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Objective To compare counts of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis and Fusobacterium nucleatum between crack users and non-users. Materials and methods A cross-sectional study was conducted involving seventy-four crack cocaine users and eighty-one non-users matched for age, gender and tobacco use. Demographic and clinical variables were analysed. Subgingival bacterial samples were collected from four sites with the greatest probing depths and were analysed using real-time polymerase chain reaction. Results No significant difference was found in the prevalence of total counts for each bacterial species analysed between groups. However, crack users had a 1.85 (95% CI: 1.03-3.31), 2.19 (95% CI 1.24-3.88), 2.53 (95% CI 1.27-5.04) and 2.40 (95% CI 1.22-4.75) greater probability of having the higher counts (≥75th percentile) for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, respectively. Conclusion Although some crack users had higher (>75th percentile) bacterial counts for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, total counts did not differ between crack users and non-users, leading to the hypothesis that the higher occurrence of periodontitis on crack users may be related to other non-bacterial factors. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between periodontitis and oral health-related quality of life (OHRQoL) in adults, and to compare OHRQoL across different severities of the disease., Materials and Methods: Searches were conducted in five electronic databases up to December 2023. Observational studies that provided a clear definition of periodontitis and used validated measures of OHRQoL were included. Meta-analyses were performed both overall and based on factors that could explain heterogeneity between studies., Results: Sixty studies comprising 14,851 individuals were included in the review. Meta-analyses showed that periodontitis was associated with impaired OHRQoL: any OHRQoL instruments (n = 33 studies; SMD: 0.75, 95% CI: 0.53-0.93), solely using the OHIP-14 (n = 26 studies; MD: 5.14, 95% CI: 3.64-6.64), and risk assessment (n = 9 studies; adjusted RR: 1.42, 95% CI: 1.12-1.78). Stages III-IV periodontitis had a greater impact than Stages I-II periodontitis. Subgroup and meta-regression analyses indicated smaller effect size estimates for individuals with comorbidities., Conclusions: Periodontitis negatively impacts OHRQoL, with a positive score-response relationship found between periodontitis severity and poorer OHRQoL. However, the magnitude of this association appears to be diminished in individuals with comorbidities., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this study was to systematically review observational studies assessing the association between socioeconomic status (SES) and traumatic dental injuries (TDI) in permanent dentition., Methods: Electronic searches were performed in PubMed, EMBASE, Web of Science, LILACS, CINAHL, COCHANE Library and ScoINDEX databases for articles published up to February 2023. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the association between individual-level socioeconomic indicators and TDI (clinically examined) in permanent teeth. Quality assessment of included articles was conducted using the Newcastle-Ottawa Scale. Global meta-analysis was performed with all studies and different subgroup analysis based on socioeconomic indicators (household income, educational level or any other indicator), age (children, early adolescents, late adolescents or young adults) and economic classification of the country (high, upper-middle or lower-middle). A random-effects model was used to estimate pooled prevalence ratios (PR) and respective 95% confidence intervals (CI) for each study., Results: The search strategy retrieved 11 315 publications. According to eligibility criteria, 17 articles were included in the meta-analysis. Individuals with low SES were 17% more likely to have TDI (PR 1.17; 95% CI 1.05-1.30). The subgroup analysis also revealed that the indicator (household income, PR 1.16; 95% CI 1.00-1.34) and the economic classification of the country (upper-middle, PR 1.19; 95% CI 1.07-1.33) influenced the association of SES with TDI occurrence., Conclusions: Individuals with lower SES were more likely to present with TDI in permanent dentition than those with higher SES., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Individuals of lower socioeconomic position (SEP) experience a greater rate of alcohol-related harms, yet they consume equal or lower amounts of alcohol than higher-SEP individuals. This phenomenon, called the "alcohol harm paradox" (AHP), gained attention recently, and different mechanisms have been proposed to explain it. Since both SEP and alcohol have been suggested to be associated with periodontitis risk, we conducted a secondary analysis using data from the National Health and Nutrition Examination Survey 2011 to 2012 and 2013 to 2014 cycles, aiming to examine 1) whether the association between alcohol consumption and periodontitis is modified by SEP and 2) the extent to which the effect of SEP inequalities on periodontitis is mediated by and/or interacts with alcohol consumption. We set educational attainment as the main SEP proxy and tested the poverty income ratio in subsequent sensitivity analyses. Effect measure modification analysis was employed, considering heavy drinking as exposure, and causal mediation analysis based on the potential outcome's framework decomposed the effect of SEP on periodontitis in proportions attributable to mediation and interaction. Models were fitted using binary logistic regression and adjusted for sex, ethnicity, age, body mass index, smoking status, diabetes, binge drinking, and regular preventive dental visits. The analytical sample comprised 4,057 participants. After adjusting for covariates, less educated heavy drinkers presented 175% (odds ratio, 2.75; 95% confidence interval [CI], 2.04-3.72) higher odds of periodontitis than their counterparts, and super-additive associations were found (relative excess risk due to interaction: 1.35; 95% CI, 0.49-2.20). Additionally, -69.5% (95% CI, -122.1% to -16.8%) of the effects of education on periodontitis were attributable to interaction with heavy drinking, consistent with the AHP. No contribution was found for the mechanism of mediation. Heavy drinking disproportionately impacts the occurrence of periodontitis in lower-SEP individuals. Lower-SEP individuals seem to experience differential effects of heavy drinking on periodontitis., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: This Bayesian network meta-analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM)., Materials and Methods: A systematic search was done up to February 2023 comparing sub-gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full-mouth probing depth reported at 3- to 6-month post-treatment., Results: Seventy-two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c., Conclusions: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus., Materials and Methods: Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were in vivo animal and in vitro studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for in vivo studies and modified CONSORT checklist for in vitro were appraised. Meta-analysis was performed using the Stata., Results: Fifty-two studies were included. In the RoB, in vivo studies fulfilled 20%-50% of the items and in vitro 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity., Conclusion: Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Conservative Dentistry and Endodontics.)

