated by areca nut which were common with OSF are regulated by TGF-β. Similarly, areca nut and TGF-β regulated profile in fibroblast cells overlapped significantly with OSF profile. Additionally, areca nut and TGF-β treatment positively enriched matrix associated and metabolic pathways among others which are reported to be differentially regulated in OSF. These observations also highlighted the importance of combined actions of areca nut and TGF-β in OSF manifestation. To test the physiological importance of combined actions of areca nut and TGF-β in the context of OSF; activation of fibroblasts by these treatments was assessed. Treatment of fibroblasts with areca nut and TGF-β enhanced the expression of myofibroblast markers αSMA and γSMA with a concomitant increase in the contractile property when compared to areca nut or TGF-β treatment alone. Further, we observed that areca nut did not regulate any of the TGF-β ligands or receptors in fibroblasts, whereas it induced TGF-β2 in epithelial cells. Therefore, this invoked a possible epithelial-mesenchymal interaction that may exist in OSF pathogenesis. To test this possibility in-vitro, epithelial cells were treated with areca nut and the secretome of these cells was put on hGF cells to study the regulation of fibrosis associated genes. This treatment enhanced the regulation of fibroblast activation markers (αSMA and γSMA) as compared to direct areca nut treatment. This increase in regulation was abrogated when induction of TGF-β2 was compromised in epithelial cells. Similar results were obtained for the regulation of other genes (TGM-2, THBS-1, EDN1, LOXL3, PLOD2, TMEPAI, TGFBI, CTGF, BMP1, LMIK1). Therefore, we concluded that TGF-β which is secreted in response to areca nut by epithelial cells influences fibroblasts in combination with areca nut to enhance fibrosis response. Furthermore, the secretome of untreated epithelial cells was found to down regulate the basal expression of fibrosis related genes in fibroblasts, invoking a role for epithelial secretome in regulating the fibrosis progression. Our data highlighted the importance of TGF-β’s influence on fibroblast response in OSF, but the mechanism for the regulation of this cytokine was not known. Areca nut did not induce TGF-β ligands in fibroblast as discussed above, but previous data from our group had reported areca nut mediated up regulation of TGF-β2 in epithelial cells. Therefore, we further elucidated the mechanistic details for this induction using immortalized keratinocytes (HaCaT and HPL1D) and correlated these in OSF tissues. The kinetics of the induction of TGF-β signaling by areca nut (5 µg/ml) in epithelial cells was established. Areca nut induced TGF-β2 transcript, protein and activated the canonical signaling (pSMAD2/3) at 2 hours post treatment, which persisted till 24 hours. The regulation of TGF-β2 mRNA at 2 hours was dependent on active transcription but was independent of protein translation whereas the activation of signaling (pSMAD2) required both transcription and translation at this time point. This warranted probing for the role of TβR-I in the activation of TGF-β signal by areca nut. A small molecule inhibitor was used to abrogate the kinase activity of TβR-I. Areca nut induced TGF-β2 mRNA at 2 hours even in the presence of TβR-I inhibitor whereas the induction was compromised at 24 hours although the activation of SMAD2 at both 2 and 24 hours was compromised in the presence of TβR-I. This result signified that induction of TGF-β signaling was dependent on the TβR-I activity at early and late time points, but the transcription of the ligand was independent of the receptor activity at early time point. These results indicated the activation of some other pathway by areca nut which could regulate the transcription of TGF-β2 and thereby activate TGF-β signaling in epithelial cells. To explore this possibility, a panel of pathway inhibitors was used and only JNK inhibitor compromised areca nut induced TGF-β2 mRNA and pSMAD2. The results were corroborated by transient knockdown of JNK1 and JNK2. Further, JNK was phosphorylated at 30 minutes to 2 hours by areca nut treatment on epithelial cells. This activation was found to be independent of TβR-I activity. In good correlation, activated JNK1/2 was also detected in OSF tissues and was not detectable in normal tissues. Since JNK activation was found to be a pre-requisite for areca nut