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Objective: The aim of this randomized double‐blind and placebo‐controlled study was to assess if periodontal treatment with or without systemic antibiotic would change the mean level of Archaea. Methods: Fifty‐nine (59) subjects were randomly assigned to receive scaling and root planing (SRP) alone or combined with metronidazole (MTZ; 400 mg/TID) or either with MTZ and amoxicillin (AMX; 500 mg/TID) for 14 days. Clinical and microbiological examinations were performed at baseline and at 6 months post‐SRP. Six subgingival plaque samples per subject were analysed for the presence and levels of Archaea using quantitative polymerase chain reaction. Results: Scaling and root planing alone or combined with MTZ or MTZ + AMX significantly reduced the prevalence of subjects colonized by Archaea at 6 months post‐therapy, without significant differences among groups (P > .05). Both therapies led to a statistically significant decrease in the mean percentage of sites colonized by Archaea (P < .05). The MTZ and MTZ + AMX group had a significantly lower mean number of sites colonized by Archaea and lower levels of these micro‐organisms at sites with probing depth ≥5 mm at 6 months compared with SRP group (P < .05). Conclusion: Periodontal treatments including adjunctive MTZ or MTZ + AMX are more effective than mechanical treatment alone in reducing the levels and prevalence of sites colonized by Archaea in subjects with chronic periodontitis. [ABSTRACT FROM AUTHOR]

Background There is evidence of a possible relationship between Archaea and periodontal disease; however, to date few studies have assessed the changes in prevalence of this domain after periodontal therapy. The aim of this randomized double-blind and placebo-controlled study was to assess if periodontal treatment with or without systemic antibiotic would change the prevalence of Archaea after periodontal therapy. Methods Thirty subjects were randomly assigned to receive scaling and root planing ( SRP) alone or combined with metronidazole ( MTZ) + amoxicillin ( AMX) for 14 days. Clinical and microbiological examinations were performed at baseline and at six months post- SRP. Nine subgingival plaque samples per subject were analysed for the presence of Archaea. Results SRP alone or combined with MTZ + AMX significantly reduced the prevalence of subjects colonized by Archaea at six months post-therapy. However, no significant differences between treatment groups were observed (p > 0.05). Both therapies led to a statistically significant decrease in the mean percentage of sites colonized by Archaea (p < 0.05). A negative Spearman correlation was observed between the presence of Archaea and the mean clinical attachment gain at six months post-therapy (r2 = -0.61; 95% CI -0.80- -0.31; p = 0.003). Conclusions SRP alone or combined with MTZ + AMX provides a similar reduction in the prevalence of Archaea in the subgingival biofilm of subjects with generalized aggressive periodontitis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the clinical and microbiological effects of scaling and root planing (SRP) alone or combined with metronidazole (MTZ) or with MTZ and amoxicillin (AMX) in the treatment of smokers with chronic periodontitis. Methods: A double-blind, placebo-controlled, randomized clinical trial was conducted in 43 subjects who received SRP alone ( n=15) or combined with MTZ (400 mg 3 x per day, n=14) or with MTZ+AMX (500 mg 3 x per day, n=14) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-therapy. Subgingival samples were analysed by checkerboard DNA-DNA hybridization. Results: Subjects receiving MTZ+AMX showed the greatest improvements in mean probing depth and clinical attachment level. Both antibiotic therapies led to additional clinical benefits over SRP alone in initially shallow, intermediate, and deep sites. The SRP+MTZ+AMX therapy led to the most beneficial changes in the subgingival microbial profile. These subjects showed significant reductions in the mean counts and proportions of periodontal pathogens such as Tannerella forsythia, Porphyromonas gingivalis and Treponema denticola, and the greatest increase in proportions of host-compatible species. Conclusion: Significant advantages are observed when systemic antibiotics are combined with SRP in the treatment of smokers with chronic periodontitis. The greatest benefits in clinical and microbiological parameters are achieved with the use of SRP+MTZ+AMX. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Evaluation of the clinical and microbiological effects of scaling and root planing (SRP) alone or in combination with 0.12% chlorhexidine (CHX) rinsing. METHODS: A blind, placebo-controlled, parallel-design, randomized clinical trial was conducted in 29 subjects with chronic periodontitis. Subjects were assigned to two therapeutic groups: control (SRP+placebo) and test (SRP+CHX during and up to 42 days post-therapy). Clinical and microbiological [N-benzoyl-dl-arginine-2-naphthylamide (BANA test)] examinations were performed at baseline, 42 and 63 days post-therapy. RESULTS: Initially, intermediate sites (4-6 mm) in the test group showed less plaque accumulation, gingival bleeding, bleeding on probing and a greater reduction in attachment level and probing depth (PD) at 63 days after treatment. The initially deep sites (>6 mm) in the CHX group also showed a better reduction in plaque accumulation and in PD compared with the control group. Both therapies led to a microbiological improvement; however, the test subjects showed a higher frequency of BANA-negative sites after treatment, which was sustained over time (p<0.001). At 63 days, the control group presented 25 BANA-negative sites and 65 positive sites, and the test group 58 and 26, respectively. CONCLUSION: The combination of CHX rinses and SRP leads to clinical benefits and to a better reduction in BANA-positive species. [ABSTRACT FROM AUTHOR]