Objectives: To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults., Methods: We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking., Results: The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%])., Conclusion: Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aims: This study aimed to test whether the alcohol harm paradox (AHP) is observed in Brazil by investigating (i) the association between educational attainment and alcohol-related consequences (ARC) and (ii) the contribution of average alcohol volume consumed (AVC), past-month heavy episodic drinking (HED), smoking, body mass index (BMI), and depression in accounting for the disparities in ARC., Methods: We analysed data from the 2019 Brazilian National Health Survey, a nationally representative household survey. The composite ARC outcome was considered present when an individual reported a past-year episode of activity failure, amnesia, and concern by others due to alcohol consumption. Adjusted binary logistic regression models were fitted using a hierarchical approach to calculate the odds ratios (OR) and respective 95% confidence intervals (CI), and to assess the contribution of each set of variables in attenuating the educational differences in ARC., Results: Those from the lowest educational strata (incomplete elementary school) exhibited higher odds of ARC than their counterparts (OR: 2.03; 95% CI: 1.73-2.37). Although smoking, BMI, and depression attenuated the educational gradient (i.e. reduced the difference between reference and riskier categories) in ARC by ~13%, the adjustment for AVC and HED amplified inequalities by 0.3% and 5.7%, respectively., Conclusion: We found evidence of the AHP in Brazil. Educational inequalities in ARC were scarcely attenuated by behavioural factors, and a suppression effect was noted when adjusting for AVC and HED., (© The Author(s) 2024. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To systematically evaluate randomized controlled trials (RCTs), with at least 6 months of follow-up, on whether professional mechanical plaque removal (PMPR) including supragingival scaling should be performed prior and separately from subgingival scaling and root planning (SRP) in nonsurgical periodontal therapy (NSPT), in terms of clinical and patient-reported outcomes (PROs) (CRD42020219759)., Methods: The MEDLINE, EMBASE, CENTRAL, LILACS and Web of Science electronic databases, as well as grey literature sources, were searched by two independent reviewers up to May 2023. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random-effects pairwise meta-analyses compared the changes in probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BoP) of a stepwise NSPT approach (PMPR prior and separately from SRP) and conventional one-step NSPT through mean differences (MDs) and associated confidence intervals (95% CI)., Results: Two RCTs were included, including data of 77 participants with severe periodontitis. One RCT presents high risk of bias and the other has some concerns. No significant differences were found between the stepwise approach and performing both steps simultaneously for any clinical outcomes, with overall very low certainty on evidence. No adverse effects were detected and there was no data on PROs., Conclusions: There is very-low certainty evidence of no significant difference on PPD and BoP reductions and CAL gain between supragingival scaling performed prior and separately from SRP and conventional one-step NSPT., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The objective of the study was to investigate whether the association between binge drinking and oral health-related quality of life (OHRQoL) differs by socioeconomic position (SEP) in Brazilian older adults., Background: The adverse health effects of alcohol consumption disproportionately affect socioeconomically disadvantaged and older individuals. Moreover, measures of binge drinking may capture different domains of the association between alcohol misuse and health that might be independent of the traditional markers of volume or frequency of consumption. Evidence of the association between alcohol use and oral health outcomes has failed to consider binge drinking and possible effect modification by SEP., Methods: We conducted a secondary cross-sectional analysis using the baseline data from The Brazilian Longitudinal Study of Ageing (2015-2016). Effect Measure Modification analyses using multivariable Poisson regression models tested whether the association between past-month binge drinking and higher scores of the Oral Impacts on Daily Performance (OIDP) questionnaire differed in magnitude by level of household wealth and educational attainment, assessed using Relative Excess Risk due to Interaction (RERI) and simple slope test., Results: The analytical sample comprised 8857 individuals. Participants who were from low-wealth households or with lower education and reported past-month binge drinking had 27% (95% CI: 1.16 to 1.39) and 28% (95% CI: 1.18 to 1.40) higher OIDP scores, respectively, than those not binge drinkers from higher SEP, and super-additive associations were detected (RERI for household wealth: 0.12; RERI for educational attainment: 0.14)., Conclusion: Binge drinkers from low SEP have poorer OHRQoL. Public oral health initiatives aiming to combat binge drinking are likely to disproportionately benefit vulnerable groups., (© 2023 Gerodontology Association and John Wiley & Sons Ltd.)

Objective: To investigate whether the association between alcohol consumption and tooth loss is modified across socioeconomic positions (SEPs) in Brazilian older adults., Methods: We conducted a secondary analysis using data of The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016). Effect Measure Modification (EMM) analyses using multivariable Poisson regression models tested whether the association between heavy drinking and lack of functional dentition (FD) varies in magnitude and direction according to levels of Household Wealth index (HWI) and educational attainment, assessed by the Relative Excess Risk due to Interaction (RERI). Sensitivity analyses using lifetime exposure to alcohol were performed., Results: The analytical sample comprised 8078 participants. Heavy drinkers living in low-wealth households and with lower education presented 7% (95% CI: 1.01-1.14) and 36% (95% CI: 1.28-1.44) higher prevalence of lack of FD, respectively, than their counterparts, and super-additive associations were detected [RERI for HWI: 0.12 (95% CI: 0.02-0.21); RERI for educational attainment: 0.20 (95% CI: 0.09-0.30)]. The associations were also super-additive in the sensitivity analyses when controlling for abstainer reference group bias., Conclusion: We suggest that alcohol consumption disproportionately impacts the prevalence of tooth loss in Brazilian older adults from lower SEP groups., (© 2022 Wiley Periodicals LLC.)

