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Background:Psychologic stress and clinical hypercortisolism have been related to direct effects on bone metabolism. However, there is a lack of information regarding the outcomes of regenerative approaches under the influence of chronic stress (CS). Enamel matrix derivative (EMD) has been used in periodontal regenerative procedures, resulting in improvement of clinical parameters. Thus, the aim of this histomorphometric study is to evaluate the healing of periodontal defects after treatment with EMD under the influence of CS in the rat model. Methods:Twenty Wistar rats were randomly assigned to two groups; G1: CS (restraint stress for 12 hours/day) (n = 10), and G2: not exposed to CS (n = 10). Fifteen days after initiation of CS, fenestration defects were created at the buccal aspect of the first mandibular molar of all animals from both groups. After the surgeries, the defects of each animal were randomly assigned to two subgroups: non‐treated control and treated with EMD. The animals were euthanized 21 days later. Results:G1 showed less bone density (BD) compared to G2. EMD provided an increased defect fill (DF) in G1 and higher BD and new cementum formation (NCF) in both groups. The number of tartrate‐resistant acid phosphatase–positive osteoclasts was significantly higher in G1 when compared to G2 and in EMD‐treated sites of both groups. Conclusions:CS may produce a significant detrimental effect on BD. EMD may provide greater DF compared to non‐treated control in the presence of CS and increased BD and NCF in the presence or absence of CS.

Background:The purpose of this study was to evaluate the adjunctive clinical, microbiologic, and immunologic effects of the systemic administration of amoxicillin and metronidazole in the full‐mouth ultrasonic debridement of patients with severe chronic periodontitis. Methods:Twenty‐five patients presenting at least eight teeth with probing depth (PD) ≥5 mm and bleeding on probing (BOP) were selected and randomly assigned to full‐mouth ultrasonic debridement + placebo (control group) or full‐mouth ultrasonic debridement + amoxicillin and metronidazole (test group). The clinical outcomes evaluated were visible plaque index, BOP, position of the gingival margin, relative attachment level (RAL), and PD. Real‐time polymerase chain reaction (PCR) was used for quantitative analysis of Aggregatibacter actinomycetemcomitans(previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia(previously T. forsythensis). The enzyme‐linked immunosorbent assay (ELISA) technique permitted the detection of prostaglandin E2,interleukin‐1β, and interferon‐gamma levels in gingival crevicular fluid. All parameters were evaluated at baseline and at 3 and 6 months post‐treatment. Results:At 6 months, the test treatment resulted in lower BOP and an additional reduction (0.83 mm) in PD (P<0.05). Data also showed RAL gain ≥2 mm at 43.52% of sites in control patients compared to 58.03% of sites in test patients (P<0.05). However, both groups had similar mean RAL gain (1.68 and 1.88 mm for the control and test groups, respectively). Real‐time PCR and ELISA failed to identify significant differences between the groups. Conclusions:Both treatments resulted in significant clinical improvements; however, there was a slight, but significantly greater, improvement in BOP and the percentage of sites with PD ≥5 mm exhibiting RAL gain ≥2 mm in the test group. Nevertheless, no improvement in the microbiologic or immunologic outcome was observed with the adjunctive use of systemic amoxicillin and metronidazole.

Objective. To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. Methods. A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables 'percentage of heads of families without income' and 'percentage of illiterate heads of families' were used in the contextual analysis (second level). Results. A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the 'percentage of illiterate heads of families' was significantly associated to gingival bleeding. Conclusions. The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding 'income.' The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality. [ABSTRACT FROM AUTHOR]