Outpatient dental procedures carried out by Pediatric Dentists within Brazil's public healthcare system

Abstract Brazil's public healthcare system (SUS) offers specialized oral health services to Brazilians, but the productivity of specialists, such as Pediatric Dentists, has not been characterized. Therefore, the objective of this study was to characterize the outpatient dental procedures (ODPs) carried out by Pediatric Dentists within the SUS. An epidemiological study with an ecological, longitudinal, retrospective, and quantitative approach was conducted. The ODPs carried out by Pediatric Dentists within the SUS were characterized based on type of procedure, complexity level, and circumstance (urgent or elective). Data were analyzed using a descriptive and analytical approach, considering a significance level of 5%, as well as the impact of the COVID-19 pandemic (the 2020-2022 years were not included in secondary analyses). In the last 15 years, 29,234,972 ODPs were carried out by Pediatric Dentists within the SUS. Clinical procedures were the majority (55.4%), significantly more frequent than all other types of procedures (all p <0.05). Among these, restorative and periodontal procedures were the most common (30.7% and 21.0%, respectively). From 2008 to 2019, excluding COVID-19 pandemic years, the trend over the last 15 years was constant for all types of procedures (all p >0.05). In addition, low complexity ODPs were the majority (90.1%), significantly more frequent than medium (9.7%) and high complexity procedures (0.1%) (both p <0.05). At last, most ODPs were not characterized by circumstance in the outpatient production reports (96.9%). Therefore, it was possible to conclude that Pediatric Dentists carried out diverse ODPs within the SUS over the past 15 years, although there was a dominant pattern of type and complexity.

Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion

Abstract Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Resumo Pacientes ortodônticos geralmente desenvolvem desmineralização e apresentam lesões de cárie após seis meses de tratamento. Procedimentos minimamente invasivos têm sido o objetivo na prática odontológica moderna. O objetivo deste estudo foi avaliar o efeito do ClinproTM XT selante ionomérico, ao redor do bráquete, com relação a rugosidade superficial do esmalte e a severidade da lesão induzida. Vinte pré-molares foram submetidos a colagem de bráquetes e indução experimental de desmineralização e divididos aleatoriamente em 2 grupos: GI - verniz fluoretado (Colgate Duraphat®); GII - Selante Ionomérico (ClinproTM XT). O tratamento foi aplicado ao redor dos bráquetes. A rugosidade da superfície dos espécimes foi analisada, antes do tratamento e 12 semanas após o tratamento por microscopia confocal a laser e severidade da lesão de mancha branca por dispositivo de fluorescência a laser. Os dados foram analisados pelo teste não paramétrico de Wilcoxon e Mann-Whitney, a 5% de significância. A taxa de redução da lesão foi calculada. A severidade da desmineralização diminuiu tanto no GI (p = 0,005) quanto no GII (p = 0,019). Os níveis de rugosidade superficial do esmalte diminuíram no GI e GII, assim como o percentual de rugosidade, sendo mais expressivo no grupo ClinproTMXT (85,09%). Colgate Duraphat® e Clinpro™ XT reduziram a severidade da desmineralização e diminuíram a rugosidade superficial do esmalte. O selante ionomérico Clinpro™ XT foi superior na redução percentual de rugosidade.

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features: An immunohistochemical study

The microscopical diagnosis of radicular cyst (RC) is straightforward; nonetheless, in some cases with unusual histopathological features, strict clinicopathological correlation is necessary to achieve the correct diagnosis. We report a case of a 5-year-old girl was referred presenting extensive carious lesion in the tooth #55, associated with vestibular sinus tract. Medical history revealed allergic asthma diagnosis. After clinical and imagi-nological exams, the deciduous tooth was extracted. Microscopically, the soft tissue lesion attached to the root showed typical RC features; however, in the cystic capsule, lymphoid follicles and vascular networks (lined by epithelioid endothelial cells) surrounded by nu-merous eosinophils, were observed. Immunohistochemistry, through CD3, CD20, CD34 and alpha-smooth muscle actin antibodies, highlighted these findings. Moreover, CD1a and CD207 were negative. To the best of our knowledge, this is the first report of RC showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features. (AU)

Activation of gelatinases in permanent human teeth after different experimental radiotherapy protocols

Abstract The objective of this study was to compare the activation of gelatinases in dentin-enamel junction (DEJ) and underlying dentin of permanent teeth after experimental radiotherapy in conventional and hypofractionated modalities. Newly extracted third molars (n = 15) were divided into three experimental radiotherapy groups: control, conventional (CR), and hypofractionated (HR) (n = 5 per group). After in vitro exposure to ionizing radiation, following standardized protocols for each modality, a gelatinous substrate was incubated on the tooth slices (n = 10 per group). Activation of gelatinases was measured by in situ zymography, expressed in arbitrary fluorescence units (mm2) from three tooth regions: cervical, cuspal, and pit. Fluorescence intensity was compared among radiotherapy protocols and tooth regions in each protocol, considering a significance level of 5%. Considering all tooth regions, the fluorescence intensity of the CR group was higher than the HR and control groups, both in DEJ and underlying dentin (p <0.001). In addition, the fluorescence intensity was higher in underlying dentin when compared to DEJ in all groups (p <0.001). Considering each tooth region, a statistically significant difference between CR and HR was only observed in the pit region of underlying dentin (p <0.001). Significant and positive correlations between fluorescence intensities in DEJ and underlying dentin were also observed (p <0.001). Experimental radiotherapy influenced the activation of gelatinases, as well as exposure to the conventional protocol can trigger a higher activation of gelatinases when compared to hypofractionated, both in DEJ and underlying dentin.

