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Background and Objective The aim of this study is to analyze the relationship between the subgingival colonization by Candida albicans and other yeasts with the severity of chronic periodontitis ( CP). Material and Methods After sample size calculation, 40 patients with CP and 20 healthy subjects ( HS) were included in the study. Cases of slight-moderate ( MCP, n = 23) and severe CP ( SCP, n = 17) were defined according to the Centers for Disease Control/American Association of Periodontology classification. Subgingival samples were acquired using sterile paper-points from the sulcus or the deepest periodontal pocket of each healthy and subject with CP, respectively, and were cultured aerobically on three selective media. Yeast colonies that grew on the surface of plates were later identified by biochemical reactions. Statistical tests were used to analyze the association between subgingival yeast colonization (number of yeast-positive individuals and colony forming units ( CFU) per subject) and periodontal disease status, considering statistical significance when P < 0.05. Results Although several yeast species were found ( C. parapisilosis, Rhodotorula sp., C. dubliniensis and C. tropicalis), only C. albicans was present in all the patients with yeast-positive CP. Twelve patients (30%) with CP presented yeasts in the subgingival biofilm while only three patients (15%) in the HS group were positive for these microorganisms. No statistical difference was found between the CP and HS groups ( P = 0.084). However, when the CP group was divided on the basis of severity, statistical differences were observed between the SCP and MCP groups (47% vs. 17%, P = 0.043), and between the SCP and HS groups (47% vs. 15%, P = 0.033). No statistical difference was observed between the MCP and HS groups (17% vs. 15%, P = 0.832). High densities of yeasts were found only in patients with MCP and SCP (mean and range 61.25 (0-100) CFU/plate and mean and range 51 (0-101) CFU/plate, respectively). Conclusion In this group of patients, subgingival colonization of some yeasts, especially C. albicans, was associated with the severity of CP. [ABSTRACT FROM AUTHOR]

Objective The present study assessed the effect of smoking on clinical, microbiological and immunological parameters in an experimental gingivitis model. Material and Methods Twenty-four healthy dental students were divided into two groups: smokers ( n = 10); and nonsmokers ( n = 14). Stents were used to prevent biofilm removal during brushing. Visible plaque index ( VPI) and gingival bleeding index ( GBI) were determined 5- on day -7 (running phase), baseline, 21 d (experimental gingivitis) and 28 d (resolution phase). Supragingival biofilm and gingival crevicular fluid were collected and assayed by checkerboard DNA- DNA hybridization and a multiplex analysis, respectively. Intragroup comparison was performed by Friedman and Dunn's multiple comparison tests, whereas the Mann-Whitney U-test was applied for intergroup analyses. Results Cessation of oral hygiene resulted in a significant increase in VPI, GBI and gingival crevicular fluid volume in both groups, which returned to baseline levels 7 d after oral hygiene was resumed. Smokers presented lower GBI than did nonsmokers ( p < 0.05) at day 21. Smokers had higher total bacterial counts and higher proportions of red- and orange complex bacteria, as well as lower proportions of Actinomyces spp., and of purple- and yellow-complex bacteria ( p < 0.05). Furthermore, the levels of key immune-regulatory cytokines, including interleukin ( IL)-8, IL-17 and interferon-γ, were higher in smokers than in nonsmokers ( p < 0.05). Conclusion Smokers and nonsmokers developed gingival inflammation after supragingival biofilm accumulation, but smokers had less bleeding, higher proportions of periodontal pathogens and distinct host-response patterns during the course of experimental gingivitis. [ABSTRACT FROM AUTHOR]

Background and Objective The evidence of effectiveness of metronidazole ( Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. Material and Methods This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth ( PPD) of ≥ 5 mm. They were randomly assigned into one of three groups ( n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl®) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [ GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. Results There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups ( p ≥ 0.05). There was no significant difference between groups in all parameters evaluated ( p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups ( p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups ( p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups ( p < 0.05). Conclusion Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings. [ABSTRACT FROM AUTHOR]

