Made available in DSpace on 2014-06-11T19:28:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-02-19Bitstream added on 2014-06-13T19:57:16Z : No. of bitstreams: 1 ishi_ep_me_arafo.pdf: 346197 bytes, checksum: 6795ce77ad2dd590c6c320a2852cea60 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal. / There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients.

A DNA probe was developed for the identification of the periodontal pathogen, Actinobacillus actinomycetemcomitans. Chromosomal DNA was extracted from A. actinomycetemcomitans, digested with a restriction enzyme, Sau3A, ligated to plasmid DNA (pUC18) and transformed into JM109 cells to give a partial A. actinomycetemcomitans library. The library was screened using Southern blot analysis. Out of the nine inserts tested, one was found to be species specific as it did not cross-hybridise to Haemophilus aphrophilus, a closely related organism which occurs in the normal oral microflora, nor did it cross-hybridise with 7 species of Bacteroides tested. A level of detection of 104 cells or 50ng of A. actinomycetemcomitans was obtained. The probe has a length of 779bp and out of 30 restriction enzymes tested, only SspI was found to have a restriction site in the insert. The probe was tested on clinical specimens obtained from five different periodontitis patient groups and was shown to correlate with culture results in eighteen out of twenty-two cases in detecting A. actinomycetemcomitans.

Resumo: Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal. / Abstract: There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients. / Orientador: Mirian Aparecida Onofre / Coorientador: Carlos Rossa Junior / Coorientador: Manoel Barros Bertolo / Banca: Silvana Regina Perez Orrico / Banca: Ricardo Guimarães Fischer / Mestre

Background: The role of cytokines in the pathogenesis of periodontal disease and the effect of smoking on these mediators has been reported. However, findings have been variable and simultaneous measurement of multiple cytokines has been limited. This study utilized a quantitative multiplex assay to measure a comprehensive panel of Th1, Th2, and pro-inflammatory cytokines and chemokines (including several novel cytokines) in gingival crevicular fluid (GCF) in chronic periodontitis subjects. The impact of cigarette smoking on these GCF mediators was also assessed. Methods: Forty subjects (age 40-75 years) with generalized severe chronic periodontitis (20 smokers and 20 non-smokers) and 12 periodontally healthy controls participated in the study. GCF was collected from four sites in the diseased groups: 2 diseased sites [(probing depth (PD) and clinical attachment level (CAL) ≥5mm with bleeding on probing (BOP)] and 2 healthy sites (PD and CAL ≤3mm, no BOP); 2 healthy sites were sampled in the healthy controls. The volumes of the GCF samples were measured and the GCF mediators assessed in duplicate utilizing a multiplex immunoassay (Luminex). Intragroup, intergroup and pooled comparisons were performed using non-parametric tests including the Mann-Whitney and the Wilcoxon matched-pairs signed-rank test. Results: GCF in diseased sites (vs. controls) contained significantly (p<0.05) higher amounts of IL-2, IFN-γ, IL-3, IL-4 (Th1/Th2 cytokines); IL-1α, IL-1β, IL-6, IL-12 (p40) (pro-inflammatory cytokines); IL-8, MIP-1, RANTES (chemokines); and IL-15 (regulator of T-cells and NK cells). IP-10 was the only mediator exhibiting lower levels (p<0.0005) in diseased sites compared to controls. Smoking had an inhibitory effect (p<0.05) on pro-inflammatory cytokines (IL-1α, IL-6, IL-12 (p40)); chemokines (IL-8, IP-10, MCP-1, MIP-1, RANTES) and regulators of T-cells and NK cells (IL-7, IL-15) in comparison to sites within non-smokers. Interestingly, smokers had elevated GCF levels (p<0.05) of IL-1α, IL-1β and IL-3 relative to sites in healthy controls. Conclusions: Similar to previous reports, periodontitis subjects had significantly elevated cytokines and chemokines compared to healthy controls. Smokers exhibited a decrease in several pro-inflammatory cytokines, chemokines and regulators of T-cells and NK-cells as compared to nonsmokers however; little influence was observed on Th1/Th2 cytokines. Interestingly, smokers exhibited decreased amounts of GCF IL-7, IL-12(p40), IL-15, IP-10, MCP-1, MIP-1 and RANTES, which calls for future investigation. The multiplex comprehensive assay used in this study to assess cytokines in a single GCF sample is a significant advancement. This technology can be used to compare serum and GCF cytokine profiles in periodontitis and correlate systemic and localized immune responses. This should provide insight into the impact of smoking, as well as other host modifiers, on important systemic and periodontal interactions.