Resumo O objetivo deste estudo foi comparar a ativação de gelatinases na junção dentina-esmalte (DEJ) e na dentina subjacente de dentes permanentes após a radioterapia experimental nas modalidades convencional e hipofracionada. Os terceiros molares recém-extraídos (n = 15) foram divididos em três grupos de radioterapia experimental: controle, convencional (CR) e hipofracionada (HR) (n = 5 por grupo). Após a exposição in vitro à radiação ionizante, seguindo protocolos padronizados para cada modalidade, um substrato gelatinoso foi incubado nas fatias de dente (n = 10 por grupo). A ativação das gelatinases foi medida por zimografia in situ, expressa em unidades arbitrárias de fluorescência (mm2) de três regiões do dente: cervical, cúspide e fossa. A intensidade da fluorescência foi comparada entre os protocolos de radioterapia e as regiões do dente em cada protocolo, considerando um nível de significância de 5%. Considerando todas as regiões do dente, a intensidade de fluorescência do grupo CR foi maior do que a dos grupos HR e controle, tanto no DEJ quanto na dentina subjacente (p <0,001). Além disso, a intensidade da fluorescência foi maior na dentina subjacente quando comparada à DEJ em todos os grupos (p <0,001). Considerando cada região do dente, uma diferença estatisticamente significativa entre CR e HR foi observada apenas na região da fossa da dentina subjacente (p <0,001). Também foram observadas correlações significativas e positivas entre as intensidades de fluorescência no DEJ e na dentina subjacente (p <0,001). A radioterapia experimental influenciou a ativação das gelatinases, assim como a exposição ao protocolo convencional pode desencadear uma maior ativação das gelatinases quando comparada ao hipofracionamento, tanto no DEJ quanto na dentina subjacente.

Caries-related hospital morbidity in the Brazilian Unified Health System from 2008 to 2022

Abstract Dental caries is an important Public Health issue. However, the treatment of this disease in tertiary dental care requires further investigation. Therefore, the objective of this study was to evaluate caries-related hospital morbidity in the Brazilian Unified Health System (SUS) from 2008 to 2022. An ecological study was conducted with secondary data on caries-related Hospital Admission Authorizations (AIH) and in-hospital dental procedures (IDP). Data were collected nationwide and statistical analysis was performed with a significance level (p) of 5%. In the last 15 years, 3,474 caries-related AIH and 63,657 IDP were approved within SUS. There was a significant upward trend in the number of caries-related AIH (p = 0.018) and a stationary trend in the number of caries-related IDP (p = 0.841). Moreover, from 2008 to 2022, R$ 1,160,843.09 was allocated for caries-related AIH. Hospital mortality was 0.29% (10 deaths), and 75.1% were elective inpatient admissions. Among SUS users, adults constituted the majority (49%), with a higher frequency of males (59.8%) and whites (46.2%). The most frequent type of caries-related IDP was restoration of permanent teeth (55.3%). Nonetheless, during the COVID-19 pandemic years, significant reductions in caries-related AIH and IDP within the SUS were observed (all p <0.05). Thus, within the SUS, caries-related tertiary dental care has shown a specific pattern over the last 15 years, including an increase in hospitalizations and a high number of in-hospital dental procedures, especially before the COVID-19 pandemic onset.

Subcutaneous tissue reaction and gene expression of inflammatory markers after Biodentine and MTA implantation

Abstract The aim of this study was to evaluate the subcutaneous connective tissue response of isogenic mice exposed to tricalcium silicate (Biodentine) and aggregated mineral trioxide (ProRoot MTA). A total of 120 mice were divided into 4 groups in 3 different experimental periods (7, 21 and 63 days): Biodentine; Pro-Root MTA; zinc oxide-eugenol and; Negative control - Sham. After the experimental periods microscopic descriptive, semi-quantitative and quantitative analysis of the inflammatory process were analyzed on H&E sections and evaluation of the gene expression of Il10, Infg, Il6, Il1r1 and Tnf (qRT-PCR) were performed. The data obtained were analyzed using the chi-square test and two-way analysis of variance (ANOVA) followed by the Bonferroni post-test (5% significance level). Results: In the microscopic analysis, a slight inflammatory infiltrate was observed, with a predominance of sparse macrophages and polymorphonuclear cells, slight tissue fibrosis, regular fibrous capsule and with dystrophic calcifications, in all groups that received the materials (Biodentine and Pro-Root MTA). In parallel, all materials modulated the gene expression of the different cytokines and receptors evaluated. Conclusion: Pro-Root MTA and Biodentine showed a tissue compatibility, mediated inflammation, with increased fibrous tissue and production of pro- and anti-inflammatory cytokines.