Aim: To evaluate associations between oral hygiene and gingival abrasion (GA) in a rural population from southern Brazil., Materials and Methods: A population-based sample representative of individuals from a rural community in southern Brazil was included. Individuals aged 15 years or older and who had five teeth or more present were selected for this analysis. GA extent was defined as the total number of abrasions per individual. An adjusted multilevel negative binomial regression analysis was used to investigate the associations between site-, tooth- and individual-level variables and GA. Mean ratios (MR) and 95% confidence intervals (95% CI) were calculated., Results: Five hundred ninety-five dentate individuals aged 15-82 years were analysed. In the adjusted models, brushing more than twice a day (MR = 1.13; 95% CI 1.02-1.26) and brushing with a hard/medium-bristle toothbrush (MR = 1.11; 95% CI 1.01-1.23) were significantly associated with more generalized GA., Conclusions: The extent of GA was independently associated with greater brushing frequency and the use of a toothbrush with harder bristles in residents of a rural area., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study aimed to conduct a systematic evaluation of the literature on whether individuals exposed to alcohol intake present differences in the subgingival microbial composition compared to those unexposed., Methods: Five databases (MEDLINE, EMBASE, LILACS, SCOPUS and Web of Science) and one source of grey literature (Google Scholar) were searched by two independent reviewers up to December 2022 according to pre-specified eligibility criteria. No restrictions were imposed regarding the date and language of publication and the periodontal status of the participants. The Newcastle-Ottawa Scale was used for methodological quality appraisal and a narrative synthesis was performed., Results: Eight cross-sectional studies and one cross-sectional analysis nested in a cohort were considered for qualitative analysis, including data of 4636 individuals. Overall, the studies exhibited considerable heterogeneity in terms of characteristics of the participants and microbiological methods. Four studies have high methodological quality. Exposed individuals have higher overall quantity of periodontal pathogens in shallow and moderate to deep pockets. Findings on richness, relative abundance, alpha- and beta-diversity were limited and inconclusive., Conclusion: The subgingival microbiota of individuals exposed to alcohol intake has higher overall quantity of red (i.e., P. gingivalis ) and orange-complex (i.e., F. nucleatum ) bacteria when compared to those unexposed., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Aims: To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis., Methods: Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis., Results: The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence., Conclusion: Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption., (© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Sleep quality disturbances are a common occurrence in post-traumatic stress disorder (PTSD) and may remain after evidence-based treatment for PTSD has been implemented. If left untreated, sleep disturbance can perpetuate or aggravate the disorder. A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted comparing efficacy, acceptability, and tolerability among antidepressants for sleep quality improvement in PTSD, using Cochane's RoB2.0 and GRADE approach for NMA. The Cochrane Library, LILACS, PsycINFO, PTSDpubs, and PubMed Central databases were searched from inception to November 29, 2020, leading to the retrieval of 3733 reports. After the selection process, seven RCTs were included in the review (N = 600). We found low certainty of evidence (LCE) that sertraline may improve sleep quality (measured by PSQI) in adult patients with PTSD (MD -0.48, 95% CrI -0.63 to -0.32). Sertraline was as well accepted (RR 1.12, 95% CrI -0.83 to 1.52, very low certainty [VLCE]) and as well tolerated as placebo (RR 0.58, 95% CrI 0.28 to 1.14, LCE). Mirtazapine (MD -3.35, 95% CrI -9.06 to 2.39, LCE), paroxetine (MD -3.13, 95% CrI -7.47 to 1.26, VLCE), nefazodone (MD -0.25, 95% CrI -5.95 to 5.38, VLCE), and bupropion (MD -2.28, 95% CrI -4.75 to 0.21, VLCE) were similar to placebo for improving sleep quality. These antidepressants resulted in little or no benefit for sleep in PTSD. Although the NMA suggested that sertraline may improve sleep in PTSD compared to placebo, due to the low certainty, these estimates are not robust enough to guide clinical decisions., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing., Material and Methods: PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes., Results: Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes., Conclusion: SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence., Clinical Relevance: There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of the