Orientador: Sandra Helena Penha de Oliveira / Banca: Michel Reis Messora / Banca: Willian Fernando Zambuzzi / Resumo: Este estudo teve como objetivo avaliar o efeito da doença periodontal (DP) induzida por ligadura nos mecanismos envolvidos na atividade osteoblástica e mineralização da matriz óssea a partir de células-tronco derivadas da medula óssea do fêmur de ratos normotensos e espontaneamente hipertensos (SHR). As linhagens (180-220 g) foram divididas em dois grupos cada: Wistar Controle [WC] e SHR Controle [SC], Wistar com DP [WDP] e SHR com DP [SDP]. Foi realizada na área de furca a análise imunoistoquímica da expressão de receptor ativador nuclear kappa-B ligante (RANKL), osteoprotegerina (OPG), fosfatase alcalina específica do osso (BALP), osteocalcina (OC), metaloproteinases de matriz (MMP)-2, e MMP-9, e fosfatase ácida tartarato resistente (TRAP) da região de furca 15 dias após a indução da DP. Célulastronco mesenquimais derivadas da medula óssea (CTMs) foram coletadas para diferenciação osteogênica. Taxa de proliferação celular, conteúdo de proteína total e atividade específica da enzima fosfatase alcalina (FAL) foram analisadas nos dias 3, 7, 10 e 14. A mineralização da matriz foi analisada no dia 17. Os dados foram expressos como média ± erro padrão da média (EPM), analisados por one- ou two-way ANOVA, seguido pelo teste de Tukey ou Bonferroni, quando apropriado. RANKL foi fracamente expresso em ambas as linhagens, mas foi moderadamente expresso em animais SDP. OPG foi moderadamente expressa em animais sem PD, mas... / Abstract: This study aimed to evaluate the effect of experimentally induced periodontitis in the mechanisms involved in osteoblastic activity and bone matrix mineralization from femoral bone marrow-derived stem cells in normotensive and hypertensive rats. Wistar and SHR rats (180-220 g) were divided into 2 groups each: Wistar control [WC] and SHR control [SC], and Wistar with PD [WPD] and SHR with PD [SPD] groups. Immunohistochemical analysis of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), bone alkaline phosphatase (BALP), osteocalcin (OC), matrix metalloproteinase (MMP)-2, MMP-9, and tartrate-resistant acid phosphatase (TRAP) of the furcation region were assessed 15 days after PD. Bone marrow mesenchymal stem cells (MSCs) were collected and assessed for osteogenic differentiation. Proliferation rate, total protein content, and ALP activity were analyzed at 3, 7, 10, and 14 days. Mineralization of matrix was analyzed at 17 days. RANKL was weakly expressed in both strains, but was moderately expressed in SPD animals. OPG was moderately expressed in animals without PD, but strongly expressed in those with PD. The expression of BALP was higher in SPD than in WPD animals. Immunolabeling for OC was absent or weak in both strains and exhibited a tendency to increase in the presence of PD. MMP-2 expression was absent or weak in animals without PD, but it increased slightly in WPD animals. MMP-9 was moderately... / Mestre

Resumo: O objetivo deste estudo foi avaliar a associação do estado nutricional à periodontite. Para isso, foram selecionadas 32 mulheres adultas com idade entre 30 e 50 anos. A amostra foi dividida em dois grupos a partir da média de perda de inserção periodontal: grupo controle (n=17) com média < 2 mm e grupo teste (n=15) com média = 2 mm. Todas as voluntárias foram submetidas a questionário de saúde geral e de freqüência alimentar. O estado sócio-econômico foi obtido pelo nível de escolaridade e pela aplicação de questionário de classificação sócio-econômica. A avaliação periodontal foi realizada a partir da determinação do Índice de Placa Visível (IPV), do Índice de Sangramento Marginal (ISM) e do nível de inserção. Foi calculado o índice de massa corporal (IMC) e foram solicitados os seguintes exames laboratoriais: hemograma, HDL-colesterol, triglicerídeos, vitamina B12, zinco sérico e ácido fólico. Os resultados revelaram que não houve diferença estatística quanto ao estado sócio-econômico entre os grupos, bem como na análise do IMC, embora tenha se observado uma alta freqüência de sobrepeso e de obesidade nos dois grupos. Comparando-se os valores médios, observou-se diferença estatisticamente significante entre os grupos controle e teste (p < 0,01) quanto à perda de inserção periodontal, ao nível de profundidade de sondagem e ao ISM. Observou-se uma maior freqüência de voluntárias que consumiam frutas, legumes e verduras pelo menos uma vez por semana nos dois grupos. O eritrograma mostrou-se alterado somente nas voluntárias do grupo teste, enquanto no grupo controle os resultados foram normais. As alterações observadas foram: número baixo de eritrócitos, hematócrito reduzido e concentração reduzida de hemoglobina, volume corpuscular médio (VCM) reduzido e índice de hemoglobina corpuscular médio (HCM) reduzido... