What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases / O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes

ABSTRACT Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

RESUMO Manifestações orofaciais ocorrem com frequência nas doenças reumáticas e, comumente, representam sinais iniciais ou de atividade da doença que ainda são negligenciados na prática clínica. Entre as doenças reumáticas autoimunes com possíveis manifestações orais, incluem-se a artrite reumatoide (AR), miopatias inflamatórias (MI), esclerose sistêmica (ES), lúpus eritematoso sistêmico (LES), policondrite recidivante (PR) e síndrome de Sjögren (SS). Sinais e sintomas orofaciais como hipossalivação, xerostomia, disfunções temporomandibulares, lesões na mucosa bucal, doença periodontal, disfagia e disfonia podem ser a primeira expressão dessas doenças reumáticas. Esse artigo revisa as principais manifestações orofaciais das doenças reumáticas que podem ser de interesse do reumatologista, para diagnóstico e acompanhamento das doenças reumáticas autoimunes.

Volume derramado, saturação de oxigênio e frequência cardíaca durante a alimentação de recém-nascidos prematuros: comparação entre dois métodos alternativos de oferta / Spilled volum, oxygen saturation, and heart rate during feeding of preterm newborns: comparison between two alternative feeding methods

RESUMO Objetivo Comparar o uso da seringa e da técnica sonda-dedo para a oferta de dieta a prematuros, considerando-se volume de dieta oferecido e volume derramado, variação da saturação de oxigênio periférico e frequência cardíaca. Métodos Estudo quasi-experimental, com 30 prematuros, 13 do gênero feminino e 17 do masculino. As médias das idades gestacionais ao nascimento e no momento da avaliação (idade corrigida) foram de 33 4/7±4/7 e 36±4/7, respectivamente. Os pesos médios ao nascimento e na avaliação foram de 1.800±140 e 1.972±88 gramas. Foi avaliado um momento de alimentação com a seringa e outro com a sonda-dedo para a mesma criança, sendo caso e controle de si mesma. Utilizou-se oxímetro de pulso portátil para verificar a variação da saturação de oxigênio e a frequência cardíaca. Uma gaze foi colocada sob o queixo do bebê como anteparo da dieta derramada. Foram utilizados os testes ANOVA, t de Student pareado, Comparação Múltipla de Tukey e Correlação de Pearson, com nível de significância de 5%. Resultados Houve diferença para o volume oferecido e para o volume de leite derramado com os dois valores, sendo maiores quando a seringa foi utilizada. A frequência cardíaca foi diferente: antes/durante e antes/depois para ambas as formas de oferta, mas com valores considerados normais, assim como a saturação de oxigênio, que apontou aumento entre os momentos antes e depois da oferta para a seringa. Conclusão A técnica sonda-dedo proporciona menor derramamento da dieta, sendo as variações da saturação de oxigênio e frequência cardíaca consideradas normais para o neonato.

ABSTRACT Purpose To compare the use of syringe and finger feeding to feed preterm newborns considering amount of milk offered, amount of milk spilled, variation of oxygen saturation, and heart rate. Methods Quasi-experimental study with 30 preterm newborns. Thirteen infants were females and 17 were males. The mean gestational age at birth and during evaluation (corrected age) was 33 4/7 ± 4/7 and 36 ± 4/7, respectively. Newborns’ mean birthweight and mean weight when evaluated was 1,800 ± 140 and 1,972 ± 88 grams. We assessed one feeding session using a syringe and another feeding session using the finger feeding technique. Both techniques were used in the same infant, so that the preterm newborns were controls for themselves. A portable pulse oximeter was used to check the variation of oxygen saturation and heart rate. A gauze pad was placed under the infants’ chin to absorb the spilled milk. The statistical tests used were: ANOVA, paired Student’s t test, Tukey Multiple Comparison test, and Pearson Correlation Coefficient. The level of significance was set at 5%. Results We found a difference between the techniques in terms of both amount of milk offered and amount of milk spilled. These amounts were larger when the syringe was used. Heart rate was different at two specific times: before/during and before/after feeding for both techniques. However, the values were within normal limits. Oxygen saturation values were also different, showing higher values after syringe feeding. Conclusions Finger feeding proved to cause less spillage, whereas the variations of oxygen saturation and heart rate were within normal limits.

Efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo em dentes decíduos e permanentes in vivo / Remineralizing effect of casein fosfopeptideo amorphous calcium phosphate in primary and permanent teeth in vivo

O presente estudo in vivo avaliou o efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo (CPP-ACP) tooth mousse em lesões de mancha branca em dentes decíduos e permanentes. Dezoito crianças de 4 a 8 anos apresentaram 81 lesões de mancha branca, as quais foram divididas de maneira randômica. Estas foram tratadas com verniz de flúor 2,26% (controle) e CPP-ACP mousse (teste), duas vezes por semana, durante seis e quatro semanas, respectivamente. Um examinador cego avaliou as lesões de mancha branca no período inicial (T0) e após 3 (T1) e 12 (T2) semanas de tratamento. Os dados de índice de placa visível, índice de sangramento gengival, índice ICDAS foram coletados. Em adição, foram realizadas tomadas fotográficas das lesões em todos os períodos analisados. Os dados foram analisados por testes qui-quadrado e t de Student. Resultados não demonstraram diferença entre os grupos controle e teste durante os períodos, a partir do índice ICDAS (p>0,05). No entanto, a partir do mesmo índice, o grupo teste demonstrou diferença significante entre os períodos analisados (p<0,05). A área das manchas brancas, em pixels, dos grupos controle e teste não demonstrou diferença estatística de cada grupo, em qualquer dos períodos analisados (p>0,05). Dessa forma, concluiu- se que a terapia de remineralização de lesões de manchas brancas foi efetiva em ambos os grupos. No entanto, devido ao número amostral reduzido e o curto período de análise do presente estudo, são necessários maiores esclarecimentos em relação a este efeito.

This in vivo study was conducted to evaluate the remineralization effects of CPP-ACP Tooth Mousse on white-spot lesion in primary and permanent teeth. Eighteen children (age from 4-8) exhibiting 81 white-spot lesions sites were randomly divided into two different treatments protocols: test group received applications of the remineralizing mousse twice a week for six weeks; control group received applications of a 2.26% fluoridated coating once a week for four weeks. A blind examiner evaluated the children at baseline, 3 and 12 weeks after the first visit, recorded visible plaque, gingival bleeding, ICDAS index and photographed the lesions. Data was analyzed with chi-square and Student t-test. According to ICDAS index, the control group was not statistically different from the treated group (p>0.05), in each time. However, results from treated group demonstrated that ICDAS index was statistically different from times (p<0.05). The area of the white spots (in pixels) of samples from control and treated groups were not statistically different from each group in any time (p>0.05). It was concluded that the remineralizing therapy of white spot lesions was efficient in the two groups. Nevertheless, due to the small sample size and the brief time for conducting the study, new research is necessary to increase the findings.

Caries Diagnosis in the Mixed Dentition Using ICDAS II

To assess the dental caries prevalence with ICDAS II in the mixed dentition, 40 children aged 7 to 11 years old, participating in a social program, whose parents and/or guardians signed a informed consent form.Material and Methods:Clinical examination was carried out after brushing. A single researcher performed the examination and the diagnosis consistency was obtained by Kappa coefficient in 12% of the sample. All dental surfaces were examined receiving a two-digit code. The first one refers to the presence of restoration/sealant and the second, the severity of carious lesions. The data was processed at SPSS software version 10.0 and analyzed using descriptive statistics (absolute distribution, percentage, mean and standard deviation). Results:The coefficient intra-examiner agreement was 0,83.Caries prevalence was considered high because 100% of the children had some surface with non-cavitated caries lesion. ICDAS II can be easily transformed to dmf-s or DMF-S without compromising its integrity. For dmf-s/DMF-S decayed surfaces were consideredICDAS codes 3 to 6, resulting in a dmf-s = 6,57 where 11 children (27,5%) presented no decayed deciduous teeth surface. DMF-S = 2,0 showed that 15 children (37,5%) had none decayed permanent surface, determining a underestimation of the caries disease when using dmf-d/dmf-s and DMF-S indexes.Conclusion:A careful viewing of initial caries lesions makes ICDAS II usefull in evaluating the health promotion actions impact, supporting the planning process, implementation and evaluation of program activities...

