Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives: Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods: A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results: No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion: PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia. .

Efeito citotóxico dos cimentos de ionômero de vidro em cultura celular / Cytotoxic effect of glass ionomer cements in cell culture

Objetivo: Avaliar a toxicidade de cimentos de ionômero de vidro (CIV) quimicamente ativados em culturas de células, após aglutinação do material e reação de presa. Materiais e Métodos: Dividiu-se os materiais em 9 grupos experimentais: I: controle, li (AP) Riva Self Cure (SOl), 111 (PP) Riva Self Cure (SOl), IV (AP) Maxxion R (FGM), V (PP) Maxxion (FGM), VI (AP) Vitro Molar (DFL), VII (PP) Vitro Molar (OFL), VIII (AP) KetacMolar Easymix, IX (PP) Ketac Molar Easymix (3M!ESPE). Manipularam-se os CIV conforme instruções do fabricante sendo depositados em laminulas em contato com a cultura de células logo após a aglutinação do material e após a reação de presa. A ação dos materiais sobre os fibroblastos cultivados foi analisada sobre o crescimento celular no curto, longo prazo e no ensaio de viabilidade e proliferação celular. Resultados: Grupos que receberam materiais após a presa apresentaram número de células viáveis e porcentagens menores que o grupo controle, porém permitiram crescimento celular durante todo experimento. Quando colocados em contato com as células logo após a aglutinação, induziram morte celular imediata. O material que demonstrou menor atividade citotóxica em fibroblastos foi o Ketac- Molar Easymix (3M!ESPE). Conclusão: Todos os CIV testados apresentaram-se tóxicos antes da reação de presa, entretanto após a reação de presa, permitiram crescimento celular

Aim: The aim of the present study was to assess the toxicity of different chemically activated GICs in fibroblast cell cultures post-agglutination (PA) and post-setting reaction (PS). Material and Methods: The materiais were divided into nine experimental groups: Group I - control; Group li (PA) - Riva Self Cure (SOl); Group 111 (PS) - Riva Self Cure (SOl); Group IV (PA) - Maxxion R (FGM); Group V (PS) - Maxxion (FGM); Group VI (PA) - Vitro Molar (OFL); Group VII (PS) - Vitro Molar (OFL); VIII (PA) - Ketac Molar Easymix; and Group IX (PS) - Ketac Molar Easymix (3M! ESPE). The cements were mixed following the manufacturers' instructions, deposited on glass slip covers and placed into contact with the cell cultures immediately following the agglutination of the material or after the setting reaction. The effect of the materiais on the cultivated fibroblasts was analyzed in terms of short-term and long-term cell growth as well as in viability and cell proliferation assays. Results: When placed in contact with the cells immediately follo- wing agglutination, the materiais caused immediate cell death. The groups having received the materiais following the setting reaction had a lower number and percentage of viable cells in comparison to the control, but the materiais allowed cell growth throughout the experiment. KetacMolar Easymix (3M!ESPE) was the glass ionomer cement with the least amount of cytoto- xic activity on fibroblasts. Conclusion: Ali glass ionomer cements tested were toxic prior to the setting reaction.However after setting reaction, allowed cell growth

Efficacy of Papacarie¯ in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial

OBJECTIVES: The aim of the present study was to analyze the efficacy of Papacarie¯ gel compared with the traditional method (low-speed bur) in reducing the counts of total bacteria, Lactobacillus, total Streptococcus and Streptococcus mutans group. METHODS: A randomized, controlled clinical trial with a split-mouth design was performed. The sample comprised 40 deciduous teeth in 20 children (10 males and 10 females) aged four to seven years. The teeth were randomly allocated to two groups: G1, or chemomechanical caries removal with Papacarie Duo¯, and G2, or the removal of carious dentin tissue with a low-speed bur. Infected dentin was collected prior to the procedure, and the remaining dentin was collected immediately following the removal of the carious tissue. Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units (CFUs) of each microorganism studied. ClinicalTrials.gov: NCT01811420. RESULTS: Reductions were found in the numbers of total bacteria, total Streptococcus and Streptococcus mutans group following either of the caries removal methods (p<0.05). A reduction was also noted in the number of Lactobacillus CFUs; however, this difference did not achieve statistical significance (p>0.05). CONCLUSION: Papacarie¯ is an excellent option for the minimally invasive removal of carious tissue, achieving significant reductions in total bacteria, total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method. .

Assessment of chemomechanical removal of carious lesions using Papacarie Duo ™: Randomized longitudinal clinical trial.