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The study's aim was to evaluate the association between nutritional status and periodontitis. For this, 32 adult women had been selected, no-smokers within the age of 30 and 50 years. The sample was divided into two groups according to mean of attachment loss: control group (n=17) with mean < 2 mm and test group (n=15) with mean = 2 mm. All the volunteers were submitted to a questionnaire of general health and of dietary frequency. The socio-economic status was determined to educational level and to questionnaire of socio-economic classification. The periodontal exam included Visible Plaque Index, Gingival Index and attachment level. The Body Mass Index (BMI) has been calculated and erythrocyte count and leukocyte count measurements were performed and levels of HDL-cholesterol, triglycerides, vitamin B12, zinc and folate. The results revealed that didn't statistics difference to socio-economic status and to BMI between the groups, although observed the high frequency of the overweight and obesity in the two groups. Comparing the mean values, there was different statistically significant between the groups control and test (p < 0,01) to attachment loss, probing depth and gingival index. There was increased frequency of the volunteers that dietary intake fruits and vegetables at least a time per week in two groups. The erythrocyte count presented altered only in the volunteers of the test group while in the control group the results were normal. The alterations were: lower numbers of erythrocytes, lower hematocrit, lower hemoglobin concentration, lower mean corpuscular volume (MVC) and lower mean corpuscular hemoglobin index (MHC). The leukocyte count showed increased frequency of the alterations in the two groups and the relative and/or absolute eosinophilia was more evident in the test group. Lower folate level was observed too in the test group... (Complete abstract, click electronic address below) / Orientador: Miriam Aparecida Onofre / Coorientador: Elaine Maria Sgavioli Massucato / Banca: Silvana Regina Perez Orrico / Banca: Luiz Eduardo Montenegro Chinellato / Mestre

Orientador: Celso Koogi Sonoda / Banca: Francisley Àvila Souza / Banca: Roberta Okamoto / Banca: Antonio Azoubel Antunes / Banca: Darklilson Pereira Santos / Resumo: Objetivos: O objetivo do trabalho foi analisar o efeito da ovariectomia e a terapia de reposição hormonal com 17β-estradiol e raloxifeno no processo de reparo do reimplante dentário tardio por meio da análise histomorfométrica em ratas. Materiais e métodos: Quarenta ratas Wistar (Rattus norvegicus, albinus) com ciclos estrais normais foram divididas aleatoriamente em 04 grupos: grupo Sham (grupo controle), grupo OVX/O (ratas ovariectomizadas e instalação de pellet com óleo de milho), grupo OVX/E (ratas ovariectomizadas e instalação de pellet com 17β-estradiol), e grupo OVX/R (ratas ovariectomizadas e tratadas com raloxifeno). Após 08 dias da ovariectomia, foi realizado extração dos incisivos superiores direito seguido de reimplante dentário tardio. Os animais sofreram eutanásia aos 60 dias após o reimplante para realização da análise histomorfométrica. Resultados: Existiram diferenças estatísticas (P<0,05) favoráveis para os grupos OVX/E e OVX/R comparados aos demais grupos, com relação as variáveis reabsorção inflamatória, e reabsorção total; não existiram diferenças estatísticas com relação a reabsorção por substituição (P≥0,05). Em relação ao perímetro de anquilose, constatou-se diferenças estatísticas favoráveis nos grupos OVX/E e OVX/R, comparados aos grupos Sham e OVX/O (P<0,05). Em relação ao perímetro de ligamento periodontal, observou-se que os