Prevalence, Etiology and Treatment Needs of Traumatic Dental Injuries in Schoolchildren aged 12 years at Brasília, Brazil

To investigate the prevalence of dental trauma, its causes, sites and age at the occurrence of injuries and treatment needs related to dental trauma in schoolchildren aged 12 years at Brasília, DF, Brazil.Material and Methods:A cross-sectional, population-based study was conducted on a sample of 1,389 schoolchildren of public and private schools. Two questionnaires were used: one targeted to parents/legal caretakers and the other responded by the schoolchildren. The criteria for classification of trauma used in the ChildrenÆs Dental Survey in the United Kingdom were adopted. The examinations were performed by two trained and calibrated examiners (inter and intra-examiner kappa: 0.85 to 1.00). The association between dental trauma and the study variables was evaluated by the chi-square test.Results:A total of 1,445 students were examined, with a response rate of 80.48%. Prevalence of 14.63% (public schools) and 23.40% (private schools) of dental trauma was found...(AU)

The most common cause of dental trauma was fall (7.87%), followed by collision with objects or persons(5.03%), inadequate use of the teeth (2.33%), sports accidents (2.11%) and car accidents (0.66%). It was observed that 256 students presented injury to at least one tooth, with predominance of enamel fracture (88.67%) followed by discoloration (5.47%), enamel and dentin fracture (3.90%) and tooth loss (1.95 %). The teeth most affected by trauma were the maxillary central incisors. The accidents occurred predominantly at home (44.25%) and at the school (26.99%). Only 28.51% had received treatment for the injuries.Conclusion:Dental trauma in the study population was significant, presenting diverse etiology and expressive treatment needs, indicating the importance of preventive programs to inform the population on the possible complications after trauma, as well as the need to follow-up traumatized teeth to avoid subsequent problems...

Evaluation of therapeutic decision for treatment of carious lesions by dental students

Objective: to evaluate the therapeutic decision making for the academic of the last year of dentistry at the universities of the Distrito Federal, on dental caries in deciduous teeth and permanent young. Material and Methods: the evaluation was obtained through the application of a questionnaire containing a diagram representing five different stages of deep carious lesions on interproximal radiographs. Were selected through census of students enrolled last semester of each institution and concluded that the theoretical discipline of pediatric dentistry in accordance with the curriculum offered by the University. Data were analyzed statistically by the chi-square test the 5% level of significance. Results: we analyzed 132 questionnaires of which 30.3% of respondents opted for immediate restorative treatment for the injuries to deciduous teeth in the dentin-enamel junction to the permanent tooth, the percentage rose to 31.1%, revealing that there was similarity between universities about which strategy to use. Regarding caries removal there was a discrepancy in an institution compared the other in choosing the more invasive treatment (p = 0.0014). Conclusion: we see the need to implement teaching strategies for the training of a professional within the philosophy of minimum intervention.

Sialometria: aspectos de interesse clínico / Sialometry: aspects of clinical interest

A saliva total é um complexo de secreções multiglandulares composto de fluido gengival, células epiteliais descamadas, microrganismos, produtos do metabolismo bacteriano, resíduos alimentares, leucócitos, muco da cavidade nasal e da faringe. A saliva possui diversas funções, incluindo reparação tecidual, tamponamento, proteção, digestão, gustação, ação antimicrobiana, manutenção da integridade do dente e sistema de defesa antioxidante. A redução do fluxo salivar (hipossalivação) é um distúrbio comum, e estima-se que cerca de 20% da população geral tenham esta alteração. A hipossalivação pode ser decorrente de diabetes mellitus, hipotireoidismo, desidratação, comprometimento do parênquima glandular por processos infecciosos, doenças granulomatosas ou condições autoimunes e inflamatórias (como a síndrome de Sjögren e a artrite reumatoide), radioterapia da região cefálica e/ou cervical, bem como pode estar associada a distúrbios do humor, efeitos adversos ocasionados pelo uso de algumas medicações ou, ainda, ser de causa idiopática. As terapias convencionais para o tratamento da redução do fluxo salivar, com o uso de sialogogos gustatórios e químicos, ainda apresentam restrições. Contudo, novas alternativas têm mostrado grande perspectiva no tratamento deste problema. Diagnosticar um paciente como hipossalivador crônico é um desafio na prática clínica, e os métodos de avaliação do fluxo salivar são pouco conhecidos pelos reumatologistas. A avaliação seriada do fluxo salivar é importante para o correto diagnóstico e prognóstico de determinadas condições bucais e sistêmicas. Esta revisão aborda alguns aspectos relacionados à função da saliva, às consequências da hipossalivação e aos métodos de medição da taxa de fluxo salivar, conceitos úteis na prática diária do reumatologista.