Background: Chemomechanical removal of carious lesions consists of the dissolution of carious tissue by the application of a natural or synthetic agent, followed by atraumatic mechanical removal. Aim: The aim of the present study was to assess the effectiveness of Papacarie Duo® gel in the chemomechanical removal of carious lesions in primary teeth in comparison to the traditional method (low-speed bur). Settings and Design: A randomized clinical trial was conducted with 20 children between 5 and 8 years of age. Materials and Methods: Two teeth were treated in each child (split-mouth design), with the randomization of two methods: Group 1 – chemomechanical caries removal with Papacarie Duo™; and Group 2 – removal of carious dentin tissue using a low-speed bur. Both methods involved restoration with glass ionomer cement and follow up. The following aspects were evaluated: time required for the procedure; pain (face evaluation scale); rtention of the restorative material in the cavity; and the presence of secondary caries after 30 days. Statistical Analysis Used: Chi-squared test, Student’s t-test, and Wilcoxon test. Results: No statistically significant differences between methods were found regarding time required for the procedure (P = 0.13), the occurrence of pain (P = 0.585), or restoration status at the 30-day clinical evaluation (P = 0.713). Conclusion: The findings of the present study demonstrate that the two methods achieve similar results. The advantages of minimally invasive treatment, such as chemomechanical caries removal with Papacarie Duo™, are its ease of use, patient comfort, and the fact that it causes less damage to dental tissue.

Tratamento de cárie proximal com infiltrante de resina em paciente adolescente / Treatment of proximal caries with resin infiltration in an adolescent patient

Este artigo apresenta um relato de caso de um paciente de 12 anos de idade, atendido em clínica de odontopediatria de instituição privada de odontologia. Mancha branca foi detectada na mesial do dente 16 durante o exame oral e foi confirmada através de radiografia bitewing. Tratamento microinvasivo da cárie foi realizado utilizando o Icon® (DMG). Verificação radiológica foi feita após 12 meses de acompanhamento e nenhuma lesão foi observada no dente tratado. Esse caso demonstra que o tratamento microinvasivo é uma alternativa viável para cáries proximais.

This article presents a case report of a twelve-year-old female patient treated at a pediatric clinic of a private school of dentistry. A mesial bright spot was detected on tooth 16 during the oral examination and confirmed by a bitewing x-ray. Micro-invasive treatment of caries was carried out using Icon® (DMG). A radiological check was made at the 12-month follow up and no lesion was observed in the treated tooth. This case report demonstrates that micro-invasive treatment is a viable alternative for proximal caries.

Correção de erupção passiva alterada por meio de cirurgia plástica periodontal / Correction of altered passive eruption by periodontal plastic surgery

Vários aspectos influenciam nas características do sorriso, tais como: linha mediana, posicionamento dental, linha do sorriso e características gengivais. A erupção passiva alterada é uma condição que interfere na estética do sorriso, por originar coroas clínicas curtas e estar associada ao sorriso gengival. Este trabalho relata um caso clínico de paciente do sexo feminino com erupção passiva alterada que, devido às suas características, interferia na harmonia do sorriso, sendo corrigida pela técnica de gengivectomia com bisel interno associada à osteotomia. A queixa da paciente estava relacionada à estética do seu sorriso, devido à diferença no tamanho das coroas clínicas dos elementos anteriores e excessiva exposição gengival na região. Após o diagnóstico de erupção passiva alterada tipo 1B na face vestibular do elemento 11, seu tratamento consistiu na realização de gengivectomia com incisão de bisel interno. Após 12 meses, pôde-se observar que o resultado almejado foi alcançado sem necessidade de cirurgias adicionais. Concluiu-se que a técnica de gengivectomia mostra-se eficaz para a correção e o restabelecimento da harmonia do sorriso, em casos de erupção passiva alterada associada apenas ao posicionamento coronário do tecido gengival em relação à junção cemento-esmalte.