present cross-sectional study was to determine whether alcohol use disorders (AUD) are independently associated with severe and extent cases of periodontitis in individuals living in a rural area of Brazil., Methods: A representative probability sample (N = 585) was evaluated using six-site full-mouth periodontal examination. AUD was assessed using the alcohol use disorders identification test (AUDIT) and considered in its unidimensional and bidimensional factor structures. The first address hazardous alcohol consumption [HAC (overall scores ≥8)], and the second deals with two distinct constructs, harmful use [HU (items 1-3 scores ≥4 for men or ≥3 for women)], and alcohol-related consequences [ARC (items 4-10 scores ≥1)]. Periodontal outcomes were defined based on the criteria proposed by the CDC-AAP (2012) and an adaptation of the EFP-AAP (2018) definition of generalized stages III or IV periodontitis (GP). Adjusted multilevel multinomial and binary logistic regression analysis were used with a conceptual hierarchical approach to calculate the odds ratios (OR) of periodontal outcomes., Results: In the adjusted model, HU (OR = 2.69; 95% CI: 1.29-5.58) and ARC (OR = 3.79; 95% CI: 1.51-9.51) were significantly associated with higher prevalence of severe periodontitis (SP). Higher occurrence of GP was detected in individuals presenting HAC (OR = 1.88; 95% CI: 1.05-3.37) and ARC (OR = 2.90; 95% CI: 1.61-5.24)., Conclusion: AUD was independently associated with higher prevalence of SP and GP in individuals living in a rural area., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To systematically evaluate the literature on whether plaque-disclosing (PD) methods, applied by dental professionals (FQ1) or at-home (FQ2), combined with verbal oral hygiene instructions and brushing demonstration (standard OHI) lead to improvements in self-performed dental plaque control in comparison to standard OHI alone., Materials and Methods: Seven databases were searched by two independent reviewers according to pre-specified eligibility criteria up to September 2020. No restrictions regarding language, date and type of report were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal. Multiple comparisons referring to a single study were included if the articles evaluated different PD agents. Narrative synthesis using evidence tables were performed., Results: Seven eligible studies were retrieved, including data of 430 individuals (159 wearers of orthodontic appliances). The studies exhibited considerable heterogeneity regarding outcome assessments and follow-up. Eleven (eight corresponding to FQ1 and three to FQ2) out of 13 relevant comparisons found no significant difference between techniques for dental plaque outcomes and three (two corresponding to FQ1 and one to FQ2) out of five comparisons indicated a positive effect of standard OHI with aid of PD methods on gingival inflammation scores. With respect specifically to orthodontic patients, three out of four comparisons indicated significant improvements on gingival inflammation scores for individuals instructed with PD methods., Conclusion: Clinicians should consider PD agents as adjunct to standard OHI in orthodontic patients. For those without appliances, PD methods can be used as an alternative., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Several studies have shown the relationship between periodontal disease and chronic kidney disease, but there is little evidence to assess the impact of the amount of inflamed periodontal tissue on the levels of systemic inflammatory markers. So the aim of this study is determine the association between high-sensitivity C-reactive protein (hsCRP) and both periodontitis and periodontal inflamed surface area (PISA) in adults with end-stage renal disease (ESRD)., Methods: Cross-sectional study was conducted with 176 adults with ESRD on regular hemodialysis. The participants were submitted to a full-mouth periodontal examination to determine the occurrence of periodontitis and PISA. Regression analysis was performed to test the independent association between periodontal conditions and serum hsCRP levels., Results: A total of 98.9% of the participants had periodontitis, with stages III and IV found in 26.1% and 52.9%, respectively. Mean hsCRP and PISA was 6.57 (SD: 6.03) mg/L and 217.15 (SD: 271.50), respectively. In the adjusted analysis, mean serum hsCRP levels were significantly higher in patients with stage III and IV generalized periodontitis compared with no/localized/generalized stages I-II (7.67 mg/L versus 5.72 mg/L, P = 0.028). After adjustments for confounding variables, individuals with PISA >490.56 mm 2 (85th percentile) had a 3.26-fold greater chance of having hsCRP above 5 mg/L than their counterparts (OR = 3.26; 95% CI: 1.25 to 8.49)., Conclusion: The inflammatory burden imposed by periodontitis can increase serum hsCRP levels in adults with end-stage renal disease., (© 2020 American Academy of Periodontology.)