Halitosis has been correlated with the concentration of volatile sulfur compounds (VSC) produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal area and the dorsum of the tongue. The aim of this investigation was to study the association among the presence of BANA-positive species (Treponema denticola,Bacteroides forsythus,Porphyromonas gingivalis), periodontal condition and halitosis in subjects with mental disabilities. This population (17–49 years of age) consisted of 17 Down Syndrome (DS) patients, 17 with Mentally Retarded (MR), and 17 mentally health (control group). The VSC in the human mouth was determined by a portable sulfide monitor (Halimeter®). Clinical parameters (Plaque Index– PlI, Probing Depth– PD and Bleeding on Probing– BOP) were obtained from six reference teeth (# 3, 8, 14, 19, 24, 30). In the same way, subgingival plaque samples were taken from the same selected teeth and from dorsal surface of the tongue and evaluated by BANATM Test (BANAMet). The results were analyzed by Mann–WhitneyUTest. PlI and BOP were higher in DS patients (P < 0.01) and PD was similar in DS and health patients (P > 0.05) but higher than MR. No difference was found among three groups for the presence of BANA-positive species, however the VSC levels were lower (P < 0.01) in DS (log1.9 ± 0.2) than in MR (log 2.2 ± 0.3) and health (log 2.2 ± 0.2) patients. Although the presence of anaerobic periodontal infection was similar in all groups the VSC levels were lower in Down syndrome patients. [ABSTRACT FROM AUTHOR]

Peri-implantitis associated with dental implants shares characteristics with destructive periodontal diseases. Both conditions are multifactorial and strongly correlated with the presence of microorganisms surrounding the prostheses or natural dentition. This study aimed to evaluate the antimicrobial activity and toxicity of a mucoadhesive hydrogel functionalized with aminochalcone (HAM-15) against Aggregatibacter actinomycetemcomitans, Fusobacterium periodonticum, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Candida albicans. Various experiments were conducted to determine the minimum inhibitory concentrations (MIC) and minimum bactericidal/fungicidal concentrations (MBC/MFC), as well as the antibiofilm potential and toxicity in human gingival fibroblasts and a G. mellonella animal model. Infection and treatment studies were also performed in G. mellonella. The results demonstrated that both aminochalcone (AM-15) and the aminochalcone-functionalized hydrogel (HAM-15) exhibited antimicrobial activity, with MICs ranging from 7.8 to 31.2 μg/mL for the tested strains. Treatment with HAM-15 at 300 μg/mL reduced the monospecies biofilm of C. albicans and P. gingivalis by 7 log 10 and 6 log 10 , respectively, and the mixed-species biofilm of these microorganisms by 7 log 10 and 8 log 10 , respectively. Regarding toxicity, HAM-15 showed cytotoxic effects on human gingival fibroblasts at high concentrations, but in the G. mellonella model, survival was 70 % at a dose of 1 mg/mL. Additionally, AM-15, when administered after larval infection, protected 90 % of the animals (p < 0.05). These results suggest that AM-15 is a promising candidate for the prevention and treatment of anaerobic infections and yeasts, demonstrating significant antimicrobial efficacy and an acceptable safety profile in experimental models., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

This study evaluated the microbial growth profile of subgingival multispecies biofilm on 3D-printable resin-based composites (PRBCs). A 96-well cell plate cultivated a 39-species biofilm associated with periodontitis over 7 days. Cylindrical specimens with 12 mm high and 3 mm diameters were prepared by the PRBC group (Cosmos Temp-Yller; Prizma 3D Bio Crown; Prizma 3D Bio Prov) and an acrylic resin as control. Further, these specimens were immersed in the well plate to allow biofilm formation. After growing for 7 days, the metabolic biofilm activity was evaluated by colorimetric assay and the microbial profile by DNA-DNA hybridization. Kruskal-Wallis and Mann-Whitney tests evaluated each bacteria count and complex group. A greater biofilm formation was observed on PRBC groups than on acrylic resin. The microbiological profile of PRBC was associated with a less pathogenic biofilm, with an absence of a red complex. Acrylic resin showed low biofilm growth, but the biofilm profile was related to periodontal disease, characterized by red-complex bacteria. The selection of PRBC may contribute more effectively to maintaining periodontal health than acrylic resin.

Aims: To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany., Methods: Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics., Results: Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12)., Conclusion: Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Evidence has shown the clear positive effects of nature-based products on biofilm control and improved gingival health. However, most studies have used in vitro models, have tested single natural components, or have not evaluated proteomic changes after treatment. This double-blind, parallel, randomized, and controlled clinical trial evaluated the benefits of a nature-based gel in controlling gingival inflammation and its effects on the proteomic gingival crevicular fluid (GCF) profile. Gingivitis patients were distributed into the following groups: (1) nature-based gel containing propolis, aloe vera, green tea, cranberry, and calendula (n = 10); (2) control-conventional toothpaste (n = 10). GCF was collected and evaluated by means of liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). At 3 months, the groups showed similar clinical benefits ( p < 0.05). A total of 480 proteins were identified across all groups. In a pooled comparison of both groups at both time points, exclusive proteins were identified in the nature-based gel (78) and the control (21) groups. The exclusive proteins identified for the toothpaste mainly acted in wound healing, and those for the nature-based gel mainly acted on immune system processes. The nature-based gel achieved similar clinical outcomes to conventional toothpaste. However, the nature-based gel markedly changed the proteomic profile of GCF after treatment, showing a profile associated with a host response.