induced TGF-β signal activation; we further explored the mechanism of JNK activation by areca nut itself. Areca nut mediated activation of JNK was found to be dependent on muscarinic acid receptor, Ca2+/CAMKII and ROS. Inhibition of these significantly compromised areca nut induced pJNK. In line with this, inhibition of muscarinic acid receptor activity, CAMKII and ROS also abrogated areca nut mediated induction of TGF-β2 mRNA and pSMAD2. The regulation of TGF-β signaling by areca nut in epithelial cells was dependent on transcription, and JNK activity was essential for this. We further sought to explore transcription factors which were regulated by JNK and therefore could possibly induce TGF-β2 promoter activity. ATF2 and c-Jun transcription factors were found to be induced at 30 minutes by areca nut and this up regulation also persisted till 24 hours. Further, activation of both ATF2 and c-Jun was dependent on JNK but independent of TβR-I activity. Moreover, areca nut treatment induced translocation of these phoshorylated transcription factors in the nucleus of epithelial cells. Additionally, pATF2 and p-c-Jun were enriched on TGF-β2 promoter after 2 hours of treatment by areca nut. To investigate the importance of this enrichment and regulation of TGF-β signal activation by areca nut, we transiently knocked down these proteins and studied the regulation of TGF-β2. Areca nut induced TGF-β2 mRNA and pSMAD2 was abrogated upon ATF2 and c-Jun knockdown, implicating JNK mediated activation of ATF2 and c-Jun in areca nut induced TGF- β signaling. To explore the significance of this mechanism in OSF, immunohistochemical staining for pATF2 and p-c-Jun was performed on OSF and normal tissues. Both the transcription factors were found in the nuclei of OSF tissues whereas their expression was not detected in normal tissues. This expression also correlated with the previously reported activation of SMAD2 in OSF tissues by our group. Hence, ATF2 and c-Jun were observed to be important in areca nut mediated TGF-β signaling in OSF. In conclusion, the work described in this thesis provides mechanistic details into OSF etiopathogenesis. Combined actions of areca nut and TGF-β induced a response in fibroblasts akin to OSF. Our results advocate a role for epithelial secreted factors in influencing fibroblast response in both normal and disease (OSF) conditions. Further, importance of TGF-β in OSF has been elucidated in terms of enhancing the fibroblast response to areca nut. We have also elucidated the mechanism for areca nut mediated activation of TGF-β signaling and have identified the contribution of JNK/ATF2/Jun axis in this process. This work can impact the management of oral submucous fibrosis by providing newer targets for treatment.

A Ciclosporina A (CsA) é o medicamento de escolha utilizado no controle da rejeição de órgãos em pacientes transplantados. Efeitos adversos associados ao fármaco, como alterações ósseas e o aumento gengival são fatores de risco para a doença periodontal. O objetivo do estudo foi avaliar o efeito da indução de doença periodontal no tecido ósseo, tecido epitelial e tecido conjuntivo de ratos previamente tratados com a CsA. Foram utilizados quarenta ratos Wistar, com 12 semanas de vida, divididos em quatro grupos (n=10): grupo Controle (GC); grupo Ciclosporina A (GCsA), administração de 10mg/kg de CsA durante sessenta dias a partir do início do experimento; grupo Ciclosporina A Ligadura (GCsAL), inserção da ligadura após trinta dias do início do experimento e administração de 10mg/Kg de CsA desde o início do experimento, durante sessenta dias; grupo Ligadura (GL), inserção da ligadura após trinta dias do início do experimento. Os animais foram sacrificados após sessenta dias por meio de perfusão cardíaca para a realização da análise histológica e histomorfométrica do tecido gengival e tecido ósseo, análise radiográfica do suporte ósseo periodontal e da densidade radiográfica e análise bioquímica da Fosfatase Alcalina. Os resultados foram submetidos à análise de variância (ANOVA, Tukey) a 5% e ao teste não paramétrico de Kruskal- Wallis. Os valores médios para GC (60.5 2.22%) e GCsAL (58.1 2.24%) foram equivalentes entre si para o suporte ósseo periodontal e diferentes de GCsA (55.0 4.44%) e GL (54.8 3.11%) (p=0.0007). Os valores médios da densidade radiográfica não apresentaram diferença estatística significativa (p=0.1776). Em relação à