Resumo Objetivo: Avaliar a resposta do tecido conjuntivo subcutâneo de camundongos isogênicos expostos à Biodentine™ e ao Trióxido Mineral Agregado (MTA). Métodos: Um total de 120 camundongos foram divididos em 4 grupos e 3 períodos experimentais diferentes (7, 21 e 63 dias): Biodentine™ (Septodont, Saint Maur des Fosses, França); Pro-Root MTA (Dentsplay, Tulsa, EUA); óxido de zinco eugenol (Biodinâmica Química e Farmacêutica LTDA., Ibiporã, PR - Brasil); e controle negativo - Sham. Após os períodos experimentais, análises microscópicas descritivas, semiquantitativas e quantitativas do processo inflamatório foram analisadas nos cortes de H&E e ainda, foi realizada a avaliação da expressão gênica de Il10, Infg, Il6, Il1r1 e Tnf (qRT-PCR). Os dados obtidos foram analisados por meio do teste do qui-quadrado e da análise de variância (ANOVA) two-way, seguido do pós-teste de Bonferroni (nível de significância de 5%). Resultados: Na análise microscópica observou-se discreto infiltrado inflamatório, com predomínio de macrófagos esparsos e polimorfonucleares, leve fibrose tecidual, cápsula fibrosa regular e com calcificações distróficas, em todos os grupos que receberam os materiais (Biodentine ™ e Pro-Root MTA). Paralelamente, todos os materiais modulam a expressão gênica das diferentes citocinas e receptores avaliados. Conclusão: Pro-Root MTA e Biodentine™ mostraram compatibilidade tecidual, inflamação mediada, com aumento do tecido fibroso e produção de citocinas pró- e antiinflamatórias.

Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic

Abstract: In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

Online teaching, quality of life and anxiety of Brazilian dental professors during the COVID-19 outbreak

Abstract: The COVID-19 pandemic led to changes in academic teaching and dental education, but the impact on dental professors' mental health and quality of life remains poorly understood. Thus, the objective of this study was to evaluate the impacts of social distancing and online teaching related to COVID-19 on the quality of life and anxiety of Brazilian dental professors. This was a cross-sectional study conducted from August 2020 to October 2020. Three instruments were used in an online version: a questionnaire about personal data, academic information and online teaching activities, the Generalized Anxiety Disorders 7 (GAD7) scale, and the Abbreviated World Health Organization Quality of Life (WHOQOL-bref) scale. All instruments were sent by e-mail, social media, and messaging apps to private and public universities and professors. Of the 318 responses, 187 (58.8%) were from female professors. Moreover, lack of good internet access and adequate place for online teaching, difficulties in producing teaching materials, and housework roles had a significant impact on the quality of life and anxiety scores (all p-values < 0.05). Also, Brazilian dental professors who declared that they would make greater efforts if the activities were face-to-face had significantly worse quality of life and anxiety scores, and female professors had significantly higher anxiety scores (all p-values < 0.05). These results provide evidence of a negative effect of social distancing and online teaching activities related to COVID-19 outbreak on the health-related quality of life and mental health of Brazilian dental professors.

Apical Periodontitis Healing Following Treatment is Impacted by Root Canal Sealer Composition: An in Vivo and in Vitro Investigation

Abstract Objective: To evaluate the periapical healing following root canal treatment in teeth with apical periodontitis (in vivo) and the cytotoxic potential of root canal sealers in vitro. Material and Methods: Apical periodontitis was induced in 60 dogs' teeth and root canals were filled with Sealapex (40 roots), EndoREZ (40 roots), intracanal dressing (20 roots), or left untreated (20 roots). After 30 and 90 days, histopathological analyses were made. In vitro, J774.1 macrophages were stimulated with root canal sealers extracts, cytotoxicity was assessed using lactate dehydrogenase assay, and qRT-PCR was used to analyze TNF-α gene expression. Results: In vivo, smaller apical periodontitis and lower inflammatory cell infiltrate were found in teeth treated with Sealapex compared to EndoREZ. In vitro, EndoREZ was cytotoxic and induced TNF-α gene expression by macrophages differently from Sealapex. Conclusion: Sealapex allowed improved tissue repair following root canal treatment in teeth with apical periodontitis compared to EndoREZ. Synthesis of TNF-α induced by LPS was enhanced by EndoREZ, whereas Sealapex prevented pro-inflammatory gene expression (AU).

M1 and M2 macrophages phenotypes modulation after stimuli with materials used in endodontic treatment

Abstract The aim of this study was to evaluate the M1 and M2 macrophage modulation after stimuli with different materials used during endodontic treatment. In bone marrow-derived macrophage cell culture, from males C57BL/6 wild-type (WT) mice, gene expression analysis of markers to M1 and M2 macrophages was performed by qRT-PCR (Cxcl10, CxCL9, iNOS, Arg1, Chil3, Retnla and MRC1) and cytokine quantification by Luminex® (GM-CSF, IL-10, IL-6, IL-1β and TNF-α) after exposure to the five endodontic sealers: AH Plus, Sealapex Xpress, Endosequence BC Sealer, BioRoot RCS and a calcium hydroxide-based paste. For normal values, ANOVA test was used, followed by Tukey post-test. For non-normal values, the Kruskall-Wallis test was used. BioRootTM RCS and EndoSequence BC SealerTM stimulated the highest expression of markers for M1 macrophages, while calcium hydroxide-based paste stimulated the lowest expression of these gene markers. For M2 protein markers, BioRootTM RCS presented the highest stimulation while calcium hydroxide-based paste also presented the lowest stimulation. It was concluded that all the evaluated filling materials increased the genetic expression of pro- and anti-inflammatory markers: TNF-α and IL-10 respectively. The others proinflammatory mediators showed differences against the filling materials. However, this process did not induce the inflammatory response polarization, resulting in a hybrid macrophage.