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Decreased phagocytic function in neutrophils and monocytes from peripheral blood in periodontal disease

Phagocytosis by neutrophils and monocytes constitutes the main defense mechanism against bacterial challenges in periodontitis. Phagocytosis by neutrophils has already been evaluated, whereas phagocytic function of monocytes has hardly been addressed so far. Objectives: The aim of this study was to assess phagocytosis by neutrophils and monocytes in periodontitis. Material and Methods: The sample included 30 subjects with severe periodontitis and 27 control subjects without periodontal disease. The phagocytic index (PhI) was calculated as the mean number of adhered/ingested Saccharomyces cerevisiae per phagocytozing monocyte or neutrophil multiplied by the percentage of phagocytes involved in phagocytosis. Results: A significant reduction in phagocyte functions was observed in individuals with periodontitis. The median of PhI of neutrophils using nonsensitized S. cerevisiae was 3 for the control group, and 1.5 for the periodontitis group (p=0.01, Mann-Whitney test). The median of PhI of monocytes with non-sensitized S. cerevisiae was 26.13 for the control group, and 13.23 for the periodontitis group (p=0.03, Mann Whitney test). The median of PhI of monocytes assessed with sensitized S. cerevisiae was 97.92 for the control group and 60.1 for the periodontitis group (p=0.005, t-test). Conclusion: The data demonstrated a reduction in the function of phagocytes, suggesting a decrease in immune defenses in periodontitis.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.

Transverse measurements of the jaws of patients with a predominance of nose and mouth breathing in children between 6 and 14 years of age / Medidas transversais dos maxilares de pacientes com predominância de respiração nasal e bucal em crianças de 6 a 14 anos

Objectives: To determine and study the occurrence of possible growth and development anomalies of the craniofacial complex in patients aged between 6 and 14, diagnosed with predominantly mouth and nose breathing patterns, and without having received prior dental treatment. Methods: We performed transverse jaw measurements on 103 patients between 6 and 14 years of age, registered for orthodontic treatment in theMilitary Hospital in the Brasilia area. Divided into two groups: Group 1, patients with predominance of nose breathing and Group 2, patientswith predominance of mouth breathing. Results: There were no statistically significant differences between the upper and lower intercanine or upper intermolar distances, between groups 1 and 2. A smaller statistically significant difference was observed in group 2 when evaluating the lower intermolar distance. Conclusion: The group of mouth breathers showed statistically lower values in the lower jaw, thus suggesting a contraction in the posterior arch of patients diagnosed with this breathing pattern.

Objetivos: Verificar e estudar a ocorrência de possíveis anomalias de crescimento e desenvolvimento do complexo craniofacial, de pacientes diagnosticados com o padrão de respiração predominante bucal e nasal, na faixa etária de 6 a 14 anos de idade, sem tratamento ortodôntico prévio.Métodos: Foram realizadas as medidas transversais maxilares em 103 pacientes na faixa etária dos 6 a 14 anos de idade, inscritos para tratamento ortodôntico no Hospital Militar de Área de Brasília. Divididos em dois grupos: 1 pacientes com predominância de respiração nasal e 2 pacientes com predominância de respiração bucal. Resultados: Não foram observadas diferenças estatisticamente significativas entre as distâncias inter-caninos superior e inferior, inter-molares superior, entre os grupos 1 e 2. Foi observada diferença estatisticamente significativa menor no grupo 2 quando avaliada a distância inter-molar inferior. Conclusão: O grupo de pacientes respiradores bucais apresentou valores estatisticamente menores na arcada inferior, sugerindo desta forma uma contração posterior na arcada dos pacientes diagnosticados com este padrão de respiração.

Alterações morfológicas das células de ligamento periodontal após contato com materiais endodônticos / Morphological cell changes at periodontalligament cells after contact with endodontic materiais