Clinical status of permanent first molars in children aged seven to ten years in a Brazilian rural community

Aim: To evaluate the clinical status of permanent first molars and associations with dental caries, gingival bleeding, dental fluorosis and malocclusion. Methods: An observational study wascarried out in a rural community denominated Morro do Saboó in the city of São Roque, state of São Paulo, Brazil. A total of 194 children aged seven to ten years were examined for dental caries using the index proposed by the World Health Organization. Other conditions were determined using the Gingival Alterations Index, Dean’s Index and Dental Aesthetic Index. The chi-squared test was used for the statistical analysis of the data. Results: A total of 85.5% of the sample exhibited gingival bleeding and 69.9% exhibited malocclusion. A total of 53.6% had a clinical aspect of normality with regard to dental fluorosis. There was a predominance of sound teeth in the upper arch and teeth with carious lesions in the lower arch. No significant differences were found between sexes regarding gingival bleeding, dental fluorosis or malocclusion. Significant associations were found between tooth status and oral alterations (gingival bleeding, malocclusion and fluorosis) in teeth 16, 26 and 46 and between tooth status and gingival bleeding in tooth 36 (p<0.001). Conclusions: Caries activity in the permanent first molars was mainly associated with dental fluorosis and malocclusion. Strategies aimed at health promotion should be adopted on a large scale to minimize the prevalence of oral diseases.

Remoción quimico-mecánica de lesión de caries en diente permanente con Papacárie Duo(TM): reporte de un caso / Chemomechanical removal of carious lesion in a permanent tooth with Papacárie Duo(TM): report of a case

Este trabajo tiene como objetivo presentar el protocolo clínico de Papacárie Duo(TM), desde el diagnóstico de la lesión de caries hasta el procedimiento restaurador. Una paciente femenina de 12 años de edad se presentó a la consulta odontopediátrica por dolor al frío y durante la ingesta de alimentos dulces. El examen clínico y radiográfico reveló caries en la pieza 46, clasificada como score 6, según el sistema ICDAS (cavidad extensa con exposición de la dentina). La conducta clínica consistió en la eliminación del tejido infectado por medio de la remoción quimico-mecánica de la caries utilizando el gel a base de papaína y restauración con ionómero vítreo. Se concluye, a partir de este protocolo, que la eliminación quimico-mecánica de la lesión de caries es un método de fácil aplicación basdado en la odontología mínimamente invasiva.

Gender as risk factor for mouth breathing and other harmful oral habits in preschoolers

Aim: To analyze associations between the mouth-breathing pattern and other harmful oral habits among preschoolers. Methods: An observational, cross-sectional study was carried out involving 198 children from 3 to five 5 of age. A questionnaire, clinical evaluation and specific tests (mirror and water tests) were used for confirmation of the mouth-breathing pattern. Results: Mean age of the participants was 4.13 ± 0.8 years and 57.1% were male. A total of 87.4% exhibited one or more harmful oral habits. Harmful habits were more common in the male gender (61.8%); this association was statistically significant (p<0.001). Mouth breathing was the most prevalent habit (49%), followed by biting/sucking on objects (33.3%). Regarding gender, statistically significant associations were found for bottle feeding (p=0.02) and nail biting (p=0.02). Mouth breathing was associated with biting on object (p=0.00), pacifier use (p=0.02) and thumb sucking (p=0.00). Conclusions: The results of the present study suggest that mouth breathing is significantly associated with biting/sucking on objects, pacifier use and thumb sucking in preschoolers and that the occurrence of harmful oral habits is more prevalent among the male gender. Early diagnosis and intervention should be established in order to avoid future consequences involving the orofacial region.

Impacto da terapia de suporte nas alterações otológicas em pacientes com desordem temporomandibular / Impact of supportive therapy for otological changes in patients with temporomandibular joint disorders

JUSTIFICATIVA E OBJETIVOS: As queixas de sintomas otológicos podem estar associadas a quadros de disfunção temporomandibular (DTM). A placa miorrelaxante é uma alternativa de tratamento para a DTM, pois oferece oclusão ideal para o paciente, atuando nos sintomas de dor. Considerando as características conservadoras e reversíveis da terapia de suporte com placa miorrelaxante, o objetivo deste estudo foi avaliar seu impacto na frequência de alterações otológicas em pacientes com DTM. MÉTODO: Realizou-se estudo de intervenção em 35 pacientes com sintomas otológicos associados à DTM. Foram considerados portadores de DTM aqueles que apresentassem pelo menos três sinais e três sintomas da morbidade, sendo um deles otalgia, zumbido, sensação de hipoacusia, sensação de plenitude auricular ou tontura. Os pacientes foram submetidos a exame clínico, orientações e confecção de placa miorrelaxante maxilar em resina acrílica termoplastificável. Ajustes da placa e avaliação dos sintomas foram realizados quinzenalmente. Utilizou-se o teste Exato de Fisher para análise estatística da diferença entre a prevalência de sinais e sintomas antes (AN) e após (AP) a terapia, com nível de significância de 5% (p < 0,05). RESULTADOS: Dezenove pacientes concluíram o tratamento. Observou-se redução na prevalência de sinais e sintomas otológicos: zumbido (AN = 14; AP = 6; p = 0,009), otalgia (AN = 13; AP = 4; p = 0,003), sensação de plenitude auricular (AN = 12; AP = 4; p = 0,006), tontura (AN = 11; AP = 4; p = 0,009) e de hipoacusia (AN = 10; AP = 2; p = 0,001). CONCLUSÃO: A placa miorrelaxante é uma terapia conservadora e reversível que mostrou ser capaz de melhorar os sintomas otológicos associados à DTM.