grupos OVX/E e OVX/R apresentaram resultados estatisticamente favoráveis sobre os demais grupos, sendo que o grupo OVX/R apresentou também diferenças estatísticas favoráveis comparado ao grupo OVX/E (P<0,05). Conclusão: Esses dados permitem concluir que a ovariectomia influenciou de forma significativa no processo de reparo do reimplante tardio. A terapia com raloxifeno favoreceu a permanência de tecido fibroso/ligamento periodontal, e diminuição do índice de reabsorção inflamatória e reabsorção total / Abstract: Objectives: The objective of this study was to analyze the effect of ovariectomy and estrogen replacement therapy with 17β-estradiol or raloxifene treatment on periodontal tissues after delayed tooth replantation using histomorphometric analysis in rats. Materials and methods: Forty Wistar rats (Rattus norvegicus, Albinus) with normal estrous cycles were divided into 04 groups: Sham group (control group), OVX/O group (ovariectomized rats with corn oil pellet), OVX/E group (ovariectomized rats with 17β-estradiol pellet), and OVX/R group (ovariectomized rats treated with raloxifene). After 08 days of ovariectomy, it was performed extraction of upper incisors followed by delayed tooth replantation. The animals were euthanized 60 days after reimplantation to perform the histomorphometric analysis. Results: There were statistically significant differences (P<0.05) favorable to the OVX/E and OVX/R groups compared to the other groups regarding the variables inflammatory resorption, and total resorption; there were no statistical differences with respect to replacement resorption (P≥0.05). In relation to the perimeter of ankylosis, it has been found favorable statistical differences in the OVX/E and OVX/R groups, compared with OVX/O and Sham groups (P<0.05). Regarding the perimeter of periodontal ligament, it was found that OVX/E and OVX/R groups had statistically favorable results of the other groups, and the OVX/R group also showed favorable statistical differences compared to the OVX/E group (P<0.05). Conclusion: These data support the conclusion that ovariectomy had a significant influence in the healing process of delayed tooth replantation. Raloxifene therapy favored the permanence of fibrous tissue/periodontal ligament, and decreased inflammatory resorption and total resorption rate / Doutor

nÃo hà / A diabetes à considerada um fator de risco significativo para a ocorrÃncia de doenÃas periodontais. Entretanto, à necessÃrio que estudos a respeito deste assunto seja realizado em diferentes populaÃÃes, com diferentes caracterÃsticas. O objetivo deste estudo transversal foi avaliar os parÃmetros clÃnicos periodontais de diabÃticos do tipo 2 com diferentes padrÃes de controle glicÃmico. Foram selecionados portadores desta doenÃa, de ambos os gÃneros, residentes na sede do municÃpio de Sobral - CearÃ. Estes deveriam ser nÃo-fumantes, com idade igual ou superior a 40 anos, possuir pelo menos 6 dentes na arcada dentÃria e fazer uso de medicaÃÃo hipoglicemiante. Os indivÃduos foram submetidos ao exame clÃnico periodontal: Ãndice de placa visÃvel (IP), sangramento gengival (IG), sangramento à sondagem (SS), profundidade de sondagem (PS) e recessÃo gengival (RG), realizado por um examinador previamente calibrado. Os indivÃduos foram divididos em trÃs grupos de acordo os nÃveis de hemoglobina glicada â Hb1Ac (Controlados - C: Hb1Ac &#8804; 7%, n=103; Descontrolados - D: 7,1% &#8804; Hb1Ac &#8804; 9%, n= 60; Elevado Descontrole = E: Hb1Ac &#8805; 9,1%, n=22). NÃo foram observadas diferenÃas significantes em relaÃÃo Ãs mÃdias de idade em anos, mÃdia de dentes presentes, IP, IG e SS. Verificou-se diferenÃa significante entre os grupos para as mÃdias de Hb1Ac e tempo de diagnÃstico da doenÃa. NÃo foi verificada associaÃÃo estatisticamente significante entre elevados nÃveis glicÃmicos e a maior presenÃa de dentes e de sÃtios periodontais com PS &#8805; 6 mm. Entretanto quando foram analisados apenas os indivÃduos que apresentaram 20 ou mais dentes isso foi observado. Assim, pÃde-se concluir que o pobre controle glicÃmico dos diabÃticos do tipo 2, foi associado a maior presenÃa de periodontite apenas nos indivÃduos com elevado nÃmero de dentes. / Diabetes is a significant risk factor for the occurrence of periodontal