Background: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide., Objectives: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP., Methods: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome., Results: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I 2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I 2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I 2  = 98.5%) and 3% (95% CI 2%-3%; I 2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I 2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I 2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I 2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I 2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I 2  = 98.3%)., Discussion: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution., Conclusions: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide., (© 2020 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Objective: Determine the association between breastfeeding and the development of mouth breathing in children., Materials and Methods: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding., Results: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18)., Conclusions: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern., Clinical Relevance: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding., Trial Registration: PROSPERO registry: CRD42017062172.

Objectives: To systematically review observational studies assessing the association between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in children, adolescents and adults., Methods: Electronic searches were performed in the PubMed, Embase, Web of Science, LILACS and Scopus databases for articles published up to September 2020. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the effect of SES on the OHRQoL in all age groups using validated methods. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for meta-analysis followed by a meta-regression analysis. A random-effects model was used to estimate the pooled calculate prevalence ratio (PR) and respective 95% confidence intervals (CI) for each study., Results: The search strategy retrieved 6114 publications. Some 139 articles met the eligibility criteria and were included in the systematic review. Of those, 75 were included in the general meta-analysis they represented a total sample of 109 269 individuals. People of lower SES had worse OHRQoL (PR 1.30; 95% CI 1.26-1.35). In the meta-analyses of different subgroups, an association was found between low SES and worse OHRQoL in countries of all economic classifications, in all age groups and irrespective of the socioeconomic indicator used. A socioeconomic gradient in OHRQoL was also observed, in which the lower the individuals' socioeconomic position, the poorer their OHRQoL., Conclusions: Individuals of low SES had poorer OHRQoL, regardless of the country's economic classification, SES indicator and age group. Public policies aiming to reduce social inequalities are necessary for better OHRQoL throughout life., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To evaluate the effect of herbal mouthrinses as an adjuvant to oral hygiene on dental plaque and gingival inflammation in subjects with gingivitis. Searches were conducted in the PubMed/MEDLINE, Cochrane-CENTRAL, EMBASE, Web of Science, LILACS/BIREME, Clinical Trials Registry and grey literature for Randomised Clinical Trials (RCTs) published up to April 2018 without language restrictions. From 4,013 paper found, 20 studies met the eligibility criteria and were included. The herbal mouthrinses achieved significant reductions in dental plaque and gingival inflammation compared to placebo rinses. Five herbal products (Camelia sinensis, Azadirachta indica, Anacardium occidentale Linn, Schinus terebinthifolius and Curcuma longa) showed better results than chlorhexidine in dental plaque and gingival inflammation reductions. However, the unclear risk of bias of most included RCTs precludes definitive conclusions. Therefore, it is necessary to improve the design of future RCT in other reduced potential bias that may affect the degree of precision of treatment outcomes in order to evaluate the effect size and clinical relevance of herbal mouthrinses., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Background: The purpose of this study was to compare efficacy and acceptability among drug treatments for adults with post-traumatic stress disorder (PTSD) through a systematic review, random-effects pairwise and network meta-analyses., Methods: Double-blind randomized controlled trials comparing pharmacological interventions for adults with PTSD were searched from database inception through Aug. 28, 2018, on Cochrane (Central), Embase, LILACS, PILOTS, PsycINFO, PubMed, and Web of Science. Clinical trial registries and the websites of pharmaceutical companies were also searched. The GRADE system was used to assess the quality of the evidence., Results: The systematic review included 58 studies comprising 6766 patients randomized to 26 different interventions. Regarding efficacy, topiramate (SMD = -0.57; 95%CrI: -1.07,-0.10), risperidone (SMD = -0.53; 95%CrI: -0.93,-0.15), quetiapine (SMD = -0.59; 95%CrI: -1.06,-0.11), paroxetine (SMD = -0.35; 95%CrI: -0.48,-0.21), venlafaxine (SMD = -0.25; 95%CrI: -0.44,-0.05), fluoxetine (SMD = -0.28; 95%CrI: -0.46,-0.08), and sertraline (SMD = -0.21; 95%CrI: -0.33,-0.09) outperformed placebo. Moreover, phenelzine (RR = 3.39; 95%CrI: 1.43,11.09), lamotrigine (RR = 4.39; 95%CrI: 1.18,26.38), and fluoxetine (RR = 1.28%CrI: 1.01,1.59) outperformed placebo in terms of acceptability., Conclusions: The NMA supports topiramate, risperidone, quetiapine, paroxetine, venlafaxine, fluoxetine and sertraline as effective pharmacological choices for the treatment of PTSD. Quetiapine and topiramate have the shortcoming of relying on a few small studies, but the clinically meaningful change in symptoms is noteworthy and merits further investigation. Among the pharmacological treatments with evidence of efficacy compared to placebo, fluoxetine achieved a relatively high rank regarding acceptability. To the best of our knowledge, this is the largest contemporary NMA on the subject and the addition of new medications is an important extension of previous meta-analyses, enabling a larger number of drug comparisons., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms "dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance)." Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.

Aim: The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil., Materials and Methods: A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP 14 ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP 14 scores., Results: In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL., Conclusions: The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: The aim of the present study was to evaluate whether periodontitis is independently associated with oral health-related quality of life (OHRQoL) in individuals with end-stage renal disease (ESRD)., Materials and Methods: Calibrated examiners assessed 180 adults with ESRD. A full-mouth periodontal examination was performed at six sites on each tooth. Periodontitis was considered a categorical variable (absent, mild/moderate or severe). OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP 14 ) questionnaire. Adjusted multivariate Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP 14 scores for periodontitis according to the severity categories., Results: In the adjusted model, mild/moderate and severe periodontitis were significantly associated with poorer OHRQoL compared to the absence of periodontitis [RR = 1.49 (95% confidence interval: 1.16-1.91) and RR 1.77 (95% CI: 1.36-2.30), respectively]. The adjusted domain-specific analysis revealed that mild/moderate periodontitis significantly impacted the psychological disability domain and severe periodontitis significantly impacted the physical pain, psychological discomfort, physical disability and psychological disability domains., Conclusions: Periodontitis exerts an influence on OHRQoL in individuals with ESRD, with a more severe condition impacting different domains., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Laboratory evidence has demonstrated the antimicrobial effect of Melaleuca alternifolia (MEL) against oral microorganisms. This randomized, double-blind, crossover clinical trial, compared the anti-biofilm and anti-inflammatory effects of MEL nanoparticles with 0.12% chlorhexidine gluconate (CHX) on biofilm-free (BF) and biofilm-covered (BC) surfaces. Before each experimental period, the participants refrained from all oral hygiene practices for 72 hours. The 60 participants were randomly assigned to professional prophylaxis in two quadrants (Q1-Q3 or Q2-Q4), and rinsed with MEL or CHX for four days. The Quigley & Hein plaque index (QHPI), gingival crevicular fluid (GCF) volume, and participants' perceptions were assessed. CHX showed significantly lower mean QHPI on BF (2.65 ± 0.34 vs. 3.34 ± 0.33, p < 0.05) and BC surfaces (2.84 ± 0.37 vs. 3.37 ± 0.33, p < 0.05). Intragroup comparisons indicated reductions in GCF in all the groups, with significant differences only for CHX on BF surfaces (p < 0.05). Intergroup comparisons revealed no significant differences (p > 0.05). Based on individual perceptions, CHX had better taste and biofilm control, but resulted in a greater change in taste. Nevertheless, MEL demonstrated anti-inflammatory effects similar to those of CHX. Further clinical trials testing different protocols, concentrations and follow-up periods are required to establish its clinical application.