BACKGROUND AND OBJECTIVES: Otological symptoms complaints may be associated to temporomandibular joint disorders (TMJD). Occlusal splint is an alternative to treat TMJD because it provides ideal occlusion to patients, acting on painful symptoms. Considering the conservative and reversible characteristics of supportive therapy with occlusal splints, this study aimed at evaluating its impact on the frequency of otological changes in TMJD patients. METHOD: An intervention study was carried out with 35 patients with TMJD-associated otological symptoms. TMJD patients were considered those with at least three signs and three symptoms of morbidity, being one of them earache, tinnitus, sensation of hypoacusis, ear fullness or dizziness. Patients were submitted to clinical evaluation, orientations and fabrication of maxillary occlusal splint in thermoplastic acrylic resin. Splint adjustments and symptoms evaluation were performed fortnightly. Fisher Exact test was used for statistical analysis of the prevalence of signs and symptoms before (BE) and after (AF) therapy with significance level of 5% (p < 0.05). RESULTS: Nineteen patients have finished the treatment. There has been decrease in the prevalence of otological signs and symptoms: tinnitus (BE = 14; AF = 6; p = 0.009), earache (BE = 13; AF = 4; p = 0.003), ear fullness (BE =12; AF = 4; p = 0.006), dizziness (BE = 11; AF = 4; p = 0.009) and hypoacusis (BE = 10; AF = 2; p = 0.001). CONCLUSION: Occlusal splint is a conservative and reversible therapy able to improve TMJD-related otological symptoms.

Associação entre paralisia facial de Bell e disfunção temporomandibular: manejo clínico / Bell?s palsy and temporomandibular disorder association: clinical treatment

Objetivo: O objetivo deste artigo é relatar o caso clínico de um paciente do gênero masculino, de 29 anos de idade, atendido na Clínica da Dor de uma instituição de ensino superior, diagnosticado como portador de paralisia facial de Bell e desordem temporomandibular, bem como de descrever a conduta terapêutica adotada. Relato de caso: O paciente relatava como queixa principal dor contínua e localizada, no lado direito da face, na região da articulação temporomandibular (ATM), com início há dois anos e piora durante os movimentos de abertura bucal e a mastigação. Apresentava ainda prurido, lacrimejamento, zumbido e parestesia. O quadro da paralisia de Bell do tipo periférica, previamente diagnosticado, caracterizou-se pela impossibilidade de oclusão voluntária das pálpebras do lado direito, paralisia dos mús culos orbiculares da boca, risório e bucinador. Associado a essa patologia, o paciente recebeu o diagnóstico de disfunção temporomandibular do tipo mialgia mediada centralmente. A conduta terapêutica adotada foi terapia oclusal, farmacoterapia, fisioterapia, fonoaudiologia e laserterapia. Após duas semanas o paciente obteve melhora significativa do quadro doloroso e estabilização da desordem muscular. Quanto à função motora do nervo facial, pequeno ganho foi observado na mímica facial do paciente. Considerações finais: A conduta terapêutica mostrou-se satisfatória e o paciente está em acompanhamento na instituição.

Tumor odontogênico cístico calcificante com proliferação ameloblastomosa em seio maxilar / Calcifying cystic odontogenic tumor with ameloblastoma proliferation in the maxillary sinus

O tumor odontogênico cístico calcificante (TOCC) com proliferação ameloblastomosa é uma variante rara entre os cistos maxilares. Este trabalho objetiva apresentar o relato clínico de um paciente do sexo masculino, 18 anos de idade, que apresentava aumento de volume extra e intraoral do lado esquerdo da maxila, firme à palpação, de característica normocrômica e indolor. A conduta consistiu em realização de tomografia Cone Beam, biópsia incisional, remoção completa da lesão, curetagem e fixação maxilar. O paciente encontra-se em acompanhamento clínico e radiográfico sem recidiva após doze meses. Dessa forma, ressalta-se a importância do diagnóstico precoce, a conduta clínica empregada e o acompanhamento periódico.