diseases. Studying the relationship of both diseases in different populations with heterogeneous characteristics are still necessary to better understand them. The aim of this cross-sectional study was to evaluate the clinical periodontal parameters of type 2 diabetes patients with different levels of glycemic control. There were selected type 2 diabetics residing in the urban area of Sobral, Ceara. They must be non-smokers, aging 40 years or more and presenting at least and 6 teeth in their mouth. All had to be using any medication to control the glycemic level. Subjects were assigned to three groups based on their respective glycated hemoglobin levels - Hb1Ac (Control - C: Hb1Ac &#8804; 7%, n=103; Moderate control - M: 7,1% &#8804; Hb1Ac &#8804; 9%, n= 60; Poor control = P: Hb1Ac &#8805; 9,1%, n=22). The following clinical data were obtained from all patients: Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), probing depth (PD) and gingival recession (GR). The mean age, number of teeth, PI, GI and BOP did not show any significance between groups. But this was observed for Hb1Ac mean levels and time of diabetes diagnosis. The presence of at least one periodontal site with PD &#8805; 6 mm was considered for the diagnosis of periodontitis. There was no association between the increase of the glycemic level and the presence of periodontitis. However, data from patients presenting at least 20 teeth showed a significant association between periodontal diseases and higher glycemic levels. It can be concluded that the poor glycemic control was associated to the presence of periodontitis only in subjects with high number of teeth.

Comparou-se pacientes diabéticos tipo 1 com pacientes controles saudáveis, para avaliar as condições periodontais e da mucosa, identificar, qualificar e inter-relacionar, com o nível glicêmico do diabético, a presença de leveduras na gengiva e na saliva, através de: teste de hemoglobina glicosilada, índice de placa, índice gengival, índice de sangramento gengival, o nível de inserção, a profundidade de sondagem, exame radiográfico, inspeção da mucosa, teste de fluxo salivar e exame microbiológico. As diferenças não foram significantes quanto às condições periodontais e de mucosa, entre os pacientes, nem quanto à prevalência de leveduras entre os locais amostrados, exceto que os pacientes diabéticos mais velhos apresentaram nível de inserção clínica 77% maior que os mais jovens e o dobro de leveduras que os demais grupos. A C. albicans foi a levedura mais freqüente. Concluiu-se que houve uma leve tendência dos pacientes diabéticos apresentarem uma susceptibilidade aumentada à doença periodontal e maior frequência de leveduras, não podendo generalizar e estender os resultados de uma população tão pequena, sugerindo que se avalie uma população maior. / This work assessed (a) the differences of periodontal and soft tissue conditions, between diabetics type 1 patients, (b) the prevalence and comparison of yeast in gingival and saliva, (c) possible association between yeast with glycaemic conditions of the diabetic patients. Twenty-four patients were subdivided in 3 groups: diabetic subjects aging from 13 to 19 years (A) and aging from 20 or more years (B) and healthy controls (C) with periodontal diseases, aging from 20 or more years. There were performed the hemoglobin glycated test, radiological examination, anamnestic information, periodontal and soft tissues condition, salivary flow and microbiological analysis of the gingival and saliva; the plaque index, gingival index, bleeding sulcular index, clinical attachment level and probing depth were recorded. There were no significant differences in relation to the periodontal and mucosa conditions between diabetic patients, exception was to group B that showed 77% more attachment loss than group A. The results showed no significant differences in the prevalence of yeast, however there were twice more numbers of yeast in group B. C. albicans was the most frequent detected yeast. Although data from this study were not significant, a slightly tendency to a high prevalence of yeast and an increased susceptibility to periodontal diseases in diabetic population were shown. So, it would be prudent to elucidate in a greater population.