The aim of this study was to evaluate the effect of the combination of neovestitol-vestitol (CNV) compounds obtained from Brazilian red propolis on the microbiological profile of a mature multispecies subgingival biofilm. The biofilm with 32 bacterial species associated with periodontitis was formed for seven days using a Calgary device. Treatment with CNV (1600, 800, 400, and 200 μg/mL), amoxicillin (54 μg/mL), and vehicle control was performed for 24 h on the last day of biofilm formation. Biofilm metabolic activity and DNA-DNA hybridization (checkerboard) assays were performed. The groups treated with CNV 1600 and amoxicillin reduced 25 and 13 species, respectively, compared to the control vehicle treatment ( p ≤ 0.05); both reduced P. gingivalis , while only CNV reduced T. forsythia . When the data from the two treatments (CNV and AMOXI) were compared, a statistically significant difference was observed in 13 species, particularly members of Socransky's orange complex. Our results showed that CNV at 1600 μg/mL showed the best results regarding the metabolic activity of mature biofilms and obtained a reduction in species associated with the disease, such as T. forsythia , showing a better reduction than amoxicillin. Therefore, CNV seems to be a promising alternative to eradicate biofilms and reduce their pathogenicity.

The control of infectious diseases caused by biofilms is a continuing challenge for researchers due to the complexity of their microbial structures and therapeutic implications. Photodynamic therapy as an adjunctive anti-infective treatment has been described as a possible valid approach but has not been tested in polymicrobial biofilm models. This study evaluated the effect of photodynamic therapy in vitro with methylene blue (MB) 0.01% and red LEDs (λ = 660 nm, power density ≈ 330 mW/cm 2 , 2 mm distance from culture) on the metabolic activity and composition of a multispecies subgingival biofilm. Test Groups LED and MB + LED showed a more significant reduction in metabolic activity than the non-LED application group (~50 and 55%, respectively). Groups LED and MB equally affected (more than 80%) the total bacterial count in biofilms. No differences were noted in the bacterial biofilm composition between the groups. In vitro LED alone or the MB + LED combination reduced the metabolic activity of bacteria in polymicrobial biofilms and the total subgingival biofilm count.

Background: Static lung compliance, which is seriously affected during surgery, can lead to respiratory failure and extubation failure, which is little explored in the decision to extubate after cardiac surgery., Objective: To evaluate static lung compliance in the postoperative period of cardiac surgery and relate its possible reduction to cases of extubation failure in patients submitted to the fast-track method of extubation., Methods: Patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) at a state university hospital admitted to the ICU under sedation and residual block were included. Their static lung compliance was assessed on the mechanical ventilator using software that uses least squares fitting (LSF) for measurement. Within 48 hours of extubation, the patients were observed for the need for reintubation due to respiratory failure. The level of significance adopted for the statistical tests was 5%, i.e., p<0.05., Results: 77 patients (75.49%) achieved successful extubation and 25 (24.51%) failed extubation. Patients who failed extubation had lower static lung compliance compared to those who succeeded (p<0.001). We identified the cut-off point for compliance through analysis of the Receiver Operating Characteristic Curve (ROC), with the cut-off point being compliance <41ml/cmH2O associated with a higher probability of extubation failure (p<0.001). In the multiple regression analysis, the influence of lung compliance (divided by the ROC curve cut-off point) was found to be 9.1 times greater for patients with compliance <41ml/cmH2O (p< 0.003)., Conclusions: Static lung compliance <41ml/cmH2O is a factor that compromises the success of extubation in the postoperative period of cardiac surgery.