Objetivo: O objetivo deste trabalho foi avaliar as alterações volumétricas e a viabilidade dascélulas do ligamento periodontal humano após contato com o extrato de materiais endodônticos. Metodologia: As alterações volumétricas e a viabilidade foram analisadas por citometria de fluxo. As células (6 x 104 células/poço) foram incubadas por 24 horas a 37°C, com extratos dos materiais em duas condições de presa (recém espatulados e após 24 horas de presa). Foram analisados Endo¬fill, Sealer 26, Cimento de Portland Branco e cimento de óxidos bioativos. A extração foi executada em dois períodos distintos (48 e 72 horas para materiais frescos; 72 e 96 horas para materiais com presa inicial de 24 horas). Depois do contato das células com os extratos, as células L de Rodamina 123 e analisadas sob um ~ foram tripsinizadas e incubadas com três comprimentos de onda entre 515-530nm (FL 1). O software CellQuest v 3.0.1 foi utilizado para análise dos dados. A análise esta¬tística foi realizada usando teste ANOVA com três fatores de interação. Resultados: Os resultados e Endofill provocaramademonstraram que os materiais Sealer 26, Sealer acentuada redução vo¬lumétrica (p < 0,0001) das células sugestivas de processo e Cimento de Portland não causaram alterações no potencialaapoptótico. Sealer de membrana mitocondrial das células. Conclusões: Conclui-se que as células do ligamento periodontal sofrem modificação de volume após contato com materiais endodônticos. Quanto à viabilidade, os cimentos endodônticos alteram significati¬vamente as células. Cimento de Portland branco demonstrou os melhores resultados.

Objective: The aims of this study were to evaluate the cell shrinkage at human periodontalligamentcells following contact with endodontic materiais and cell viability. Material and Methods: Cell skrinkage and cell viability were evaluated by observing a loss of cellular volume by flow cytometry. The cells (6 x 104 cells/well) were incubated for 24 hours at 37°(, with material extracts in two conditions (fresh or set stage).The materiais were Endofill, Sealer 26, White Portland cement and bioactive oxide-based endodontic material. The extraction was executed in two distinct time point after mixed (48 e 72 h for fresh material; 72 e 96 h for set stage). After contact, the cells were L rodhamine 123 solution and the emission~harvested and incubated with 3 wavelength was adjusted to 515-530 nm (FU). The CellQuest software v 3.0.1 was used for data analysis. The values obtained were compared using ANOVA with three facto r interactions. Results: Sealer 26, Endofill and a new bioactive oxide-based endodontic material caused significant cell skrinkage (p < 0.0001) that suggest apoptosis. However, new bioactive oxide-based endodontic material and white Portland cement do not cause change the mitochondrial membrane po¬tential. Conclusion: Endodontic materiais can cause cell volume changes. Root canal sealers caused some type of change that decreases the cell viability. The whithe Portland cement showed the best results.

Espectroscopia Atômica Identifica Diferenças nos Parâmetros de Elementos Traço na Saliva de Pacientes Portadores de Fibrose Cística / Atomic Spectroscopy Identifies Differences in Trace Element Parameters in the Saliva of Patients with Cystic Fibrosis

Objetivo: Determinar elementos traço na saliva de indivíduos com fibrose cística.Métodos: Trinta e cinco indivíduos com fibrose cística e trinta e nove indivíduos saudáveis participaram deste estudo. A distribuição de 24 elementos traço na saliva total estimulada foi avaliada por espectrometria de massa com plasma de argônio acoplado indutivamente (ICP-MS), espectrometria de emissão óptica com plasma de argônio acoplado indutivamente (ICP-OES) e espectrometria de absorção atômica (AAS).Resultados: Verificou-se uma diferença significativa na distribuição de elementos traço na saliva de indivíduos com fibrose cística quando comparado a indivíduos sem a doença. Sódio; Potássio; Vanádio; Cromo; Arsênio e Selênio apresentaram valores estatisticamente diferentes entre os grupos, enquanto Alumínio, Boro, Bário, Cadmo, Cobre, Ferro, Mercúrio, Magnésio, Manganês, Níquel, Titânio, Estrôncio e Zinco não apresentaram diferenças significativas entre os grupos. As análises estatísticas indicaram que os elementos Sódio e Potássio apresentaram maiores teores, enquanto que os elementos traço Vanádio, Cromo, Selênio e Arsênio apresentaram menores teores nos indivíduos com fibrose cística.Conclusões: A espectroscopia atômica mostrou um potencial considerável no desenvolvimento de metodologia destinada a detectar a fibrose cística neonatal. A saliva deve ser considerada como material biológico para análise de diagnóstico