Foram examinados 30 pacientes (10 mulheres e 20 homens - média 44,89 anos). Todos os pacientes estavam sob terapia com ciclosporina-A (CsA), e não tinham sido submetidos à antibioticoterapia e nem a tratamento periodontal prévio, por pelo menos 3 meses do início do estudo. O paciente deveria ter, no mínimo 6 dentes. Foram registrados os índices de placa bacteriana (IP), índice gengival (IG), e os valores de profundidade clínica de sondagem (PCS) e nível clínico de inserção (NCI). Análise microbiológica foi realizada a partir de amostras coletadas do sulco/bolsa (s/b) gengival e da saliva estimulada (se). Os pacientes foram divididos em 2 grupos: com crescimento gengival (CCG) e sem crescimento gengival (SCG). Após análise estatística (Teste do Qui-quadrado; teste t de Student; Prova exata de Fisher; ?£0,05), concluiu-se que não houve diferença entre os dois grupos de pacientes com relação ao sexo dos pacientes, dosagem de CsA, tempo decorrido após o transplante, IP, IG, PCS e NCI. O exame microbiológico das amostras coletadas mostrou a presença de Actinobacillus actinomycetemcomitans (s/b-23% e se-13%), Porphyromonas sp. (s/b-36% e se-13%), Prevotella sp. (s/b-93% e se-93%), Campylobacter sp. (s/b-30%), Fusobacterium sp. (s/b-66% e se-50%), Peptostreptococcus micros (66%) e Streptococcus b-hemolítico (s/b-57% e se-83%). Destes microorganismos, apenas P. micros mostrou-se diretamente associado ao grupo CCG. Foi possível a detecção de Candida sp. (s/b-30% e se-30%), na amostra de saliva estimulada a presença de Candida sp. estava associada aos pacientes SCG. / This cross-sectional study was aimed at determining the association among cyclosporin-A induced gingival overgrowth in heart transplant patients and periodontal and microbiological conditions. Thirty patients (10 female, 20 male) undergoing cyclosporin treatment were evaluated using gingival index (GI), plaque index (PI), pocket depth (PD) and clinical attachment level (CAL). Subgingival and saliva samples were collected for microbial analysis. All patients had 6 teeth at least. Exclusion criteria was no antibiotic and/or periodontal treatment could been done 3 months prior. Patients were divided in two groups: with gingival overgrowth (WGO) and no gingival overgrowth (NGO). After statistical analysis (Qui-square test, t-Student test, Exact Fisher test, ?£0,05), was concluded that there was no statistically differences between WGO and NGO groups when compared CsA dosage, time of transplant, GI, PI, PD and CAL. Microbiological exam from subgingival sample detected: A. actinomycetemcomitans (23%), Porphyromonas p. (36%), Prevotella sp. (93%), Campylobacter sp. (30%), Fusobacterium sp. (66%), Peptostreptococcus micros (66%), Streptococcus b-hemolítico (57%). It was found a positive association between P. micros and WGO group. From subgingival and saliva samples was possible the detection of microorganism Candida sp. (30%). There was a positive association between presence of Candida sp. in saliva and NGO group.

A inter-relação entre o diabetes mellitus (DM) e a doença periodontal (DP) aponta para o DM como fator de risco para DP, aumentando sua prevalência, extensão e severidade. Além disso, a DP é considerada a sexta complicação do DM. Diante da atual epidemia mundial de diabetes, incluindo aumento da incidência de casos de diabetes mellitus tipo 1 (DM1) em pacientes cada vez mais jovens, o objetivo deste trabalho observacional foi avaliar a condição periodontal e salivar de uma amostra de pacientes com DM1 da cidade de Bauru-SP. Trinta pacientes divididos entre grupo teste (GDM1 com diagnóstico de diabetes tipo 1) e grupo controle (GC - normoglicêmicos) foram avaliados clinicamente através dos parâmetros periodontais - profundidade de sondagem (PS), nível clínico de inserção (NCI), índice de placa (IP) e índice de sangramento à sondagem (ISS) e salivares pH, capacidade tampão, glicose salivar e atividade da peroxidase, além disso tiveram a glicemia capilar mensurada. Para GDM1, foi solicitado a apresentação do resultado do teste de hemoglobina glicada (HbA1c) mais recente. A análise estatística foi feita através do teste t de student para dados pareados e correlação de Pearson (p<0,05). Entre os parâmetros clínicos periodontais, houve diferença estatisticamente significante entre os grupos apenas para IP e ISS (p<0,01). Quando as variáveis foram analisadas correlacionando-se aos resultados da HbA1c, as correlações positivas