Resumo O objetivo deste estudo foi avaliar a modulação dos macrófagos M1 e M2 após estímulos com diferentes materiais utilizados durante o tratamento endodôntico. Em cultura de células de macrófagos derivados da medula óssea de camundongos machos C57BL/6 wild-type (WT), após a exposição à cinco cimentos endodônticos: AH Plus, Sealapex Xpress, Endosequence BC Sealer, BioRoot RCS e pasta à base de hidróxido de cálcio foi realizada a análise da expressão gênica dos marcadores para macrófagos M1 e M2 por qRT-PCR (Cxcl10, CxCL9, iNOS, Arg1, Chil3, Retnla e MRC1) e quantificação de citocinas por Luminex® (GM -CSF, IL-10, IL-6, IL-1β e TNF-α). Para valores normais, foi utilizado o teste ANOVA, seguido do pós-teste de Tukey. Para valores não normais, foi utilizado o teste de Kruskall-Wallis. BioRootTM RCS e EndoSequence BC SealerTM estimularam maior expressão de marcadores para macrófagos M1, enquanto a pasta à base de hidróxido de cálcio estimulou expressão mais baixa desses marcadores gênicos. Para o marcador de proteínas para M2, BioRootTM RCS apresentou a maior estimulação, enquanto a pasta à base de hidróxido de cálcio também apresentou menor estimulação. Concluiu-se que os materiais obturadores avaliados aumentaram a expressão genética de marcadores pró- e anti-inflamatórios: TNF-α e IL-10 respectivamente. Os demais marcadores pró inflamatórios mostraram diferenças em relação aos materiais obturadores. No entanto, esse processo não induziu a polarização da resposta inflamatória, resultando em um macrófago híbrido.

Múltiplas lesões dentárias em paciente com Síndrome de Lennox-Gastaut / Multiple dental lesions in a patient with Lennox-Gastaut Syndrome

Introdução: A Síndrome de Lennox-Gastaut (SLG) é uma encefalopatia epiléptica grave na infância. Seu tratamento é complexo, principalmente devido à multiplicidade das crises epilépticas, o que favorece à ocorrência de lesões dentais Objetivo: O objetivo deste relato é apresentar o manejo clínico de um paciente com SLG, vítima de traumas recorrentes, discutir os achados dentais observados e o tratamento odontológico realizado. Relato do caso: Paciente L.H.D.L., do sexo masculino, com 15 anos de idade, apresentando grande acúmulo de biofilme dental, alto risco de cárie, fluorose leve e gengivite generalizada. Clinicamente foi possível observar fratura de esmalte dos dentes 12 e 14. Os dentes 21, 22, 32 e 42 estavam ausentes clinicamente, o que se confirmou radiograficamente. Além disso, notou-se giroversão de 180 graus do dente 11, com a face palatina voltada para a vestibular. O dente apresentou-se com leve alteração de cor, mas com resposta positiva aos testes de vitalidade. Resultados: Técnicas de manejo de comportamental, foram adotadas e orientações quanto à higiene bucal e dietéticas foram fornecidas tanto ao paciente quanto ao seu cuidador. Quatro sessões de profilaxia e aplicação tópica de flúor foram realizadas semanalmente. O tratamento endodôntico foi realizado no dente 12, seguido da restauração de resina composta do dente 12 e 14 e a restauração estética do dente 11 (girovertido). Por fim, foi realizada uma prótese adesiva para restaurar a estética da região de incisivo central superior. Apesar das dificuldades para tratar pacientes com SLG, no presente caso foi possível obter resultados funcionais e estéticos satisfatórios com um diagnóstico e tratamento cuidadoso, envolvendo uma equipe multiprofissional treinada no atendimento de pacientes com necessidades especiais. Conclusão: Pode-se concluir que o cirurgião dentista deve estar familiarizado com as possíveis manifestações bucais da SLG e realizar uma pesquisa criteriosa de sinais de traumatismo dental e, sempre que possível, solicitar um exame radiográfico para que traumatismos não identificados ao exame clínico não passem desapercebidos.

Introduction: Lennox-Gastaut Syndrome (LSG) is a severe childhood epileptic encephalopathy. Its treatment is complex, mainly due to the multiplicity of epileptic crises, which in turn favors the occurrence of dental injuries. Objective: The aim of this case report is to present the clinical management of a patient with LGS, victim of recurrent trauma, discuss the observed dental findings and the dental treatment. Case report: Patient L.H.D.L., male, 15 years old presenting high quantity of oral biofilm, mild fluorosis and generalized gingivitis. Clinically, it was possible to observe enamel fractures of teeth 12 and 14. Teeth 21, 22, 32 and 42 were clinically absent, which was confirmed radiographically. In addition, a 180-degree rotation of tooth 11 was noted, with the palate facing the buccal aspect. The tooth presented a slight change in color, but with a positive response to vitality tests. Results: Behavioral management techniques were adopted and guidelines on oral hygiene and diet were provided to both the patient and their caregiver. Four sessions of prophylaxis and topical application of fluoride were performed weekly. Endodontic treatment was performed on tooth 12, followed by aesthetic restoration of teeth 12 and 14 and esthetic restoration of tooth 11 (rotated). Finally, an adhesive prosthesis was performed to restore the esthetics of the upper central incisor region. Despite the difficulties of treating patients with LGS, in the present case it was possible to obtain satisfactory functional and aesthetic results with a careful diagnosis and treatment, involving a multidisciplinary team trained in the care of patients with special needs. Conclusion: It can be concluded that the dental surgeon must be aware with the possible oral manifestations of GLS and carry out a careful search for signs of dental trauma and, whenever possible, request a radiographic examination so that unidentified traumas on clinical examination do not pass unnoticed.