Objectives: The aim of this study was to assess with histological and inflammatory analysis the use of flossing as a diagnostic method for detecting proximal gingivitis., Material and Methods: This is a diagnostic accuracy paper composed of two different studies. In the first study, three groups were identified based on papilla status: bleeding (+) with both methods (N = 26); bleeding (+) with dental floss, but no bleeding (-) with probing (N = 26); and no bleeding (-) with either method (N = 26). One papilla from all 78 participants was biopsied and analyzed for the determination of inflammatory infiltrate and percentage of collagen fibers. Sensibility, specificity, positive and negative predictive, and accuracy values were analyzed. In the second study, the volume of gingival crevicular fluid (GCF) was analyzed in 49 participants with flossing+/probing- and flossing-/probing- at contralateral proximal sites. The GCF volume was compared between these sites (n = 172)., Results: Significantly greater frequencies of moderate/intense inflammation were found in the flossing+/probing+ (100%) and flossing+/probing- (92.3%) groups compared to those in the flossing-/probing- (0%) group. Significantly different percentages of collagen fibers were found among the three groups (flossing+/probing+ (40.90 ± 3.68); flossing+/probing- (45.78 ± 4.55); flossing-/probing- (60.01 ± 36.66)) (P < 0.001). Dental floss increased the balance between sensitivity and specificity values and showed highest positive predictive (100%) and accuracy (97%) values. Among the 172 sites evaluated, positive bleeding sites had a significantly greater volume of GCF (38 (27-68)) than negative sites (25 (16-51)) (P < 0.001)., Conclusions: The findings suggest that flossing can be used as a diagnostic method for proximal gingivitis in subjects with no history of periodontitis., Clinical Relevance: Dental floss can be used as a complementary diagnostic method for proximal gingivitis in adults without clinical attachment loss in clinical practice as well as epidemiology studies.

Objective: To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process., Methods: A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed., Results: Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy., Conclusions: The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Temporomandibular myofascial pain presents a major challenge in the diagnosis of temporomandibular disorders (TMD). Due to the characteristics of this condition, intramuscular injection procedures are often needed for adequate control of symptoms and treatment. Thus, the aim of this systematic review was to evaluate the effectiveness of dry needling and injection with different substances in temporomandibular myofascial pain. Electronic databases PubMed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus, Web of Science and CAPES Catalog of Dissertations and Theses were searched for randomized clinical trials until January 2018. Manual search was performed in relevant journals and in the references/citations of the included studies. The selection of studies was carried out by two independent reviewers according to eligibility criteria. From 7128 eligible studies, 137 were selected for full-text analysis and 18 were included. Due to the heterogeneity of the primary studies it was not possible to perform a meta-analysis. The narrative analysis of the results showed that most of the studies had methodological limitations and biases that compromised the quality of the findings. Dry needling and local anaesthesic injections seem promising, but there is a need to conduct further randomized clinical trials, with larger samples and longer follow-up times, to evaluate the real effectiveness of the technique and evaluated substances., (Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to investigate the impact of the use of crack and other illicit drugs on oral health-related quality of life (OHRQoL) in young adults., Methods: This cross-sectional study evaluated 106 crack users at a public treatment center for drug addiction and 106 controls matched for gender, age, and use of tobacco. Clinical examinations were performed for dental caries and periodontal disease. The outcome was OHRQoL, which was determined using the Oral Health Impact Profile (OHIP-14). The association between OHRQoL and illicit drugs was modeled using conditional Poisson regression., Results: Users of crack and other illicit drugs had a poorer OHRQoL than the controls (p < .001). Among the crack users, the odds ratio to yield high OHIP-14 was 3.40 (95% confidence interval, 1.91-6.08). Adjustment for sex, age, schooling, income, smoking, dental caries, and periodontal disease did not change such an estimate considerably. The functional limitation and psychological discomfort domains were associated with the use of illicit drugs., Conclusion: Users of crack and other illicit drugs exerted a negative impact on OHRQoL independently of socio-demographic characteristics and tobacco use, suggesting the need for special attention regarding the specific oral health needs of this population as well as drug prevention and treatment strategies., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

This is a systematic review of clinical and laboratory studies evaluating the effect of Melaleuca alternifolia on periodontopathogens, dental plaque, gingivitis, periodontitis, and inflammatory responses. The PubMed, Cochrane, Web of science, Bireme, Lilacs, Prospero, Open Grey, and Clinical Trials databases were searched to identify potentially eligible studies through October 2016. Of 1,654 potentially eligible studies, 25 were included in the systematic review. Their methodology was evaluated through the Cochrane Handbook for clinical studies and the GRADE system for in vivo/in vitro studies. Although clinical studies must be interpreted with caution due to methodological limitations, laboratory studies have found promising results. In vitro evidences showed that M. alternifolia has bactericidal and bacteriostatic effects against the most prevalent periodontopathogens. Clinical studies found comparable effects to chlorhexidine 0.12% in reducing gingival inflammation, although the antiplaque effect was lower. M. alternifolia also showed antioxidant properties, which are beneficial to the host, allied to the reduction on immune-inflammatory responses to pathogens. This systematic review suggests that the M. alternifolia has potential anti-inflammatory and antimicrobial properties, which can be easily applied to the periodontal tissues. However, further clinical trials are needed to elucidate the clinical relevance of its application., (Copyright © 2017 John Wiley & Sons, Ltd.)

