Terapia de manutenção periodontal: perfil microbiológico e efeito do tabagismo na perda dental

Abstract

PERIODONTAL MAINTENANCE THERAPY: MICROBIAL PROFILE AND EFFECTS OF SMOKING ON TOOTH LOSS This Thesis reports two distinct issues related to periodontal maintenance therapy (PMT): microbiological findings of 6 years related to compliance of individuals and effect of smoking on tooth loss. The rationale for these studies is based on two specific aspects: (1) Although the association of smoking as a risk factor for periodontitis and worse response to PMT has been demonstrated in many studies, the isolated effect of smoking on tooth loss in patients undergoing PMT has not been reported in systematic reviews; (2) Few studies have been conducted on longitudinal changes in the subgingival microbiota of individuals in PMT and to date, no study related levels of bacteria to the degree of cooperation of individuals in PMT. In this sense, the aim of this PMT study is developed in two articles: (1) conduct a systematic review and meta- analysis of the effect of smoking on tooth loss in individuals in PMT with the following PICO question " What is the effect of smoking on tooth loss in patients in periodontal maintenance therapy ? " (P - individuals in TMP ; I - smokers ; C non-smokers ; O - tooth loss); (2) longitudinally evaluate, for 6 years, the effect of cooperation in PMT in the frequency of bacteria Actinomyces naeslundii, Porphyromonas gingivalis, Tanerella forsythia and Treponema denticola. In the systematic review the databases MEDLINE, WEB OF SCIENCE, COCHRANE LIBRARY and SCOPUS were searched until February 2017. The search strategy identified 728 articles. After removing duplicates, remaining 591 articles for reading the titles and abstracts and these were selected 36 articles to read the full text. After thorough reading of these articles, we selected 10 articles to include in this systematic review and 3 for meta-analysis. The scientific evidence and meta- analysis showed that PMT smokers had a greater chance of dental loss than non-smokers. The methodology of microbiological study included a total of 56 subjects, all recruited from a prospective cohort of 212 participants in a PMT program were included in the study and followed for 6 years, 5 times of ratings: T1 (before the active periodontal therapy), T2 (after active periodontal therapy), T3 (last visit to PMT in 24 months), T4 (last visit to PMT in 48 months) and T5 (last visit to PMT in 72 months). 28 regular cooperators individuals (RC) were randomized and matched by gender and age to 28 individuals irregular cooperators (IC). During the PMT, the following clinical periodontal examinations were performed: plaque index (PI), probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP). Quantitation of bacteria at full load and levels of A. naeslundii, P. gingivalis, T. forsythia and T. dentícola was performed by quantitative polymerase chain reaction (qPCR). This study concluded that IC had worse periodontal clinical parameters and higher total bacterial load levels that RC reflecting the beneficial role of cooperation in the PMT in maintaining the stability of the periodontal condition.