Tratamento odontológico de paciente com Síndrome de Singleton-Merten / Dental treatment of a patient with Singleton-Merten Syndrome

Introdução: A Síndrome de Singleton-Merten (SMS) é uma doença autossômica dominante hereditária rara caracterizada por alterações cardiovasculares, ósseas e dentais, pouco discutida na literatura em relação ao tratamento odontológico. Objetivo: O objetivo do presente estudo foi relatar o caso de uma paciente com SMS, descrevendo seus aspectos bucais e o plano de tratamento proposto, em conjunto com uma equipe multiprofissional. Relato do caso: Durante a anamnese constatou-se que o paciente apresentava alterações cutâneas decorrentes da síndrome. Os exames clínico, radiográfico e tomográfico revelaram maxila e mandíbula parcialmente edêntulas, ampla reabsorção do osso maxilar, além da maioria dos dentes permanentes incluídos e com raízes curtas. O plano de tratamento multidisciplinar incluiu a extração de dentes com formação radicular deficiente, tração ortodôntica dos caninos superiores incluídos e a confecção de próteses parciais superiores e inferiores removíveis, para reabilitação das funções mastigatória, fonética e estética. Conclusão: É importante ressaltar que durante o atendimento odontológico de pacientes com SMS, deve-se considerar o estado geral de saúde anterior, principalmente em relação às possíveis complicações cardiovasculares existentes, e a necessidade de reabilitação destes pacientes, por apresentarem perda dentária extensa.

Intoduction: Singleton-Merten Syndrome (SMS) is a rare in herited autosomaldominant disorder. Characterized by cardiovascular, bone and dental alterations, little discussed in the literature regarding dental treatment. Objective: The aim of this study was to report the case of a patient with SMS, describing her oral aspects and the proposed treatment plan, together with a multidisciplinary team. Case report: During the anamnesis it was found that the patient has alterations due to the syndrome. Clinical, radiographic and tomographic examinations revealed partially edentulous maxilla and mandible, wide resorption of maxillary bone, in addition to most of the permanent teeth included and with short roots. The multidisciplinary treatment plan included the extraction of teeth with deficient root formation, orthodontic traction of the included upper canines and the making of removable upper and lower partial dentures, for rehabilitation of masticatory, phonetic and aesthetic functions. Conclusion: It is important to emphasize that during dental care of patients with SMS, the previous general state of health should be considered, especially in relation to possible existing cardiovascular complications, and the need for rehabilitation of these patients, since they will present extensive tooth loss.

Web search trends related to oral health issues during the Covid-19 outbreak in Brazil: an infodemiological survey

Objective: To compare the web search trends related to oral health issues during the COVID-19 outbreak with the previous year, focusing on dental trauma (DT), bruxism (BX) and toothache (TA). Methods: It was an infodemiological study carried out using Google Trends tool. Popular terms related to oral health issues investigated were used in Portuguese to retrieve relative search volumes (RSV) normalized by the algorithm. The case period consisted of data relating to the interval from December 12, 2019 to December 12, 2020, while the control period referred to the interval from December 11, 2018 to December 11, 2019. Results: Within the case and control periods, popular terms related to TA were significantly more searched on the web, followed by BX and DT terms (all p-value <0.05). There were higher RSV for all popular terms related to oral health issues investigated during the COVID-19 outbreak than in the previous year (all p-value <0.05), especially in the third and fourth quarters. The mean frequencies were significantly higher in the case period for all oral health issues (all p-value <0.05). Conclusion: In Brazil, it was possible to observe that the web search trends related to oral health issues investigated were greater during the COVID-19 outbreak than in the previous year.

Objetivo: Comparar as tendências de pesquisa na web relacionadas a problemas de saúde bucal durante o surto de COVID-19 com o ano anterior, com foco em trauma dentário (TD), bruxismo (BX) e dor de dente (DD). Métodos: Foi um estudo infodemiológico realizado com a ferramenta Google Trends. Termos populares relacionados aos problemas de saúde bucal investigados foram usados ​​em português para recuperar os volumes relativos de pesquisa (RSV) normalizados pelo algoritmo. O período do caso consistiu em dados referentes ao intervalo de 12 de dezembro de 2019 a 12 de dezembro de 2020, enquanto o período de controle referiu-se ao intervalo de 11 de dezembro de 2018 a 11 de dezembro de 2019. Resultados: Nos períodos de caso e controle, os termos populares relacionados à DD foram significativamente mais pesquisados ​​na web, seguidos pelos termos BX e TD (todos os valores de p<0.05). Houve maior RSV para todos os termos populares relacionados aos problemas de saúde bucal investigados durante o surto de COVID-19 do que no ano anterior (todos os valores de p<0,05), especialmente no terceiro e quarto trimestres. As frequências médias foram significativamente maiores no período do caso para todos os problemas de saúde bucal (todos os valores de p<0,05). Conclusão: No Brasil, foi possível observar que as tendências de buscas na web relacionadas aos problemas de saúde bucal investigados foram maiores durante o surto de COVID-19 do que no ano anterior.

Photosensitizers and exposure times to light showed tissue compatibility in isogenic mice / Fotossensibilizadores e tempo de exposição a luz em relação a compatibilidade de tecidos em ratos isogênicos

Objective: The aim of this study was to evaluate the subcutaneous tissue response after different protocols to photodynamic therapy (PDT). In Phase 1, were tested the diode laser (used for 1min) associated to the photosensitizer phenothiazine chloride solution (PCS) in different concentrations. In Phase 2 ­ the diode laser and LED were tested associated to two different photosensitizers, PCS and Curcumin, in different exposure times of light application. Material and Methods: After 7, 21 and 63-days the animals were euthanized and the subcutaneous tissue processed to histological analysis. Qualitative and semi-quantitative descriptions of the inflammatory process and immunohistochemical technique were performed. The obtained data were analyzed by Kruskal-Wallis and Dunn's post-test (α= 0.5). Results: On Phase 1, the tissue response was very similar among the groups. For the inflammatory infiltrate, PCS with concentration of 10mg/mL exhibited the most intense reaction (p > 0.05). On Phase 2, at 7-days period, the analyzed parameters presented small magnitude and after 21 and 63-days, all the parameters demonstrated tissue compatibility. Conclusion: Both photosensitizers presented proper tissue compatibility regardless the different concentrations used on Phase 1 and different durations of light exposure on Phase 2 (AU)