Calcifying cystic odontogenic tumors (CCOT) with proliferative ameloblastoma are a rare variant among maxillary cysts. This study aims to present a clinical report of an 18-year-old male patient with extra and intra oral swelling of the left maxilla, firm to touch, with normochromic characteristics and painless. The clinical approach comprised cone-beam tomography, incisional biopsy, complete removal of the lesion, curettage and maxilla fixation. His clinical and radiographic follow-up has revealed no relapse after 12 months. Hence, this study corroborates the importance of early diagnosis, clinical approach and periodical follow-ups.

Manifestações orais da infecção simultânea pelo toxoplasma gondii e citomegalovírus: relato de caso / Oral manifestations of simultaneous infection with toxoplasma gondii and cytomegalovirus: a case report

Este trabalho objetiva apresentar o relato de um paciente, sexo masculino, leucoderma, com 59 anos de idade, que compareceu a Cínica de Estomatologia de Instituição Pública de Ensino Superior. O paciente tinha como queixa principal o aparecimento de úlceras na região de lábio superior e inferior, cavidade nasal e asa do nariz, associado a dor, queimação local e febre. Ao exame físico observou-se vesículas, áreas ulceradas com a presença de crostas sobre algumas lesões e linfoadenopatia submandibular bilateral...

This study reports a case of a 59-years-old caucasian male who seeked the Stomatology Clinic of a school of dentistry at a public university. The pacient's chief complaint was the emergence of ulcers in the upper lip and lower nasal cavity and nasal wings, associated with pain, localized burned skin and fever. On physical examination, vesicles, ulcerated areas with some scab lesions, and bilateral sub-mandibular lymphadenopathy were noted...

Laser de baixa potência no tratamento da síndrome da ardência bucal: relato de caso clínico / Low-level laser in the treatment of the burning mouth syndrome: a clinical report

A Síndrome da Ardência Bucal é uma afecção intra-oral dolorosa complexa caracterizada pela sensação de queimação da mucosa bucal. Este trabalho objetiva apresentar o relato de uma paciente, sexo feminino, 87 anos de idade, leucoderma que compareceu ao o serviço de Estomatologia de Universidade pública de ensino superior em Odontologia do Rio de Janeiro - RJ com a queixa de queimação em língua há um ano sem nenhum fator iniciador, porém com aumento da intensidade ao consumir alimentos ácidos e ao longo do dia. Na anamnese referiu não apresentar desordens metabólicas ou fazer uso de medicamentos e no exame físico não foram observadas alterações orais que justificassem o quadro de ardência. A hipótese diagnóstica foi de síndrome da ardência bucal, confirmada através da ausência de achados clínicos e de alterações nos exames sorológicos solicitados. A conduta consistiu em aplicações de laser de baixa potência de forma pontual e em varredura na língua durante dois meses (15 sessões), período em houve estabilização do quadro, e remissão significativa do sintoma (escala visual analógica inicial = 8 e final = 2). Desta forma, o laserterapia mostrou-se uma alternativa terapêutica eficaz no tratamento deste caso de Síndrome da Ardência Bucal e ressalta-se a importância da exclusão de outras morbidades antes de concluir o diagnóstico desta entidade.

The Burning Mouth Syndrome is complex and painful intra-oral affection characterised by burning sensation of oral mucosa. This study is aimed at reporting a case of a 87-year-old Caucasian female patient who attended the stomatology service, at a public university in Rio de Janeiro, complaining that her tongue was "burning" for more than one year despite the absence of a cause, although such a sensation worsened during consumption of acid food as well as over the day. In the anamnesis, she reported no metabolic disorders or use of medications, and no oral alteration explaining such burning symptoms was observed on clinical examination. The diagnostic hypothesis was burning mouth syndrome, which was confirmed because of the absence of both clinical findings and serological changes in the exams. The procedure consisted of applying low-level laser on the tongue in punctual and scanning modes during two months (15 sessions), period in which the clinical picture become stable and significant remission of the symptom was observed (initial and final analogical visual scales = 8 and 2, respectively). In this way, laser therapy was shown to be an efficient therapeutic alternative in the treatment of the present case of Burning Mouth Syndrome, thus emphasising the importance of ruling out other morbidities prior to considering the diagnosis of this condition.