Objective: To determine trace elements in the saliva of individuals with cystic fibrosis.Method: Thirty-five individuals with cystic fibrosis and thirty-nine healthy individuals participated in this study. The distribution of 24 trace elements in stimulated whole saliva was evaluated by inductivelycoupled plasma mass spectrometry (ICP-MS), inductively coupled plasma optical emission spectrometry (ICP-OES) and atomic absorption spectrometry (AAS).Results: There was a statistically significant difference in the distribution of trace elements in the saliva of individuals with cystic fibrosis compared with individuals without the disease. Sodium, potassium, vanadium, chromium, arsenic and selenium presented significantly different values between the groups, while no significant differences was found between the groups for aluminum, boron, barium, cadmium, copper, iron, mercury, magnesium, manganese, nickel, titanium, strontium and zinc. Statistical analyses indicated higher contents of the trace elements sodium and potassium and lower contents of the trace elements vanadium, chromium, selenium and arsenic in the individuals with cystic fibrosis.Conclusion: Atomic spectroscopy showed a considerable potential in the development of a methodology to detect a neonatal cystic fibrosis. The saliva should be considered as biological material for diagnostic analysis

Prevalence of dental caries and caries-related risk factors in premature and term children

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75 percent of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.

Perfil da condição bucal de idosas do Distrito Federal / Oral health status of elderly women from the Brazilian Federal District

Os trabalhos realizados no Brasil a respeito das principais afecções bucais dos gerontes mostram situação preocupante. O objetivo deste estudo foi estimar a frequência de edentulismo, analisar o uso e a necessidade de prótese, calcular o índice CPOD e verificar a condição periodontal de idosas residentes no Distrito Federal. Cento e quarenta mulheres com idade igual ou superior a sessenta anos foram examinadas. A condição de cada prótese foi avaliada observando presença de prejuí­zo estético ou funcional. Em seguida, foi realizado exame clínico para detectar a presença de cárie, restaurações e dentes perdidos para cálculo do índice CPOD. O exame periodontal incluiu a verificação do índice de placa visível, índice de sangramento gengival, medidas de profundidade de sondagem clínica, perda de inserção clínica e mobilidade dental de todos os dentes presentes. Os resultados revelaram péssimas condições bucais dos pacientes examinados. A taxa de edentulismo mostrou-se elevada, o índice CPOD foi alto (29,8), com predomínio do componente extraído (87,1 por cento) e a condição periodontal foi considerada grave. A partir destes dados, pode-se concluir que o perfil da condição bucal das idosas representadas neste estudo é precário, o que reflete a necessidade de se elaborar programas de promoção de saúde e de reabilitação para este segmento da população.

Data from Brazilian researches that evaluated oral health of elderly people show a worrisome situation. The purpose of this study was to estimate the frequency of edentulism, analyze both the use and need profiles of prosthesis, calculate the DMFT index and check the condition of periodontal elderly residents in the Federal District. One hundred and forty women aged 60 years or above were examined. The condition of each prosthesis was evaluated to detect the presence of functional or aesthetic damage. Then, clinical examination was carried out to detect the number of decayed, missing or filled teeth in order to calculate the DMFT index. The periodontal examination included the index of visible plaque, bleeding index, measurement of clinical probing depth, measurement of clinical attachment level and teeth mobility. The results showed poor oral conditions of the patients. The rate of edentulism was high, the DMFT index was elevated (29.8) with a predominance of the extracted component (87.1 percent) and periodontal condition was considered severe. From these data we can conclude that the oral condition of elderly represented in this study is precarious and reflects the need for health promotion and rehabilitation programs for this segment of the population.

Use of diagnodent® for diagnosis of non-cavitated occlusal dentin caries

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Avaliação do tratamento intensivo com clorexidina na redução das contagens salivares de estreptococos grupo mutans na fase de dentadura mista / Assessment of chlorhexidine intensive treatment on salivary mutans streptococci during mixed dentition

Introdução - Clorexidina tem demonstrado efetividade na redução das contagens de Estreptococos Grupo Mutans (SM) na saliva e placa dentária. Entretanto, poucos estudos clínicos avaliaram seus efeitos na dentadura mista. O objetivo deste trabalho foi avaliar o tratamento intensivo com clorexidina (gel a 1%) em comparação com o tratamento com flúor fosfato acidulado a 1, 23%, na redução das contagens salivares de SM em crianças ente 5 a 11 anos. Materiais e Métodos - Os participantes receberam tratamento odontológico na clínica de Odontologia Pediátrica do Hospital Universitário de Brasília - (HUB), Brasília - Brasil. Trinta e cinco crianças saudáveis foram alocadas em dois grupos formados por randomização simples (G1 /G2). O Grupo 1 (G1) recebeu seis aplicações de Clorexidina em dois dias consecutivos. O Grupo 2 (G2) recebeu duas aplicações de flúor durante 4 minutos, também em dois dias consecutivos. As contagens salivares foram realizadas através do Kit CARITEST SM - Herpo Produtos Odontológicos - Rio de Janeiro - Brasil, antes do tratamento (baseline) e após 4, 12 e 24 semanas. A análise estatística foi realizada pelo teste de Tukey (p<0,05). Resultados - Os resultados mostraram que somente no G1 as médias das contagens salivares foram significantemente reduzidas (82,14%). Após 24 semanas, houve aumento nas contagens salivares no G2 (não significativo) e tendência à redução nas contagens do G1, em comparação com a baseline. Conclusão - Os resultados permitem concluir que o tratamento intensivo com Clorexidina foi efetivo na redução das contagens salivares de SM durante 4 e 12 semanas após dupla aplicação, havendo, no entanto, retorno aos níveis iniciais ao final de 24 semanas.