Surface functionalized ultrafine CoFe 2 O 4 nanoparticles (NPs), with mean diameter ∼5 nm, were investigated by means of DC magnetization and AC susceptibility over the temperature range of 4-400 K. All NPs present the same CoFe 2 O 4 core, with different molecular surface coatings, increasing gradually the number of carbon atoms in the coating layer: glycine (C 2 H 5 NO 2 ), alanine (C 3 H 7 NO 2 ), aminobutanoic acid (C 4 H 9 NO 2 ), aminohexanoic acid (C 6 H 13 NO 2 ), and aminododecanoic acid (C 12 H 25 NO 2 ). Samples were intentionally fabricated in order to modulate the core-core magnetic dipolar interaction, as the thickness of the coating layer increases with the number of carbon atoms in the coating molecule. The magnetic data of the uncoated CoFe 2 O 4 NPs were also collected for comparison. All investigated CoFe 2 O 4 NPs (coated and uncoated) are in a magnetically blocked state at room temperature as evidenced by ZFC/FC measurements and the presence of hysteresis with ∼700 Oe coercivity. Low temperature magnetization scans show slightly constricted hysteresis loops with coercivity decreasing systematically with a decreasing number of carbon atoms in the coating molecule, possibly resulting from differences in magnetic dipole coupling between NPs. Large thermomagnetic irreversibility, slow monotonic increase in the FC magnetization and non-saturation of the magnetization give evidence for the cluster glass (CG) nature in the CoFe 2 O 4 NPs. The out of phase part ( χ '') of AC susceptibility for all samples shows a clear frequency dependent hump which was analyzed to distinguish superparamagnetic (SPM), cluster glass (CG) and spin glass (SG) behavior by using Néel-Arrhenius, Vogel-Fulcher, and power law fittings. These analyses rule out the SPM state and suggest the presence of significant inter-cluster dipolar interaction, giving rise to CG cooperative freezing in the high-temperature region. In the low-temperature range, however, the disordered spins on the nanoparticle's surface play an important role in the formation of the SG-like state, as evidenced by Arrott plots and temperature dependency of d M /d H in the initial magnetization curves. In summary, the magnetic measurements showed that undercooling the system evolves from a SPM state of weakly interacting spin clusters, through the CG state induced by strong dipolar interaction, to the SG state resulting from the frustration of the disordered surface spins.

Helicobacter pylori infection is a significant global health concern. It cannot be diagnosed based solely on the patient's medical history and symptoms, and laboratory and imaging tests are often required to confirm the diagnosis. Both noninvasive and invasive methods are available for diagnosing H. pylori infection, including conventional and advanced detection techniques. It is not uncommon for patients to present with false-negative results due to the use of inadequate investigation methodologies, which prevents the adoption of appropriate clinical management. Thus, an analysis of the literature regarding the methods of diagnosis of H. pylori, with its advantages and disadvantages, is necessary. Publications in specialized scientific journals will undoubtedly contribute to facilitating access by professionals interested in the topic providing greater knowledge and potentially clinically useful guidance. In this review, the authors have sought to analyze and summarize the invasive and noninvasive methods, their applications, limitations, and the conditions that affect the sensitivity of the tests used for diagnosing H. pylori, an essential step for the successful treatment of this infection. It is essential to treat all patients infected with H. pylori. This represents a significant change in the approach, as the treatment was recommended previously only for patients showing symptoms of infection. Therefore, it is crucial to understand the limitations of traditional diagnostic methods and help raise awareness among healthcare professionals about the latest advances in diagnosing this important bacterium., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Dehiscence in surgeries involving membranes often leads to bacterial contamination, hindering the healing process. This study assessed bacterial colonization on various membrane materials. Polydioxanone (PDO) membranes, with thicknesses of 0.5 mm and 1 mm, and a collagen membrane were examined. Packages containing polystyrene pins were crafted using these membranes, attached to 24-well plates, and exposed to oral bacteria from supra and subgingival biofilm. After a week's anaerobic incubation, biofilm formation was evaluated using the DNA-DNA hybridization test. Statistical analysis employed the Kruskal-Wallis test with Dunn's post hoc test. The biofilm on the polystyrene pins covered by the 0.5 mm PDO membrane showed a higher count of certain pathogens. The collagen membrane had a greater total biofilm count on its inner surface compared to both PDO membranes. The external collagen membrane face had a higher total biofilm count than the 0.5 mm PDO membrane. Furthermore, the 1 mm PDO membrane exhibited a greater count of specific pathogens than its 0.5 mm counterpart. In conclusion, the collagen membrane presented more biofilm and pathogens both internally and on its inner surface.

Background: Whether, and to what extent, diabetes mellitus (DM) can affect the subgingival biofilm composition remains controversial. Thus, the aim of this study was to compare the composition of the subgingival microbiota of non-diabetic and type 2 diabetic patients with periodontitis using 40 "biomarker bacterial species.", Methods: Biofilm samples of shallow (probing depth [PD] and clinical attachment level [CAL] ≤3 mm without bleeding) and deep sites (PD and CAL ≥5 mm with bleeding) of patients with or without type 2 DM were evaluated for levels/proportions of 40 bacterial species by checkerboard DNA-DNA hybridization., Results: A total of 828 subgingival biofilm samples from 207 patients with periodontitis (118 normoglycemic and 89 with type 2 DM) were analyzed. The levels of most of the bacterial species evaluated were reduced in the diabetic compared with the normoglycemic group, both in shallow and in deep sites. The shallow and deep sites of patients with type 2 DM presented higher proportions of Actinomyces species, purple and green complexes, and lower proportions of red complex pathogens than those of normoglycemic patients (P < 0.05)., Conclusions: Patients with type 2 DM have a less dysbiotic subgingival microbial profile than normoglycemic patients, including lower levels/proportions of pathogens and higher levels/proportions of host-compatible species. Thus, type 2 diabetic patients seem to require less remarkable changes in biofilm composition than non-diabetic patients to develop the same pattern of periodontitis., (© 2023 American Academy of Periodontology.)