foram encontradas com IP e ISS (p<0,01). Os níveis de glicemia capilar apresentaram diferença estatisticamente significante entre grupos (p<0,01) e correlações positivas foram encontradas apenas no GC, nos parâmetros PS e NCI (p?0,05). Para análises salivares, nenhuma diferença estatisticamente foi encontrada entre os grupos (p>0,05). Concluiu-se que os pacientes com DM1 apresentaram pior condição periodontal, porém sem diferenças nos parâmetros salivares. / Diabetes Mellitus is a risk factor for periodontal disease increasing its prevalence, extension and severity. Periodontal disease is considered the sixth complication of diabetes. There is a global epidemic of diabetes, including an increase of incidence of type 1 diabetes (T1D) in younger patients. Thus, the aim of this observational study was to evaluate the periodontal and salivary condition of a sample of patients with T1D of Bauru SP Brazil. Thirty patients were divided in test group (T1DG type 1 diabetes) and control (CG normoglycemic). Periodontal clinical parameters were evaluated by means of probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), plaque index (PI). Salivary tests consisted of pH, buffer capacity, salivary glucose and peroxidases activity. The capillary glycemia was recorded for all patients and the glycated hemoglobin (HbA1c) for the T1DG. The statistical analysis was performed through Students t test for comparisons between groups and Pearsons correlation (p<0.05). Results showed statistically significant differences for groups for PI and BOP (p<0.01). Positive correlations were found for HbA1c, PI and BOP (p<0.01). Levels of capillary glycemia were statistically significant differences between groups (p<0.01). Positive correlations between capillary glycemia, PD and NCI were encountered only for control group (p<0.01). There was no significant difference between groups for salivary analysis (p>0.05). In conclusion, T1D patients present worse periodontal conditions and no difference in salivary parameters.

Periodontal diseases (PD) affect 46% of American adults over age 30. These diseases cause symptoms including bleeding and swelling of the gums, bone resorption, and tooth loss, that affect quality of life and have a high economic burden. Periodontal diseases are caused by an imbalance in the oral microbiome, from a healthy state that contains anti-inflammatory commensals like Streptococcus gordonii and mitis, to a diseased state that has pro-inflammatory anaerobic pathogens including Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Tannerella forsythia. The latter initiate disease progression in the oral cavity. However, it’s the host immune response that causes a majority of the symptoms. Ideally, treatment for PD would be approached from both sides to reduce the numbers of pro-inflammatory bacterial cells in the oral cavity but also reduce the host immune response. A novel therapeutic, amixicile, has been created, which specifically targets anaerobes through the pyruvate:ferredoxin oxidoreductase (PFOR) system, the mechanism of energy metabolism found in anaerobic organisms. Our studies show that amixicile inhibits in vitro growth of oral anaerobes in monospecies cultures at concentrations as low as 0.5 µg/mL in broth and 1 µg/mL in biofilms, without affecting the Gram-positive commensal species. In multispecies cultures, amixicile specifically inhibited anaerobes, even in biofilms, with the concentration as low as 5 µg/mL in broth and 10 µg/mL in biofilms. By not affecting the commensal bacteria, we think this treatment could restore a healthy oral microbiome. Aside from the bacterial presence, the host response, particularly the innate immune response is not well understood. Using a Drosophila melanogaster infection model, we elucidated the innate immune response to both mono- and multispecies infections. The 7-Species infection included bacteria mentioned above and Aggregatibacter actinomycetemcomitans in order to replicate in vivo-like disease conditions. We determined that both Drosophila Toll and Imd pathways, which mimic TLR/IL-1 and TNF signaling pathways of mammalian innate immunity respectively, respond to the 7-Species challenge. We also verified virulent bacteria in Drosophila, including P. gingivalis and P. intermedia. Future directions include RNA sequencing to determine the full scope of immune gene expression and using human immune cells to further clarify the response.