Introduction - Chlorhexidine has been shown effective in reducing mutans streptococci (SM) counts in saliva and dental plaque. To date, few studies have compared its effects in mixed dentition children. The aim of the study was to assess the effects of an intensive treatment of 1% Chlorhexidine gel in comparison to a conventional fluoride preventive treatment on MS counts in saliva of children from 5 to 11 years old. Materials and Methods - All the participants received general dental care in the Pediatric Clinic at the Hospital of the University of Brasília - DF, Brazil . Thirty-five healthy children were randomly assigned in 2 groups. Group 1 (G1) received 6 applications of Chlorhexidine in 2 consecutive days. Group 2 (G2) received 2 applications of 1,23% sodium fluoride gel during 4 minutes. The MS salivary counts were determined by CARITEST SM Kit (Herpo Dental Products - Rio de Janeiro - Brazil) at the baseline, prior to treatments, and after 4, 12 and 24 weeks. The data were statistically analyzed by Tukey test (P<0,05). Results - Results showed that in G1 the MS mean counts were significantly reduced by chlorhexidine treatment at 4 and 12 weeks (82, 14%), while the G2 mean counts were not significantly affected. After 24 weeks there was a slight increase in MS counts in G2 (non significant) and a reduction tendency in G1, compared to the baseline counts. Conclusion - It was concluded that chlorhexidine intensive treatment was effective at reducing SM salivary counts during 4 and 12 weeks after double application, however there was a return to the baseline counts after 24 weeks.

Prevalence of dental caries in children born prematurely or at full term

The objective of this study was to evaluate the prevalence of dental caries in 192 children, 96 born prematurely and 96 at full term, in a regional hospital in Brazil. Mean age at clinical examination was 40.72 months in the full-term group (G1) and 30.44 months in the premature group (G2). The children were divided in two age subgroups: 0 to 3 and 4 to 6 years. Statistical results (Student's t and Kruskal-Wallis tests) showed that dmft was 0.43 for G1 and 0.01 for G2 in the 0-3 age subgroup, and 1.7 for G1 and 1.1 for G2 in the 4-6 age subgroup. Differences were significant between G1 and G2 only in the 0-3 age subgroup (p = 0.047). Caries evaluation showed that, of the 96 children in G1, 75 were caries free, while in G2, 84 did not have the disease. These differences were not significant (p = 0.088). The lower mean dmft found in the 0-3 age subgroup in G2 may be attributed to routines established by the hospital's neonatology staff, such as frequent dental visits and preventive instructions about oral habits, oral hygiene and diet. After this age, with the completion of the primary dentition, values increased and became similar between the G1 and G2 groups. Results also suggested a highly skewed distribution since most caries were found in only a small number of children.

O objetivo deste estudo foi avaliar a prevalência da cárie dentária em 192 crianças, 96 nascidas prematuramente e 96 a termo, em um hospital regional no Brasil. A média de idade ao exame clínico foi de 40,72 meses e 30,44 meses para os grupos a termo (G1) e prematuro (G2), respectivamente. As crianças foram divididas em faixas etárias de 0 a 3 e 4 a 6 anos. Os resultados estatísticos (testes t de Student e Kruskal-Wallis) mostraram que, entre 0 a 3 anos, o ceo-d foi 0,43 para o G1 e 0,01 para o G2. Entre 4 e 6 anos, o ceo-d foi 1,7 e 1,1 para G1 e G2, respectivamente. Os resultados foram significativos entre G1 e G2 apenas na faixa etária entre 0 e 3 anos (p = 0,047). A experiência de cárie mostrou que, das 96 crianças do G1, 75 estavam livres de cárie, enquanto que no G2, 84 não haviam tido a doença. Essas diferenças não foram significativas (p = 0,088). Conclui-se que o ceo-d médio menor encontrado no G2 entre 0 e 3 anos pode ser atribuído às freqüentes visitas de rotina e orientações sobre hábitos de higiene oral e dieta, oferecidos pela equipe de neonatologia. Após esta idade, com a dentição decídua completa, os valores aumentaram e se equipararam entre os grupos. Parece que o fenômeno de polarização esteve presente, visto que a experiência de cárie concentrou-se em um reduzido número de crianças.