fosfatase alcalina, novamente não foi observada diferença significativa entre os grupos (p=0.2806). Os valores médios de células TRAP+ por grupo experimental, não apresentaram diferença estatística significativa (p=0.3995). Os valores médios para GC (0.29 0.03mm2) e GCsA (0.30 0.02mm2) foram equivalentes entre si para a área do ligamento periodontal e diferentes de GCsAL (0.43 0.17mm2) e GL (0.41 0.11mm2) (p=0.3994). Na área total do tecido gengival, os valores médios para GCsA (0.088 0.033mm2) e GL (0.101 0.034mm2) foram equivalentes entre si e diferentes de GC (0.053 0.020mm2) e GCsAL (0.146 0.047mm2) (p=0.000001). Na proporção área do conjuntivo e área total, os valores médios para GC (28.60 8.64%) foi equivalente ao GCsA (32.72 14.13%) e diferente do GCsAL (38.50 10.98%) e GL (37.70 7.49%) (p=0.0093). Em relação à proporção área do epitélio e área total, os valores médios para GC (71.39 8.64%) foi equivalente ao GCsA (67.27 14.13%) e diferente do GCsAL (61.49 10.98%) e GL (63.37 7.44%) (p=0.0142). Na proporção área do epitélio e área do conjuntivo, os valores médios para GC (2.80 1.13) foi equivalente ao GCsA (2.18 1,32) e diferente do GCsAL (1.89 1.17) e GL (1.81 0.80) (p=0.0334). Baseados nestes resultados pode-se concluir que a exposição prévia a CsA não modificou significativamente a evolução da doença periodontal induzida em ratos. / Cyclosporine A (CsA) is the drug of choice used to prevent organ transplant rejection. Side effects associated to the drug, like bone alterations and gingival overgrowth are considered risk factors to periodontal disease. The objective of the present study was to evaluate the effect of periodontal disease on the bone tissue, epitelial tissue and connective tissue of the rats previously treated with CsA. Forty Wistar rats with 12 weeks were divided into four groups: Control Group (CG, n=10); CsA Group (CsAG, n=10), with CsA (10mg/kg) administration during 60 days since the beginning of the experiment; CsA and Ligature Group (CsALG, n=10), with ligature placement at 30 days after the beginning of the experiment with CsA administration during the whole period; and, Ligature Group (LG, n=10), with ligature placement at 30 days after the beginning of the experiment. After blood sample collection for the biochemical analysis of the Alkaline Phosphatase (PA) activity, the animals were sacrificed by intracardiac perfusion at 60 days after the beginning of the experiment. The mandibles were removed for histologic and histometric analyses of the gingival and bone tissues, and radiographic analysis of the alveolar bone support and density. The data were subjected to analysis of variance (ANOVA, Tuckey) at 5% and to the non-parametric test of Kruskal-Wallis. The mean percentage of alveolar bone support for the CG (60.5 2.22%) was similar to the CsALG (58.1 2.24%) and different to the CsAG (55.0 4.44%) and LG (54.8 3.11%) (p=0.0007). Bone density and PA activity were not statistically different among groups (p=0.1776, and p=0.2806, respectively). The mean values for TRAP+ cells were not statistically different among experimental groups (p=0.3995). The mean values of the periodontal ligament area for CG (0.29 0.03mm2) were similar to the CsAG (0.30 0.02mm2) and statistically different to the CsALG (0.43 0.17mm2) and to the LG (0.41 0.11mm2) (p=0.3994). With regards to the total area of the gingival tissue, the mean values for the CsAG (0.088 0.033mm2) and LG (0.101 0.034mm2) were similar between each other and statistically different to the CG (0.053 0.020mm2) and CsALG (0.146 0.047mm2) (p=0.000001). Regarding the proportion of connective tissue area to the total area, the mean value of the CG (28.60 8.64%) was similar to the CsAG (32.72 14.13%) and statistically different to the CsALG (38.50 10.98%) and to the LG (37.70 7.49%) (p=0.0093). In relation to the proportion of the epithelial tissue area to the total area, the mean value for the CG (71.39 8.64%) was similar to the CsAG (67.27 14.13%) and different to the CsALG (61.49 10.98%) and LG (63.37 7.44%) (p=0.0142). In the proportion of epithelial tissue area to the connective tissue area, the mean value for the CG (2.80 1.13) was similar to the CsAG (2.18 1.32) and different to the CsALG (1.89 1.17) and LG (1.81 0.80) (p=0.0334). Based on these results it can be concluded that previous exposure to CsA did not significantly modify the development of periodontal disease induced in rats.