Microbial biofilms represent a challenge in the treatment of infections, due to the low efficacy of the antimicrobials. This study evaluated the antimicrobial effect of nanoparticles of Melaleuca alternifolia (TTO) in dental biofilm. Thirty-eight volunteers used an oral device in situ in situ including four bovine enamel specimens for 07 days. From the fifth day four solutions were applied randomly for each specimen: Physiological Saline Solution (0.85% NaCl) (C+), Chlorhexidine 0.12% (CHX), M. alternifolia oil 0.3% (TTO), and a nanoparticle solution of 0.3% M. alternifolia oil (NPTTO). The nanoparticles of TTO were characterized for pH, IPD, medium size, zeta potential and Transmission Electron Microscopy. Antimicrobial activity was evaluated by viable microorganisms count and the structure of the biofilm by atomic force microscopy. The NPTTO presented pH 6.4, particle diameter of 197.9 ± 1 nm, polydispersion index of 0.242 ± 0.005, zeta potential of -7.12 mV and ±0:27 spherical shape. The C+ resulted in 100% of bacterial vitality, while CHX, TTO and NPTTO showed 34.2%, 51.4% and 25.8%, respectively. The AFM images showed biofilms with an average roughness of 350 nm for C+, 275 nm for CHX, 500 nm for TTO and 100 nm for NPTTO. The NPTTO demonstrated excellent antimicrobial activity in the biofilm formed in situ and will possibly be used in future for the treatment/prevention of oral biofilms., (Copyright © 2017. Published by Elsevier Ltd.)

Objective: The aim of this study was to assess the associations of gingival bleeding with individual and community social variables among schoolchildren., Methods: This cross-sectional study evaluated a representative, multistage, random sample of 1,134 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. The participants were examined clinically, and full-mouth gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding). The children's parents or guardians answered questions regarding their socioeconomic status and social capital, and an assessment of the associations was performed using multilevel Poisson regression models., Results: The prevalence of gingival bleeding was 96.21 percent. The multilevel adjusted assessment revealed that socioeconomic, clinical, and social capital variables at the individual level were associated with higher levels of gingival bleeding. Children whose fathers had a low educational level, children who had dental plaque and dental crowding, and children who never/almost never attended religious meetings exhibited significantly higher levels of gingival bleeding than their counterparts. This social gradient remained significant even after adjusting for contextual-level covariates., Conclusion: The results indicate that the socioeconomic status and features of social capital are associated with the levels of gingival bleeding among schoolchildren., (© 2016 American Association of Public Health Dentistry.)

Objective: To compare the performance of partial-mouth periodontal examination (PMPE) protocols with different cut-off points to the full-mouth examination (FME) in the assessment of the prevalence and extent of gingival bleeding in adolescents., Methods: A cross-sectional study was conducted involving 12-year-old adolescents. Following a systematic two-stage cluster sampling process, 1134 individuals were evaluated. Different PMPE protocols were compared to the FME with six sites per tooth. Sensitivity, specificity, area under the ROC curve (AUC), intraclass correlation coefficient (ICC), relative and absolute biases and the inflation factor were assessed for each PMPE protocol with different cut-off points for the severity of gingival bleeding., Results: The highest AUC values were found for the six-site two-diagonal quadrant (2-4) (0.97), six-site random half-mouth (0.95) and Community Periodontal Index (0.95) protocols. The assessment of three sites [mesiobuccal (MB), buccal (B) and distolingual (DL)] in two diagonal quadrants and the random half-mouth protocol had higher sensitivity and lower specificity than the same protocols with distobuccal (DB) sites. However, the use of DB sites led to better specificity and improved the balance between sensitivity and specificity, except for the two-diagonal quadrant (1-3) protocol. The ≥1 cut-off point led to the most discrepant results from the FME., Conclusion: Six-site two-diagonal quadrant (2-4) and random half-mouth assessments perform better in the evaluation of gingival bleeding in adolescents. However, when a faster protocol is needed, a two-diagonal quadrant assessment using only MB, B and DL sites can be used with no important loss of information., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults., Methods: The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE., Results: We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5)., Conclusions: The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: It is not clear how using partial-mouth periodontal examination (PMPE) protocols affects estimates of the association between gingival bleeding (GB) and oral health-related quality of life (OHRQoL). The aim of the present study is to assess impact of different PMPEs on the association between GB and OHRQoL in 12-year-old adolescents., Methods: A total of 1,134 adolescents were evaluated for clinical and subjective variables. GB was determined by full-mouth examination (FME) of six sites (disto-buccal [DB], mid-buccal [B], mesio-buccal [MB], disto-lingual [DL], mid-lingual, and mesio-lingual [ML]) and different PMPEs were calculated using a 15% cut-off point: 1) full-mouth (MB-B-DB/MB-B-DL); 2) two diagonal quadrants (six sites/MB-B-DB/MB-B-DL); 3) two randomly selected half-mouth quadrants (six sites/MB-B-DB/ MB-B-DL/MB-DB-ML-DL); and 4) the community periodontal index. OHRQoL was assessed using the Child Perceptions Questionnaire (CPQ 11-14 ). Adjusted negative binomial regression models were used to calculate the rate ratio of CPQ 11-14 scores for each PMPE., Results: Adolescents with GB showed significantly poorer OHRQoL than their counterparts when FME was used. In contrast, more than half of PMPE protocols did not detect significant associations between GB and CPQ 11-14 scores in the adjusted analysis., Conclusions: Using PMPE to assess GB in adolescents significantly affects associations with OHRQoL outcomes, depending on the protocol used. PMPEs that evaluated MB-B-DL sites of randomly selected half-mouth quadrants (1 or 2 and 3 or 4) achieved results closer to those obtained with FME.