We assessed the level of evidence for the presence of new periodontal pathogens by (i) comparing the occurrence of non-classical periodontal taxa between healthy vs. periodontitis patients (Association study); (ii) assessing the modifications in the prevalence and levels of these species after treatments (Elimination study). In the Association study, we compared the prevalence and levels of 39 novel bacterial species between periodontally healthy and periodontitis patients. In the Elimination study, we analyzed samples from periodontitis patients assigned to receive scaling and root planing alone or with metronidazole+ amoxicillin TID/ 14 days. Levels of 79 bacterial species (39 novel and 40 classic) were assessed at baseline, 3 and 12 months post-therapy. All samples were analyzed using Checkerboard DNA-DNA hybridization. Out of the 39 novel species evaluated, eight were categorized as having strong and four as having moderate association with periodontitis. Our findings suggest strong evidence supporting Lancefieldella rimae , Cronobacter sakazakii , Pluralibacter gergoviae , Enterococcus faecalis , Eubacterium limosum , Filifactor alocis , Haemophilus influenzae , and Staphylococcus warneri , and moderate evidence supporting Escherichia coli , Fusobacterium necrophorum , Spiroplasma ixodetis , and Staphylococcus aureus as periodontal pathogens. These findings contribute to a better understanding of the etiology of periodontitis and may guide future diagnostic and interventional studies., Competing Interests: No potential conflict of interest was reported by the authors., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Natural products are well-known due to their antimicrobial properties. This study aimed to evaluate the antimicrobial effect of Desplac® product (composed of Aloe Vera, Propolis Extract, Green Tea, Cranberry, and Calendula) on the subgingival biofilm. Two different protocols were used to treat the 33-species biofilms: (A) 2×/day (12/12  h) for 1  min with Desplac® or Noplak Toothpaste (Chlorhexidine + Cetylpyridinium Chloride) or Oral B ProGengiva (stannous Fluoride) or a placebo gel; (B) a 12-h use of the Desplac® product or 0.12% chlorhexidine gel or a placebo gel. After 7 days of biofilm formation, the metabolic activity (MA) and biofilm profile were determined by 2,3,5-triphenyltetrazolium chloride and Checker-board DNA-DNA hybridization, respectively. Statistical analysis used the Kruskal-Wallis test followed by Dunn's post-hoc. In protocol A, all treatments presented reduced MA compared to the placebo ( p  ≤ 0.05). The Desplac®-treated biofilm showed a similar microbial profile to other antimicrobials, although with higher bacterial total counts. In protocol B, MA of Desplac®-treated biofilms was lower than the placebo's MA but higher than chlorhexidine-treated biofilms ( p  ≤ 0.05). Pathogen levels in Desplac®-treated biofilms were lower than in placebo-treated biofilms and elevated compared to the chlorhexidine-treated biofilms ( p  ≤ 0.05). Desplac® inhibited the biofilm development and disrupted the mature subgingival biofilm, highlighting its effect on Tannerella forsythia counts., Competing Interests: EO was the owner of Sysplac Company that produces Desplac product. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bueno-Silva, Kiausinus, Gonçalves, Moreira, Oliveira, Brugnera Junior, Feres and Figueiredo.)

The effect of systemic antibiotics on the microbial profile of extracrevicular sites after periodontal treatment is currently the subject of research. This study evaluated the microbiological effects on different oral cavity sites of scaling and root planing (SRP) combined with antimicrobial chemical control in the treatment of periodontitis. Sixty subjects were randomly assigned to receive SRP alone or combined with metronidazole (MTZ) + amoxicillin (AMX) for 14 days, with or without chlorhexidine mouth rinse (CHX) for 60 days. Microbiological samples were evaluated by checkerboard DNA-DNA hybridization until 180 days post therapy. The adjunctive use of antibiotics plus CHX significantly reduced the mean proportions of red complex species from subgingival biofilm and saliva ( p < 0.05). Furthermore, the analysis of all intraoral niches showed a significantly lower mean proportion of the red complex species in the same group. In conclusion, the concomitant use of antimicrobial chemical control (systemic and local) demonstrated a beneficial effect on the composition of the oral microbiota.

Background: Despite the body of evidence supporting the clinical benefits of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of young patients with periodontitis, the microbiological outcomes of this antibiotic protocol have been less explored. This study evaluated the microbiological effects of adjunctive MTZ+AMX in the treatment of young patients with periodontitis., Methods: Subjects with periodontitis Stages III or IV and ≤30 years old were randomly allocated to receive scaling and root planing (SRP) with placebo (n = 15) or with MTZ (400 mg) and AMX (500 mg) three times a day for 14 days (n = 15). Nine subgingival biofilm samples per subject (three samples from each probing depth (PD) category: ≤3, 4-6, and ≥7 mm) were collected at baseline and 3-, 6-, and 12-months post-treatment and individually analyzed for 40 bacterial species by checkerboard DNA-DNA hybridization., Results: Thirty subjects (15/group) with mean ages 27.6 ± 3.5 (control) and 26.8 ± 3.9 (test) were included. At 12 months post-therapy, the antibiotic group harbored lower proportions of red complex (1.3%) than the placebo group (12.5%) (p < 0.05). SRP + MTZ+AMX was more effective than mechanical treatment in reducing levels/proportions of several pathogens and increasing proportions of Actinomyces species (p < 0.05). Levels/proportions of Aggregatibacter actinomycetemcomitans were only reduced in the antibiotic group (p < 0.05). This group also exhibited greater reduction in the number of sites with PD ≥5 mm and higher percentage of subjects reaching the clinical end point for treatment (≤4 sites with PD ≥5 mm) than the control group (p < 0.05)., Conclusion: SRP+MTZ+AMX allowed for establishing a long-term healthier subgingival biofilm community and periodontal clinical condition, than SRP only., (© 2022 American Academy of Periodontology.)