Objetivo: Este estudo avaliou a resposta do tecido subcutâneo após terapia fotodinâmica, utilizando na Fase 1 - laser diodo por 1min e solução fotossensibilizadora de cloreto de fenotiazina (CF) em diferentes concentrações e Fase 2 - laser diodo e LED e dois fotossensibilizadores, CF e Curcumina, em diferentes tempos de exposição da aplicação de luz. Material e Métodos: Após 7, 21 e 63 dias, foram realizadas descrições qualitativas e semiquantitativas do processo inflamatório e técnica de imunoistoquímica. Os dados foram analisados pelo pós-teste de Kruskal-Wallis e Dunn (α = 0,5). Resultados: Na Fase 1, a resposta do tecido foi muito semelhante. O infiltrado inflamatório, na concentração de 10 mg / mL, exibiu reação mais intensa (p > 0,05). Na Fase 2, aos 7 dias, os parâmetros analisados apresentaram pequena magnitude. Aos 21 e 63 dias, todos os parâmetros demonstraram compatibilidade com o tecido. Conclusão: Ambos os fotossensibilizadores apresentaram compatibilidade de tecido adequada, independentemente das diferentes concentrações utilizadas na Fase 1 e diferentes durações de exposição à luz na Fase 2 (AU)

Evaluation of microbial contamination and efficacy of antimicrobial agents in disinfection of handicapped patients' toothbrushes

This study aimed to evaluate the contamination of toothbrushes usedby patients with disabilities, by microbial culture and cariogenic biofilm formation,and to explore two methods of disinfection. Methods: Experimental procedures were divided into three stages, with the same interval between each stage. In the first stage, the patients brushed their teeth, rinsed them with water, and their toothbrushes were sprayed with sterilized tap water. In the second and third stages, the steps were similar to those of Stage I, except the toothbrushes were sprayed with 0.12% chlorhexidine and 0.05% cetylpyridinium chloride solutions, respectively. At the end of each stage, the toothbrush bristles were cultured in bacitracin sucrose broth (CaSaB) medium. Data were analyzed through Friedman's nonparametric test (5% significance level). Results: In Stage I, mutans group streptococci (MS) were present in 30 toothbrushes (76.9%), and the number of colonies/biofilms ranged from 0 to +100. In Stage II, no MS colonization was observed. In Stage III, only 10.2% of the toothbrushes were contaminated with MS, and the number of colonies/biofilms ranged from 1 to 31. Conclusion: Bristles of toothbrushes used by patients with disabilities became contaminated with MS after a single brushing. The 0.12% chlorhexidine solution eliminated all microorganisms from the bristles of the toothbrushes used by the patients. Both 0.12% gluconate chlorhexidine and 0.05% cetylpyridinium chloride spray solutions can effectively be used for toothbrush disinfection to reduce contamination.

Objetivo: O presente estudo teve como objetivo avaliar a contaminação de escovas de dente utilizadas por pacientes especiais, por meio de cultura microbiana e formação de biofilme cariogênico, explorando dois métodos de desinfecção. Métodos: O estudo foi dividido em três estágios, com o mesmo intervalo de tempo entre cada estágio. No primeiro estágio, os pacientes escovaram os dentes e enxaguaram com água, em seguida, suas escovas foram borrifadas com água destilada. No segundo e terceiro estágios, as etapas foram semelhantes às do estágio I, exceto que as escovas de dente foram borrifadas com soluções de clorexidina 0,12% e cloreto de cetilpiridínio 0,05%, respectivamente. Ao final de cada etapa, as cerdas das escovas de dente foram cultivadas em meio de Caldo Sacarose Bacitracina (CaSaB). Os dados foram analisados por meio do teste não paramétrico de Friedman (nível de significância de 5%). Resultados: No estágio I, os estreptococos do grupo mutans (EM) estavam presentes em 30 escovas de dente (76,9%), e o número de colônias / biofilmes variou de 0 a +100. No estágio II, nenhuma colonização por MS foi observada. No estágio III, apenas 10,2% das escovas de dente estavam contaminadas com MS, e o número de colônias / biofilmes variou de 1 a 31. Conclusão: As cerdas das escovas de dente utilizadas por pacientes especiais contaminaram-se com EM após uma única escovação. A solução de clorexidina 0,12% eliminou todos os microrganismos das cerdas das escovas de dente utilizadas pelos pacientes. Ambas as soluções em spray (gluconatode clorexidina 0,12% e cloreto de cetilpiridínio 0,05%) podem ser utilizadas com eficácia para desinfecção das escovas de dente para reduzir a contaminação.