Defeitos de desenvolvimento do esmalte dentário: relato de casos clínicos / Developmental defects of enamel: cases report

Os desvios da aparência normal do esmalte dentário são, em geral, resultantes de defeitos estruturais oriundos da disfunção de constituintes do órgão do esmalte, em particular das células formadoras do esmalte, ou seja, os ameloblastos. Assim sendo, o aparecimento desses defeitos está relacionado a distúrbios da amelogênese. A formação do esmalte passa por várias fases, iniciando-se por uma fase secretora, em que as células produzem principalmente amelogeninas simutaneamente ao inicio da mineralização, ou seja, a deposição orientada de cristais de hidroxiapatita. Esta fase é seguida pela reabsorção das amelogeninas, criando-se dessa maneira os espaços necessários para o crescimento das longas fitas de hidroxiapatita. Outras proteinas aparecem em seguida, havendo intensa reabsorção de água, fase em que os ameloblastos se modificam e tornam-se especializadas na reabsorção. Esses eventos levam, finalmente, a formação do esmalte maduro, constituído por aproxidamente 96% de minera.

Abnormalities of dental enamel are developmental defects arising from dysfunction of constituents of the enamel organ, in particular of ameloblasts, during amelogenesis. Enamel defects are observed in deciduous and permanent dentitions and are associated with a variety of local factors and systemic diseases. The purpose of this study was to review recent literature on the subject and to present two clinical cases. Thus, our observations, together with the literature, confirm that infections, nutritional problems, genetic factors, and preterm babies are more likely to be associated with enamel defects. The general dental practioner must therefore be aware of all the possibilities for a correct diagnosis and treatment.

Assessment of treatment for functional posterior cross-bites in patients at the deciduous dentition phase

O objetivo deste estudo foi avaliar clinicamente o resultado do tratamento das mordidas cruzadas posteriores de origem funcional, através de desgaste seletivo, em indivíduos na fase de dentição decídua, durante o período de 12 meses. Foram examinadas 1011 crianças, com idades entre 2 e 6 anos, selecionando-se 26 indivíduos que apresentavam mordida cruzada posterior funcional. A amostra foi dividida em 2 grupos de 13 crianças cada, sendo o grupo 1 o que recebeu o tratamento proposto e o grupo 2 servindo como controle. Após o tratamento, foram realizados exercícios com o objetivo de modificar a memória muscular da criança. Os resultados possibilitaram constatar que houve correção da mordida cruzada posterior funcional em todas as crianças tratadas, ocorrendo estabilidade da correção após 12 meses. O grupo controle não apresentou nenhum caso de autocorreção da maloclusão.

Morphological alterations of the parotid gland of rats maintained on a liquid diet

Esse trabalho teve por objetivo analisar as alterações morfológicas das glândulas parótidas de ratos submetidos a uma dieta líquida. Trinta e seis animais foram divididos aleatoriamente em dois grupos. O grupo controle recebeu dieta sólida, e o grupo experimental recebeu dieta líquida. Os animais foram sacrificados 8, 15 e 30 dias após o início da experimentação. As glândulas foram incluídas em parafina e analisadas no microscópio de luz. Os resultados mostraram uma redução estatisticamente significante no peso das glândulas parótidas dos animais do grupo experimental quando comparado aos dos animais do grupo controle nos períodos de 15 e 30 dias. A alteração morfológica mais importante foi a evidenciação de vacúolos no citoplasma das glândulas parótidas dos animais alimentados com dieta líquida. Os vacúolos citoplasmáticos reagiram negativamente às técnicas de coloração específicas para glicoproteínas e mucopolissacarídeos (PAS e Alcian blue). Concluiu-se que a dieta líquida causou atrofia das glândulas parótidas nos períodos experimentais de 15 e 30 dias.