This study evaluated the effect of a mouthwash containing 0.075% cetylpyridinium chloride and 0.28% zinc lactate (CPC + Zn) in a multispecies biofilm model. A 7-days 33-species biofilm, formed on Calgary device, was 1-min treated with: 0.12% chlorhexidine (CHX), culture medium (negative control), 0.075% cetylpyridinium chloride (CPC) or CPC + Zn, 2x/day, from day 3 until day 6. The metabolic activity and the microbial composition were evaluated by colorimetric method and checkerboard DNA-DNA hybridization, respectively. The three antimicrobials (CPC, CPC + Zn and CHX) reduced metabolic activity, total biofilm count and several species counts, including Porphyromonas gingivalis , Fusobacterium nucleatum , Parvimonas micra , Campylobacter gracili s and Streptococcus mutans . However, only CPC + Zn reduced counts of the pathogen Prevotella intermedia and did not interfere with the levels of some beneficial species in relation to the negative control. The treatment of multispecies subgingival biofilm with CPC + Zn was effective in controlling periodontal pathogens and favored the colonization of health-associated bacterial species.

Objectives. This study aimed to identify the prevalence of musculoskeletal symptoms among blue-collar and white-collar workers stratified by gender and age. Methods . The sample was composed of 390 blue-collar and 510 white-collar workers. Musculoskeletal symptoms were evaluated using the Nordic musculoskeletal questionnaire. An independent t test or Mann-Whitney test was used for inter-group comparisons. The χ 2 association test was applied for categorical variables. Logistic regression analysis was used to determine the influence of gender and age on musculoskeletal symptoms. Results . The prevalence of shoulder, lower back and ankle/foot symptoms was higher among blue-collar workers compared to white-collar workers. In the analysis stratified by gender, female blue-collar workers had a higher frequency of shoulder symptoms and male blue-collar workers had a higher frequency of lower back symptoms. In the analysis stratified by age, younger blue collar-workers had a higher frequency of shoulder, lower back and ankle/foot symptoms compared to young white-collar workers, and older white-collar workers had a higher frequency of neck symptoms compared to older blue-collar workers. Conclusions . Gender and age exerted an influence on self-reported symptoms in blue-collar and white-collar workers.

Aim: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features., Materials and Methods: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire., Results: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p &lt; .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events., Conclusions: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The oral cavity harbors hundreds of microorganisms that may be uncontrolled and provoke several diseases. In this sense, periodontitis is a complex multifactorial disease with an essential microbial component in its etiology. Periodontal treatment involves mechanical control of the supra- and subgingival biofilm, but not all patients respond predictably to treatment. In this way, the biofilm chemical control helps in the reduction of periodontal pathogens during treatment or in the delay of bacterial re-colonization after scaling and root planning. Several products have been studied as adjunctive therapy and have shown promising results. Therefore, the present article reviews the biological effects of propolis, aloe vera, green tea, cranberry, calendula, myrrha and salvia that may support their use in the control of subgingival biofilm in patients with periodontitis. All the natural products cited above showed exciting results against microorganisms related to oral diseases, mainly periodontitis. These substances also have anti-inflammatory and antioxidant activities. The natural agents propolis, aloe vera, green tea, cranberry, calendula, myrrha and salvia demonstrated potential to be used as oral hygiene products, based on their antimicrobial and anti-inflammatory actions.

Objectives: to analyze the personal and work-related burden factors associated with physical and emotional symptoms of informal caregivers of the elderly., Methods: cross-sectional study conducted with 121 informal caregivers and 121 seniors who received care, assessed individually for the risk of: physical overload, musculoskeletal symptoms, Self-Reporting Questionnaire, effort perception, and Katz index., Results: a greater perception of effort raises up to 3.3 times the chances of presenting symptoms of pain in the spine region (p=0.01), and lower functional capacity of the elderly increases up to 1.3 times the chances of presenting pain symptoms in the spine region (p=0.02). The symptoms of emotional overload were associated with the caregiver's low income (p=0.02)., Conclusions: the perception of effort, dependence of the elderly, caregiver's age, and symptoms of emotional overload are involved with caregivers' symptoms of physical overload, and low income, with emotional overload.