Association between P561T polymorphism in growth hormone receptor gene and mandibular prognathism: systematic review and metaanalysis

Objective: Through a systematic review and meta-analysis, the aim this study was evaluating the association between the P561T polymorphism in GHR (rs6184) with skeletal Class III malocclusion in different populations. Methods: A broad search for studies was conducted using the databases: PubMed, Web of Science, Scopus, Cochrane, Google Scholar and Open Grey until December 2018. The study design according to PECOS was: P-Orthodontic patients; E- polymorphism P561T in GHR; C- absence of polymorphism P561T in GHR; O- linear dimension alterations in maxilla and mandibular measurements; S- Cross-sectional studies. The selected studies were qualified by 10-point scoring sheet methodological quality. The subgroups evaluation was performd according to the linear measurements evaluated in two or more studies, as follows: body height, N-S, A'-PTM', Gn-Go, Pog'-Go, and Co-Go.A fixed effect model was used and the mean differences were performed using the inverse-variance meta-analysis. The I2 (95%) was used to measure statistical heterogeneity between studies, where I2 values of 25%, 50%, and 75% signified low, medium, and high heterogeneity, respectively. Results: The initial search identified 146 studies. After excluding duplicate abstracts, 138 were selected. Seven studies were included in the systematic review. Only one study was classified as having low methodological quality. Three studies were included in the meta-analysis. The meta-analysis demonstrated an association between the Co-Go linear measure and CC genotype (p<0.0001), with a mean difference and confidence interval of 3.79 [2.06, 5.52]. CC was associated with greater mandibular height. Conclusion: The polymorphism P561T in GHR is associated with Co-Go measurement in Asians, with low level of evidence.

Objetivo: Por meio de uma revisão sistemática e meta-análise, o objetivo deste estudo foi avaliar a associação entre o polimorfismo P561T em GHR (rs6184) com a maloclusão de Classe III esquelética em diferentes populações. Métodos: Uma ampla pesquisa de estudos foi realizada utilizando os bancos de dados PubMed, Web of Science, Scopus, Cochrane, Google Scholar e Open Grey até dezembro de 2018. O desenho do estudo de acordo com o PECOS foi: P-Pacientes ortodônticos; Polimorfismo P561T em GHR; Causência de polimorfismo P561T em GHR ; O-alterações na dimensão linear das medidas maxilares e mandibulares; S- Estudos transversais. Os estudos selecionados foram qualificados pela qualidade metodológica em uma escala de 10 pontos. A avaliação emsubgrupos. O subgrupo foi realizada de acordo com as medidas lineares avaliadas em dois ou mais estudos, como a seguir: altura corporal, N-S, A'-PTM ', Gn-Go, Pog'-Go. Foi utilizado o modelo de efeito fixo e as diferenças médias foram realizada usando a metanálise de variância inversa. O I2 (95%) foi utilizado para medir heterogeneidade estatística entre estudos, em que valores de I2 de 25%, 50% e 75% significaram baixa, média e alta heterogeneidade, respectivamente. Resultados: A pesquisa inicial identificou 146 estudos. Após excluir resumos duplicados, 138 foram selecionados. Sete estudos foram incluídos na revisão sistemática. Apenas 1 estudo foi classificado como de baixa qualidade metodológica. Três estudos foram incluídos na meta-análise. A metaanálise demonstrou uma associação entre a medida linear Co-Go e o genótipo CC (p<0,0001), com diferença média e intervalo de confiança de 3,79 [2,06; 5,52]. CC foi associado com maior altura mandibular. Conclusão: O polimorfismo P561T em GHR está associado à medida Co-Go em asiáticos, com baixo nível de evidência.

Pulpal and periapical response of dogs' teeth after pulpotomy and use of enamel matrix derivative as a capping agent

Objective: To evaluate the pulpal and periapical response of dogs' teeth after pulpotomy and use of Enamel Matrix Derivative (EMD) as capping agent. Methods: Pulpotomy was performed in 40 teeth from 4 dogs and the remaining pulp tissue was recovered with the following materials: Groups I and IV: EMD (Emdogain®); Groups II and V: calcium hydroxide; Groups III and VI: zinc oxide and eugenol cement. After 7 days (Groups I, II, and III) and 70 days (Groups IV, V, and VI), the animals were euthanized and the teeth were removed and processed for histological analysis; were analyzed using Kruskal-Wallis test followed by Dunn test or Mann Whitney test ( =0.05). Results: 7-day period: in Group I, it was observed a mild to moderate inflammatory infiltrate and intense vascular proliferation while Group II presented a mild inflammatory infiltrate and an intact pulp tissue (p < 0.05). Group III presented a moderate to severe inflammatory infiltrate. 70- day period: Groups IV and VI showed no dentin bridge formation, the remaining pulp tissue presented necrotic areas with inflammatory cells in the periapical region and bone and cementum resorption (p > 0.05). In Group V, there was dentin bridge formation, absence of inflammation and absence of mineralized tissue resorption (p < 0.05). Conclusion: EMD as a capping material after pulpotomy did not show either satisfactory tissue response or capacity of inducing deposition of mineralized tissue in dental pulp.

Objetivo: Avaliar a resposta pulpar e periapical de dentes de cães após pulpotomia e uso de Derivados de Matriz de Esmalte (EMD) como agente de capeamento. Métodos: A pulpotomia foi realizada em 40 dentes de 4 cães e o tecido pulpar remanescente foi recuperado com os seguintes materiais: Grupos I e IV: EMD (Emdogain®); Grupos II e V: hidróxido de cálcio; Grupos III e VI: cimento de óxido de zinco e eugenol. Após 7 dias (Grupos I, II e III) e 70 dias (Grupos IV, V e VI), os animais foram eutanásiados e os dentes foram removidos e processados para análise histológica; foram analisados pelo teste de Kruskal-Wallis, seguido pelo teste de Dunn ou Mann Whitney ( = 0,05). Resultados: Período de 7 dias: no Grupo I, observou-se infiltrado inflamatório leve a moderado e intensa proliferação vascular, enquanto o Grupo II apresentou infiltrado inflamatório leve e tecido pulpar intacto (p <0,05). O grupo III apresentou infiltrado inflamatório moderado a grave. Período de 70 dias: os grupos IV e VI mostraram, na formação da ponte de dentina, que o tecido pulpar remanescente apresentava áreas necróticas com células inflamatórias na região periapical, reabsorção óssea e de cemento (p> 0,05). No Grupo V, houve formação de ponte de dentina, ausência de inflamação e ausência de reabsorção tecidual mineralizada (p <0,05). Conclusão: O EMD como material de cobertura após pulpotomia não mostrou resposta tecidual satisfatória ou capacidade de induzir deposição de tecido mineralizado na polpa dentária.

