Gengivite proximal diagnosticada pelo fio dental: avaliação clínica e histológica

Abstract

In the presence of contact point, dental floss detects more bleeding sites than probing, possibly by greater contact with more inflamed internal part of papilla. However, there is a lack of validation evidences. The aim of this thesis was to validate the use of dental floss for the diagnosis of proximal gingivitis. After clinical diagnosis with dental floss against gingiva (BF) followed by periodontal probe (GBI) after 10 minutes, three subjects groups were identified: BF+/GBI+ bleeding papillae with both methods (n=26); BF+/GBI- bleeding with dental floss, but non-bleeding with probe (n=26); BF-/GBI- were non-bleeding with both methods (n=26). Subsequently, one papilla of each adult participant, with no history of periodontitis, was biopsied and histologically analyzed by a blind examiner. Inflammatory infiltrate analysis in gingival conjunctive tissue (scores 0-3) and percentage of collagen fibers were performed. Significantly higher frequencies of moderate/severe inflammation were observed in BF+/GBI+ (100%) and BF+/GBI- (92.3%) groups compared to BF-/GBI- (0%) and significantly different percentage of collagen fibers between three groups [BF+/GBI+ (40.90±3.68) BF+/GBI- (45.78±4.55) and BF-/GBI- (60.01±36.66)] (P<0.001). Also, non-bleeding contralateral proximal sites with marginal probing (GBI-) and bleeding (BF+) or not (BF-) with dental floss were identified in 49 subjects. After 24-48 hours, volume of gingival crevicular fluid (VGCF) was collected with absorbent paper strips and compared at test (BF+/GBI-) and control (BF-/GBI-) sites. From a total of 172 sites evaluated, test sites had a significantly higher VGCF (Periotron units) than control sites (BF+ 38 [26.5–68] versus BF- 25 [15.7–51.25]; P<0,001, Wilcoxon test). This difference was maintained for both anterior (BF+ 37 [23–66] versus BF- 21 [14– 45], P<0.001, Wilcoxon test) and posterior sites (BF+ 46 [28–92] versus BF- 34 [21– 70], P=0.04, Wilcoxon test). In absence of bleeding after probing, sites with flossing bleeding present significantly greater inflammation than sites with no flossing bleeding. Our results suggest flossing application as a diagnostic method for proximal gingivitis in subjects with no periodontitis history.