Described here is the implementation of a lung ultrasound course for physiotherapists focused on the acquisition and retention of knowledge and skills. Initially, we provided online lectures in a virtual learning environment (VLE), in which we taught the semiquantification of edema through a lung ultrasound score (LUS). Afterward, the physiotherapists participated in face-to-face lectures (which resumed the online lectures), followed by hands-on training and simulation with ultrasound. We assessed knowledge acquisition through a multiple-choice test with 30 questions (totaling 10 points). The test was applied before accessing the VLE (pre-VLE), before the face-to-face course and at its end (pre- and post-course). Physiotherapists collected actual patients' ultrasound scans, which were uploaded to the VLE and assessed by three supervisors, who performed a consensus LUS calculation and gave virtual written feedback. Thirteen physiotherapists collected 59 exams. The test results were 3.60 ± 1.58 (pre-VLE), 5.94 ± 1.45 (pre-course) and 8.50 ± 0.71 (post-course), with p &lt; 0.001 for all. The intraclass correlation coefficient for LUS between physiotherapists and supervisors was 0.814 (p &lt; 0.001), with moderate-to-weak agreement for LUS of the lung apical, median and basal zones, with κ = 0.455.334, and 0.417 (p &lt; 0.001 for all). Trainees were found to have increased short-term acquisition and retention of knowledge and skills, with a good intraclass correlation coefficient between them and the consensus of supervisors for the LUS of actual patients., Competing Interests: Conflict of interest disclosure —The authors declare there are no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors., (Copyright © 2022 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

This systematic review evaluated the features of the progression of experimentally induced gingivitis and peri-implant mucositis in humans. Included were studies that evaluated clinical, immunological, or microbiological responses between experimentally induced gingivitis and peri-implant mucositis in periodontally healthy patients. A total of 887 articles were initially identified, but only 12 were included in the final analysis. Implants accumulate less biofilm and suffer the most heterogeneous alterations in the microbiota, in the abstinence of oral hygiene, compared with the tooth. Interestingly, although dental implants presented less biofilm accumulation, the peri-implant mucosa showed a more exacerbated clinical response than the gingival tissue. The risk of bias of the selected studies was moderate to low, with one study presenting serious risk. The progression events of peri-implant mucositis were similar to those of experimental gingivitis but led to a different host response. This review was registered in the PROSPERO database CRD420201 123360.

Introduction: An evidence synthesis approach compiling biological/laboratory data is effective in advancing health-related knowledge. However, this approach is still underused in the oral health field., Methods: This commentary discusses the opportunities and challenges of systematic and scoping reviews of laboratory data in dentistry. Special focus is on the potential of these reviews to elucidate etiological and treatment concepts of oral diseases, such as periodontitis and peri-implantitis., Results: The following difficulties associated with such studies are discussed: (i) selection of ideal study design, (ii) assessment of "risk of bias" and definition of "certainty of evidence", (iii) evidence assembly and summary, and (iv) the paper review process., Discussion: Despite those challenges, high-quality reviews integrating laboratory data may generate relevant scientific information and help identify new avenues for future investigations. Experts in different oral health topics should build a process capable of helping researchers assemble and interpret these types of data., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Anodization is a routine industrial galvanic method that produces a titanium oxide layer on the surface of titanium. Considering the possibility that this technique could influence microbial adsorption and colonization, this in vitro study was conducted to evaluate the impact of a process of anodization applied to a titanium surface on the microbial profile of multispecies subgingival biofilm. Titanium discs produced by using two different processes-conventional and Anodization-were divided into two groups: conventional titanium discs with machined surface (cpTi) Control Group and titanium discs with anodic oxidation treatment (anTi) Test Group. Subgingival biofilm composed of 33 species was formed on the titanium discs that were positioned vertically in 96-well plates, for 7 days. The proportions and the counts of microbial species were determined using a DNA-DNA hybridization technique, and data were evaluated using Mann-Whitney test ( p  < 0.05). Mean total bacterial counts were lower in Test Group in comparison with Control Group ( p  < 0.05). Nine bacterial species differed significantly, and were found in higher levels in Control Group in comparison with Test Group, including T. forsythia , E. nodatum, and F. periodonticum. In conclusion, titanium discs with anodization could alter the microbial profile of the biofilm formed around them. Further clinical studies should be conducted to confirm the clinical impact of these findings.