No description available.

Oral health may serve as an indicator of overall systemic health, with each disease or condition manifesting differently in the oral cavity. Sickle cell disease (SCD) is a genetic disorder in which sickled red blood cells cause blood vessel occlusion and potentially bleeding in specific sites (e.g., gastrointestinal and intracranial bleeding). With SCD being one of the most common hereditary diseases in the world, it is essential to understand the disease and improve awareness to better treat this population. While studies have been done to evaluate the oral health of persons with SCD, few have explored the occurrence of gingival bleeding and their experience with dental care. Due to this gap in the literature, the present study investigates the potential relationship between SCD, gingival bleeding, and certain other oral manifestations. Adults with and without SCD responded to an online questionnaire regarding oral health and dental care. The data was collected and analyzed during the 2022 spring semester. The data collected from Qualtrics was downloaded into JASP for statistical analysis. While there was a greater prevalence of gingival bleeding and caries in those with SCD, analysis of the sample showed no significant association between the oral manifestations and SCD. A deeper subgroup analysis suggested that those with SCD and no employment may be at higher risk for dental caries, orofacial pain, and gingival bleeding. Further investigation is necessary to determine the direct effect of the disease. The findings may justify further studies to include clinical evaluations by oral health care providers and larger quantity of participants. A better understanding of the relationship between SCD and oral health may lead to oral hygiene improvement strategies geared explicitly toward persons with SCD.

Kronisk parodontit orsakar vävnadsdestruktion till följd av matrixmetalloproteinasaktivitet. Dessa enzym härrör från värdcellerna och är en del av det immunologiska svaret på bakteriella virulensfaktorer. Grönt te har studerats för sina hälsofrämjande egenskaper, som omfattar bland annat anti-inflammatoriska effekter. Effekten beror delvis på enzyminhibering av tepolyfenoler. Syftet med denna studie var att ytterligare undersöka den inhiberande effekten av grönt te, med fokus på enzymatisk aktivitet i gingivalvätska från patienter med parodontal sjukdom. Patienter med kronisk parodontit valdes ut för att delta i studien. Gingivalvätska extraherades med mikropipetter från patienternas gingivala sulci. Proverna behandlades med grönt te och jämfördes med obehandlade prover från samma försöksperson. Fluorescens proteasanalys med kasein som substrat utfördes på fjorton prover för att detektera skillnader i kaseinolytisk aktivitet. Zymogramanalys med användning av gelatin som substrat utfördes på fyra prover, för att undersöka skillnader i gelatinolytisk aktivitet och analysera molekylvikter för de olika enzymerna. Den fluorometriska analysen visade en signifikant lägre enzymaktivitet i prover med tillsatt grönt te jämfört med obehandlade prover (p<0.001). Zymogramanalysen visade en skillnad i enzymaktivitet som var mest uttalad i banden för molekylär vikt runt 255 kDa, analogt med komplex av matrixmetalloproteinas-9. Sammanfattningsvis har det i denna studie påvisats att grönt te har en hämmande effekt på kaseinolytisk aktivitet och en mindre, mer specifik, hämmande effekt på gelatinasaktivitet. / Chronic periodontitis involves tissue destruction by matrix metalloproteinase, derived from the host cells, as part of the immunological response to bacterial virulence factors. Green tea has been studied for its health promoting properties, which includes anti-inflammatory effects. The effect is in part due to enzyme inhibition by tea polyphenols. The aim of this study was to further investigate the inhibitory effect of green tea, focusing on enzymatic activity in gingival crevicular fluid from patients with periodontal disease. Patients with chronic periodontitis were selected for participation in the study. Gingival crevicular fluid was extracted with micropipettes from the gingival sulci of the patients. Samples were treated with green tea and compared with untreated samples from the same subject. Fluorescence protease assay with casein as substrate was made using fourteen samples for detecting differences in caseinolytic activity. Zymogram assay using gelatin as substrate was done using four samples to test gelatinolytic activity and analyse molecular weights of the different enzymes. The fluorometric assay showed a significantly lower enzyme activity in samples mixed with green tea than untreated samples (p<0.001). The zymogram assay showed a difference in band strength which was most pronounced in the bands of molecular weight around 255 kDA, analogous to complexes of matrix metalloproteinase-9. In conclusion, green tea has been shown in this study to have a strong inhibitory effect on caseinolytic activity and a lesser, more specific, inhibitory effect on gelatinase activity.