Background and Objective Although chronic periodontitis ( CP) is a multifactorial condition, few studies have investigated the potential association of gene variants with the outcome of periodontal therapy. In a previous study, we reported that variants in the interleukin- 8 ( IL8) gene were associated with CP in a Brazilian population. The aim of this nonrandomized study was to investigate whether genetic susceptibility to CP, conferred by the presence of the IL8 ATC/ TTC haplotype, influences the clinical outcomes of nonsurgical periodontal therapy and the IL-8 protein levels in the gingival crevicular fluid. Material and Methods Forty-one individuals were grouped according to the presence (susceptible to CP; n = 21) or absence (not susceptible to CP; n = 20) of the IL8 ATC/ TTC haplotype. These individuals received nonsurgical periodontal therapy from one periodontist, who was blinded to the genetic status of each patient, and follow up continued for 45 d. The clinical parameters and gingival crevicular fluid samples were collected at baseline and on day 45. The IL-8 levels were determined by an ELISA. The data were subjected to the Mann-Whitney U-test, Wilcoxon and Spearman tests and to multiple logistic-regression analysis. Results No significant differences between patients with or without the IL8 ATC/ TTC haplotype were found for the outcome of nonsurgical periodontal therapy and IL-8 levels. The multiple logistic-regression analysis did not show a statistically significant association between the IL8 haplotype and the variables studied. Conclusion In this longitudinal clinical study, we observed that neither the outcome of nonsurgical periodontal therapy nor the IL-8 levels were influenced by the IL8 ATC/ TTC CP-susceptibility haplotype. Additional studies of CP patients from other ethnic populations are necessary to confirm these results. [ABSTRACT FROM AUTHOR]

Background and objective Tooth loss ( TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy ( PMT) over 5 years. Methods The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers ( RC) and 116 irregular compliers ( IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. Results TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups ( p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. Conclusion IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT. [ABSTRACT FROM AUTHOR]

Background and Objective: A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. Material and Methods: A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks ( n = 30, test group) or only one appointment for supragingival calculus removal ( n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. Results: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites ( p < 0.001). Periodontal therapy significantly reduced the levels of IL-1β and IL-8 in gingival crevicular fluid ( p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1β in the gingival crevicular fluid of the test group were significantly lower than were those in the control group ( p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. Conclusion: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers. [ABSTRACT FROM AUTHOR]

Background and Objective: There is a bidirectional relationship between periodontal disease and type-2 diabetes mellitus (DM). Inflammatory mediators may negatively affect glycemic control, and increased glucose levels and resultant glycation end-products may alter the host response against bacterial infection. However, no agreement has been reached regarding the effect of DM on periodontal subgingival microbiota. Therefore, the purpose of the present study was to compare the subgingival biodiversity in deep periodontal pockets of subjects with chronic periodontitis and either uncontrolled type-2 diabetes or no diabetes using 16S rRNA gene cloning and sequencing. Material and methods: Twelve subjects with uncontrolled type-2 diabetes (glycated hemoglobin > 8%) and eleven nondiabetic subjects presenting severe and generalized chronic periodontitis were selected. Subgingival biofilm from periodontal pockets > 5 mm were assessed using the 16S rRNA gene cloning and sequencing technique. Results: Significant differences were observed in subgingival microbiota between diabetic and nondiabetic subjects. Diabetic subjects presented higher percentages of total clones of TM7, Aggregatibacter, Neisseria, Gemella, Eikenella, Selenomonas, Actinomyces, Capnocytophaga, Fusobacterium, Veillonella and Streptococcus genera, and lower percentages of Porphyromonas, Filifactor, Eubacterium, Synergistetes, Tannerella and Treponema genera than nondiabetic individuals ( p < 0.05). Moreover, some phylotypes, such as Fusobacterium nucleatum, Veillonella parvula, V. dispar and Eikenella corrodens were detected significantly more often in diabetic subjects than in nondiabetic subjects ( p < 0.05). Conclusion: Subjects with uncontrolled type-2 diabetes and chronic periodontitis presented significant dissimilarities in subgingival biodiversity compared with nondiabetic subjects. [ABSTRACT FROM AUTHOR]