Objectives: To evaluate propolis type-3 mouthrinse effects on the concentration of volatile sulfur compounds (VSCs) and on tongue dorsum microbial profile., Materials and Methods: A three-step double-blind, crossover, randomized study with 10 individuals divided into three groups: I-placebo (P); II-ethanolic extract of propolis type-3 3% (EEP); and III-chlorhexidine 0.12% (CHX) and instructed to rinse twice daily for 5 days. Each experimental period was followed by a 21-day washout interval. Morning mouth breath was assessed by VSC concentrations and microbiological samples were obtained from tongue dorsum at baseline and the end of period of rinses and analyzed using checkerboard DNA-DNA hybridization technique for 39 bacterial species., Results: CHX and EEP presented the lowest VSC concentration when compared with placebo (p < 0.05). Even in the absence of mechanical plaque control, CHX and EEP treatments reduced VSC levels and there were no statistical differences for VSC measurement between CHX and EEP. There was a significant reduction in mean counts of 10 species including some VSC producers (Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) by EEP. Total counts of organisms, gram-negative and gram-positive bacterial species showed a decrease for EEP and CHX (p < 0.05). In addition, no statistical difference was observed between EEP and CHX (p > 0.05). A positive correlation was observed between decrease of bacterial counts and decrease of VCSs concentration for the EEP and CHX., Conclusions: The use of a 3% propolis type-3 mouthrinse is an effective way to prevent morning bad breath. Thus, propolis may be a promising agent for the treatment of halitosis., Clinical Relevance: Propolis type-3 may be used as adjuvant treatment for morning breath malodor., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Periodontitis is a multifactorial inflammatory condition associated with an oral microbiome dysbiosis that results in gingival inflammation and clinical attachment loss. Periodontal therapies are based on scaling and root planing to disturb the bacterial biofilm mechanically and remove calculus and contaminated cementum. Research does not support the use of root modifiers for decontamination and biomodification of periodontally affected root surfaces. Standardized clinical trials in large populations, assessing biological and patient-reported outcome measures, are necessary to evaluate candidate biomaterials for decontamination and biomodification of periodontally affected root surfaces., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The development of oral biofilm models has been extremely important to study the specific role of most microbial species at the early stages of periodontitis. The current knowledge on monospecies or multispecies biofilms originates mainly from the observation of in vitro dynamic or static biofilm model systems, which were engineered to mimic clinical oral conditions. In the last few decades, mounting evidence has confirmed that biofilms are the major form of bacterial lifestyle, and more importantly, that microorganisms dwelling in sessile mixed-species aggregates display completely different phenotypes and physiological characteristics than when living in planktonic pure cultures. Interspecies interactions within these communities, mediated by chemical communication systems, have been shown to affect biofilm physiology and increase antimicrobial resistance by up to 1000 fold. These aspects reinforce the importance of developing multispecies biofilm models to better understand and control biofilms. Literature reports demonstrate that while monospecies models are still most commonly used in caries research, authors have used different multispecies models to study periodontal diseases. Periodontitis is a polymicrobial biofilm-dependent disease mainly associated with Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Interestingly, these species hardly adhere to substrates commonly used for biofilm formation, which makes multispecies models essential for an accurate analysis of periodontitis-related biofilms. The multispecies models currently available are generally composed of 6-10 species, but a more recent 34-species model was developed to better examine the dynamics within oral biofilms. The complexity of such polymicrobial biofilm models mimics more consistently the oral microbiome and different aspects of the oral environment. Collectively, the evidence on multispecies biofilm models described herein may support future studies on the use of antimicrobials for biofilm control as well as provide research opportunities to expand the current knowledge on interspecies interactions. The present manuscript reviews the most recent updates on in vitro biofilm model systems for periodontitis., (© 2022. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Objective: to evaluate musculoskeletal symptoms in formal and informal caregivers of elderly people, and check association with personal and work-related factors., Methods: this is a cross-sectional study. Instruments for assessment were the International Physical Activity Questionnaire, Self-Reporting Questionnaire-20, Borg's effort perception scale and Nordic Musculoskeletal Questionnaire., Results: informal caregivers had been working for a longer time (60.2% vs. 41%), had more hours of work (37.4% >12h for day), less time off (85.4% vs. 2.5%) and lack of care guidelines (90.2%). The region with the most musculoskeletal symptoms was the spine and the greater dependence of the elderly, the greater the chances of developing musculoskeletal symptoms (OR= 1.3, 95% CI= 1.1-1.6, p <0.05)., Conclusion: personal and work-related factors were more prevalent in informal group and the elderly person's dependence interferes with the increase in musculoskeletal symptoms of caregivers.

Background: The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis., Methods: Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines., Statistical Analyses: The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%., Trial Registration: ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.

Background: To our knowledge, to date, no studies have comprehensively assessed the changes occurring in the subgingival microbiome of young patients with periodontitis treated by means of mechanical and antibiotic therapy. Thus, this study aimed to use next-generation sequencing to evaluate the subgingival microbial composition of young patients with severe periodontitis treated with scaling and root planing and systemic metronidazole and amoxicillin., Methods: Subgingival samples from healthy individuals and shallow and deep sites from periodontitis patients were individually collected at baseline and 90 days post-treatment. The samples were analyzed using 16S rRNA-gene sequencing (MiSeq-Illumina) and QIIME pipeline. Differences between groups for the microbiological data were determined using principal coordinate analysis (PCoA), linear mixed models, and the PERMANOVA test., Results: One hundred samples were collected from 10 periodontitis patients and seven healthy individuals. PCoA analysis revealed significant partitioning between pre-and post-treatment samples. No major differences in the composition of the subgingival microbiota were observed between shallow and deep sites, at baseline or at 90-days post-treatment, and the microbiome of both site categories after treatment moved closer in similarity to that observed in periodontal health. Treatment significantly improved all clinical parameters and reduced the relative abundance of classical periodontal pathogens and of Fretibacterium fastidiosum, Eubacterium saphenum, Porphyromonas endodontalis, Treponema medium, Synergistetes, TM7, and Treponema spp, and increased that of Actinomyces, Rothia, Haemophilus, Corynebacterium, and Streptococci spp., Conclusion: Mechanical treatment associated with metronidazole and amoxicillin promoted a beneficial change in the microbiome of young individuals with severe periodontitis., (© 2020 American Academy of Periodontology.)