Background: Crack cocaine can alter functions related to the immune system and exert a negative influence on progression and severity of periodontitis. The aim of this study is to compare periodontal status between crack cocaine users and crack cocaine non-users and investigate the association between crack cocaine and periodontitis after adjustments for confounding variables., Methods: This cross-sectional study evaluated 106 individuals exposed to crack cocaine and 106 never exposed, matched for age, sex, and tobacco use. An examiner determined visible plaque index (VPI), marginal bleeding index, supragingival dental calculus, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Logistic regression was used to model associations between crack cocaine and periodontitis (at least three sites with CAL >4 mm and at least two sites with PD >3 mm, not in the same site or tooth)., Results: Prevalence of periodontitis among crack non-users and crack users was 20.8% and 43.4%, respectively. Crack users had greater VPI, BOP, PD ≥3 mm, and CAL ≥4 mm than crack non-users. Periodontitis was associated with age >24 years, schooling ≤8 years, smoking, moderate/heavy alcohol use, and plaque rate ≥41%. Crack users had an approximately three-fold greater chance (odds ratio: 3.44; 95% confidence interval: 1.51 to 7.86) of periodontitis than non-users., Conclusion: Occurrence of periodontitis, visible plaque, and gingival bleeding was significantly higher among crack users, and crack use was associated with occurrence of periodontitis.

This study evaluated the clinical diagnosis of proximal gingivitis by comparing two methods: dental flossing and the gingival bleeding index (GBI). One hundred subjects (aged at least 18 years, with 15% of positive proximal sites for GBI, without proximal attachment loss) were randomized into five evaluation protocols. Each protocol consisted of two assessments with a 10-minute interval between them: first GBI/second floss, first floss/second GBI, first GBI/second GBI, first tooth floss/second floss, and first gum floss-second floss. The dental floss was slid against the tooth surface (TF) and the gingival tissue (GF). The evaluated proximal sites should present teeth with established point of contact and probing depth ≤ 3mm. One trained and calibrated examiner performed all the assessments. The mean percentages of agreement and disagreement were calculated for the sites with gingival bleeding in both evaluation methods (GBI and flossing). The primary outcome was the percentage of disagreement between the assessments in the different protocols. The data were analyzed by one-way ANOVA, McNemar, chi-square and Tukey's post hoc tests, with a 5% significance level. When gingivitis was absent in the first assessment (negative GBI), bleeding was detected in the second assessment by TF and GF in 41.7% (p < 0.001) and 50.7% (p < 0.001) of the sites, respectively. In the absence of gingivitis in the second assessment (negative GBI), TF and GF detected bleeding in the first assessment in 38.9% (p = 0.004) and 58.3% (p < 0.001) of the sites, respectively. TF and GF appears to be a better diagnostic indicator of proximal gingivitis than GBI.

Background: Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects., Aim: The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects., Material and Methods: The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model., Results: The WMD in PD reduction [-0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) -0.24, -0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (-0.14 mm, n = 9, p = 0.11, 95% CI -0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI -0.04, 8.07; and -1.91%, n = 7, p = 0.39, 95% CI -6.32, 2.51 respectively) did not favour adjunctive antibiotic use., Conclusion: Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Although the use of injectable anesthesia prior to subgingival scaling and root planing (SRP) reduces pain, many patients report fear and prolonged numbness of adjacent tissues. The aim of the present study was to compare the effects of a eutectic mixture containing 25 mg/g of lidocaine and 25 mg/g of prilocaine, injectable 2% lidocaine, topical 2% benzocaine and a placebo substance on reducing pain during SRP. In this randomized, split-mouth, masked clinical trial, thirty-two patients presenting more than two teeth with probing depth and clinical attachment level ≥ 5 mm in at least 4 sextants were randomly allocated to four groups: EMLA(r); injectable 2% lidocaine; topical 2% benzocaine and placebo. Pain and discomfort were measured using a visual analogue scale (VAS) and verbal scale (VS). Repeated-measures analysis of variance and Poisson regression were used for analysis. Patient satisfaction with the anesthesia was determined at the end of each treatment session. VAS and VS scores did not differ between injectable 2% lidocaine and EMLA (p > 0.05) and both substances showed significantly better pain control compared to 2% benzocaine and placebo (p < 0.05). 93.7% and 81.2% of the individuals were satisfied with the injectable anesthetic and EMLA, respectively (p = 0.158). Dissatisfaction with benzocaine and placebo was approximately 10 times greater than injectable anesthesia (p = 0.001). In conclusion, EMLA showed an equivalent effect on pain control when compared to the injectable anesthesia and performed better than 2% benzocaine in SRP. Thus, EMLA is a viable anesthetic option during scaling and root planning, despite the frequent need for second application.

Background: Child oral health-related quality of life (COHRQoL) has been increasingly assessed. However, the full relationship between gingivitis and COHRQoL has been assessed by only a small number of studies. This study aims to assess the association between gingival bleeding and how a child perceives its OHRQoL., Methods: This cross-sectional study used multistage random sampling to enroll 1,134 12-year-old schoolchildren from Santa Maria, a southern city in Brazil. Participants were examined for gingival bleeding according to the community periodontal index criteria, a full-mouth clinical examination of six sites per tooth. COHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-Year-Old Children (CPQ11-14), and data on socioeconomic status were collected. Multilevel Poisson regression models fitted the association of gingivitis with overall and domain-specific CPQ11-14 scores., Results: In general, children with bleeding in ≥15% of sites had higher total CPQ11-14 scores and domain-specific scores than their counterparts. This association persisted after adjustment for other potential confounders. The presence and extent of gingival bleeding was associated mainly with emotional limitation domains of the CPQ11-14; those with extended levels of gingivitis had a 1.20 times higher mean score than those with low-level/no gingival bleeding (rate ratio = 1.20; 95% confidence interval = 1.10 to 1.31)., Conclusion: The present results indicate that the presence of extensive levels of gingivitis might be negatively associated with how children perceive their oral health and their daily life.