Introduktion: Ungefär en fjärdedel av alla barn och ungdomar födda under samma år genomgår någon form av behandling som innefattar förflyttning av tänder. Syfte: Primär fokus med denna studie är att undersöka om ett samband finns mellan gingival retraktion och användning av fast apparatur på avdelningen för Ortodonti, Malmö Högskola.Metod: Studiemodeller, intraorala bilder och klinisk undersökning (återbesök 2014) användes för att identifiera gingival retraktion med ja eller nej. Om det fanns gjordes en mätning. Försöksobjekt valdes från patienter som blivit färdigbehandlade 2008/2009. Resultat: Studiemodeller för 2008 visade färre gingivala retraktioner efter behandling p-värde, (p=0,0034 som är statistiskt signifikant). För lite data fanns från klinisk undersökning och intraorala bilder för att göra analays. Slutsats: Gingivala retraktioner verkar inte ha någon koppling med ortodontisk behandling på avdelningen för Ortodonti, Malmö Högskola. Kliniska intraorala foton är ett grovt mått diagnostiskt verktyg för att bedöma gingivala retraktioner. Det är baserat på begränsad data och inte slutgiltigt. Studie med större grupp av patienter behövs

Background: Studies of gingival bleeding and the effects of antioxidants on extracellular matrix and immunologic and inflammatory responses provide a rationale for hypothesizing that antioxidants reduce the risk for gingival bleeding.Methods: This study evaluated the role of antioxidants as contributing risk factors for gingival bleeding utilizing the Third National Health and Nutrition Examination Survey (NAHNES III). A sample of 18,825 adults (20 to ≥ 90 years of age), with dental measurement and assessment of serum levels of antioxidants were included in the study. Gingival bleeding was defined as those who had more than 30 percent of gingival bleeding in 28 sites examined. SPSS version 11.0 software and Epi-info 2000 were used to perform the statistical analysis.Results: Using multiple logistic regression in five separate antioxidants, the study showed an association between increased plasma levels of vitamin C (ascorbic acid) and decreased risk for gingival bleeding (OR= 0.33; 95% CI 0.15 to 0.72). An inverse relationship was also found between gingival bleeding and serum levels of beta carotene (OR=1.93; 95% CI 1.05 to 3.54). However, negative association was found between gingival bleeding and vitamin A (OR=2.60; 95% CI 1.04 to 6.50). No statistically significant association was observed between gingival bleeding and serum levels in vitamin E (alpha tocopherol) and selenium.Conclusion: Antioxidants, vitamin C, vitamin A, and beta carotene, were significant risk factors for gingival bleeding. This should be emphasized for improving the oral health of the U.S. adult population.

O enxerto gengival livre (EGL) promove aumento do tecido queratinizado, mas apresenta contração tecidual, problemas estéticos e dor pós-operatória. Recentemente, uma técnica modificada de EGL visa a menor contração e melhor coloração. O objetivo deste estudo foi comparar a eficácia da técnica modificada de EGL com a técnica original de EGL, em relação à largura ápico-cervical do tecido queratinizado após 1 ano de seguimento. Para isso, foi realizado um ensaio clínico randomizado, multicêntrico, em que 40 indivíduos foram submetidos a uma cirurgia de aumento de tecido queratinizado na região de incisivos inferiores com a técnica original (Grupo controle; n=20) ou com a técnica modificada (Grupo teste; n=20). O preparo do leito receptor deu-se de forma idêntica em ambas as técnicas. No grupo controle, o EGL foi estabilizado com suturas e deixado exposto. No grupo teste, o EGL foi recoberto pelo retalho. O desfecho primário foi a largura ápico-cervical do tecido queratinizado (LTQ) e, juntamente com a espessura do tecido queratinizado (ETQ) e os parâmetros clínicos: retração gengival (RG), profundidade clínica de sondagem (PS), nível clínico de inserção (NCI), índice PASS (IPASS) e índice de sangramento à sondagem (ISS), foram analisados antes da cirurgia e aos 3, 6 e 12 meses após a cirurgia. O tempo transcirúrgico (TT), a dor pós-operatória (DPO) na área doadora e receptora, a quantidade de medicação consumida (QM), a contração vertical do enxerto (CV), a correspondência de cor da gengiva (COR) e a satisfação estética do paciente (SE), também foram avaliadas. O teste t e ANOVA de medidas repetidas, seguido do teste post-hoc de Newman-Keuls foram utilizados para análise dos desfechos. O nível de significância foi estabelecido em 5% (p<0,05). Ambas as técnicas promoveram aumento de LTQ e ETQ. Não houve diferença significativa entre as técnicas para LTQ, ETQ, CV, COR e SE. O grupo teste apresentou significativamente menos dor, tanto na área doadora quanto na receptora, aos 7 dias. Ademais, consumiu significativamente menos analgésicos durante o período pós- operatório. Portanto, a técnica modificada de EGL foi tão eficaz quanto a técnica original no aumento da largura ápico-cervical de tecido queratinizado, apresentando como vantagem um menor desconforto pós-operatório. / Free gingival graft (FGG) promotes keratinized tissue augmentation, though graft shrinkage, esthetic issues and postoperative pain may occur. Recently, a modified technique was proposed aiming less shrinkage and better color matching. The objective of this study was to compare the efficacy of the modified FGG technique with the original technique, in relation to the apico-coronal width of keratinized tissue after 1 year of follow-up. A multicentric randomized clinical trial was designed and included 40 subjects who were submitted to a surgery for keratinized tissue augmentation in lower incisor area. Control group (n=20) received the original technique and test group (n=20) received the modified technique. Recipient area was prepared identically for both groups. In control group, FGG was sutured and left exposed whereas in test group, FGG was recovered by the flap. Primary outcome was the apico-coronal width of keratinized tissue (WKT). Additionally, thickness of keratinized tissue (TKT) and clinical parameters: gingival recession (GR), probing depth (PD), clinical attachment level (CAL), PASS index (PI) and bleeding on probing (BoP) were measured before surgery and after 3, 6 and 12 months. Surgery time (ST), postoperative pain (POP) at recipient and donor site, number of pain killers consumed (PC), vertical shrinkage (VS), color matching (CM) and patient\'s esthetic satisfaction (ES) were also analyzed. Statistical analysis of the outcomes was performed with t test and ANOVA for repeated measures, followed by the Newman-Keuls post-hoc test. Significance level was stablished at 5% (p<0.05). Both techniques were effective in augmenting WKT and TKT. There was no statistically difference between techniques for WKT, TKT, VS, CM and ES. Test group showed less pain at recipient and donor site at 7 days of follow-up. Also, test group consumed significant less pain-killers. Therefore, the modified technique of FGG was as effective as original technique in augmenting apico-coronal width of keratinized tissue, but presented less postoperative discomfort as an advantage.