Purpose: To determine the characteristics influencing periodontal practices in Virginia and report on the anticipated changes in practice. Methods: A REDCap survey was emailed to Virginia based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in dental treatment and practice models, and how periodontists will adjust to account for these trends. Results: The response rate was 31% (n=46). Respondents report greater referrals from more experienced general practitioners (GPs). Student debt was associated with age. Respondents ranked biologic advances, treatment of peri-implantitis, digital dentistry, development of corporate and group practice models, and GPs incorporating more periodontal services in their practices as most likely to impact periodontal practices. The most reported periodontal practice adjustments included expansion of existing services, increasing the number of periodontists in the practice, and joining with other specialists or GPs to create group practices. Conclusions: Periodontists perceive the need to expand services, increase number of providers in their practices or create group practice models as future practice adjustments.

A gengivite é um agravo frequente entre crianças e adolescentes e pode afetar a qualidade de vida destes.O objetivo desta investigação foi avaliar o impacto da gengivite na qualidade de vida relacionada á saúde bucal de escolares de 12 anos do Distrito Metropolitano da cidade de Quito- Ecuador. Foram avaliados 998 escolares através do índice CPI para a presença de sangramento gengival (SG) e cálculo (C). A qualidade de vida relacionada á saúde bucal foi verificada pelo questionário CPQ11-14. Um questionário estruturado para registro de dados demográficos e condições econômicas foi entregue aos pais dos escolares. Dos 998 escolares, 93% (IC 95% 91,4% a 94,6%) apresentaram sangramento gengival e 73% (IC 95%70,%7 a 76,2%) tinham cálculo dentário. A análise univariada mostrou que escolares que tinham mais de um sextante com sangramento gengival tinham média de CPQ11-14 18% maior (RT = 1,18; 95% IC= 1,11 a 1,27) que aquelesque tinham nenhum ou apenas um sextante afetado. Por sua vez, escolares do sexo masculino apresentaram média de CPQ 15% mais baixa (RT= 0,85; 95% IC= 0,76 a 0,96). A escolaridade do pai também apresentou associação significativa com qualidade de vida, pois crianças cujos pais tinham educação secundária incompleta ou superior tiveram média de CPQ 15% menor (RT= 0,85; 95% IC= 0,77 a 0,94).A presença de sangramento em mais de um sextante foisignificativamenteassociada com qualidade de vida, nos domínios bem-estar emocional (RT=1,40; 95%IC=1,03 a 1,90) e bem-estar social (RT=1,76; 95%IC=1,32 a 2,34). Podemos concluir que a presença de sangramento gengival teve impacto negativo na qualidade da vida dos escolares de 12 anos,principalmente nos domíniosbem-estar emocional e social. / Gingivitis are common among children and adolescents and may affect their quality of life. The objective of this study was to evaluate the impact of gingivitis on oral health-related quality of life among 12-yearold schoolchildren from the Metropolitan District of the city of Quito, Ecuador. We evaluated 998 schoolchildren using the CPI index for periodontal conditions: gingival bleeding (GB) and calculus (C). Quality of life was assessed with the CPQ11-14 questionnaire. A structured questionnaire was applied to record demographic data and socioeconomic conditions. Of the 998 schoolchildren, 93% (95% CI 91.4% to 94.6%) had gingival bleeding and 73% (95% CI, 70% to 76.2%) had dental calculus. The univariate analysis showed that schoolchildren who had more than one sextant with gingival bleeding had a 1.18 times higher mean CPQ11-14 (RR = 1.18, 95% CI = 1.11 to 1.27) than those who had none or just one affected sextant. On the other hand, male schoolchildren presented a mean CPQ of 15% lower (RT = 0.85; 95% CI = 0.76 to 0.96). Father\'s schooling also showed a significant association with quality of life, since children whose parents had incomplete secondary education or higher had a mean CPQ 15% lower (RT = 0.85; 95% CI = 0.77 to 0.94). The presence of bleeding in more than one sextant was significantly associated with worse quality of life for the emotional well-being domain (RT = 1.40, 95% CI = 1.03 to 1.90) and social well-being domain (RT = 1.76, 95% CI = 1.32 to 2.34). In conclusion, gingival bleeding had a negative impacton oral health-related quality of life of 12-years old schoolchildren, mainly in the emotional and social well-being domain.