In vivo evaluation of inflammation and matrix metalloproteinase expression in dental pulp induced by luting agents in dogs

Objectives: To evaluate the inflammatory tissue response and matrix metalloproteinase (MMP)-2 and -9 expression in the pulp-dentin complex in response to RelyX TM Unicem (RU) and Ketac Cem TM Easymix (KC) cements. Methods : Class V cavities were prepared in 56 teeth from six dogs, and indirect pulp capping was performed using RU (n=20), KC (n=20), zinc oxide, and eugenol cement (control, n=16). At 7 and 70 days following indirect pulp capping, the animals were euthanized, and tissues were removed for histological evaluation. The distance from the cavity floor to the odontoblastic layer was measured, and the numbers of inflammatory cells, fibroblasts, and odontoblasts were counted in pulp tissue. MMP-2 and -9 expression levels were immunohistochemically assessed. Statistical analyses were performed for all experiments (significance level=5%). Results : The dentin remnant thickness between the cavity floor and the pulp chamber was similar for all materials, ranging from 469 to 739 µm (p>0.05). At 7 days, KC and RU induced a small inflammatory response in the pulp-dentin complex, similar to the control (p>0.05). At 70 days, RU induced a tissue response characterized by fewer odontoblasts and more mononuclear cells (p<0.05), whereas KC induced a response similar to the control (p>0.05). Lutingagents induced low levels of MMP-2 and MMP-9 expression, similar to the control (p>0.05). Conclusion : KC and RU luting agents are compatible materials for use in deep cavities close to dental pulp tissue, although RU led to a slightly diminished odontoblastic population with a higher percentage of mononuclear cells.

Objetivo : Avaliar a resposta tecidual inflamatória e a expressão de metaloproteinase de matriz (MMP) -2 e -9 no complexo polpa-dentina em resposta aos cimentos RelyX TM Unicem (RU) e Ketac Cem TM Easymix (KC). Métodos : Cavidades classe V foram preparadas em 56 dentes de seis cães, e capeamento pulpar indireto foi realizado com cimento de RU (n = 20), KC (n = 20), óxido de zinco e eugenol (controle, n = 16). Aos 7 e 70 dias após o capeamento pulpar indireto, os animais foram eutanasiados, e os tecidos foram removidos para avaliação histológica. A distância entre o assoalho da cavidade e a camada odontoblástica foi medida, e os números de células inflamatórias, fibroblastos e odontoblastos foram contados no tecido pulpar. Os níveis de expressão de MMP-2 e -9 foram avaliados por imuno-histoquímica. Análises estatísticas foram realizadas para todos os experimentos (nível de significância = 5%). Resultados : A espessura da dentina remanescente entre o assoalho da cavidade e a câmara pulpar foi semelhante para todos os materiais, variando de 469 a 739 µm (p> 0,05). Aos 7 dias, KC e RU induziram uma pequena resposta inflamatória no complexo polpa-dentina, semelhante ao controle (p> 0,05). Aos 70 dias, a RU induziu uma resposta tecidual caracterizada por menos odontoblastos e mais células mononucleares (p <0,05), enquanto o KC induziu uma resposta semelhante ao controle (p> 0,05). Os agentes cimentantes induziram baixos níveis de expressão de MMP-2 e MMP-9, semelhantes ao controle (p> 0,05). Conclusão : Os agentes cimentantes KC e RU são materiais compatíveis para uso em cavidades profundas próximas ao tecido da polpa dentária, embora a UR tenha levado a uma população odontoblástica levemente diminuída, com maior porcentagem de células mononucleares.

Bone callus formation is highly disrupted by dietary restriction in growing rats sustaining a femoral fracture

Abstract Purpose: To evaluate the effects of food restriction on fracture healing in growing rats. Methods: Sixty-eight male Wistar rats were assigned to two groups: (1) Control and (2) Dietary restriction. After weaning the dietary restricted animals were fed ad libitum for 42 days with 50% of the standard chow ingested by the control group. Subsequently, the animals underwent bone fracture at the diaphysis of the right femur, followed by surgical stabilization of bone fragments. On days 14 and 28 post-fracture, the rats were euthanized, and the fractured femurs were dissected, the callus was analyzed by dual-energy X-ray absorptiometry, micro-computed tomography, histomorphometry, mechanical tests, and gene expression. Results: Dietary restriction decreased body mass gain and resulted in several phenotypic changes at the bone callus (a delay in cell proliferation and differentiation, lower rate of newly formed bone and collagen deposition, reductions in bone callus density and size, decrease in tridimensional callus volume, deterioration in microstructure, and reduction in bone callus strength), together with the downregulated expression of osteoblast-related genes. Conclusion: Dietary restriction had detrimental effects on osseous healing, with a healing delay and a lower quality of bone callus formation.

Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants

Abstract Objectives: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this in vivo study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. Methodology: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). Results: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). Conclusions: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure.