Dental care for patients with special needs at a private higher education institute / Atendimento odontológico a pacientes com necessidades especiais em uma instituição privada de ensino superior

Objetivo: Pacientes com necessidades especiais são aqueles indivíduos que necessitam de cuidados especiais por tempo indeterminado ou por toda a vida. O presente estudo tem como objetivo abordar o atendimento odontológico de pacientes com necessidades especiais em uma instituição privada de ensino superior da cidade de São Paulo. Material e Métodos: Foi realizado um estudo descritivo, retrospectivo, para análise de 210 prontuários odontológicos de pacientes com necessidades especiais atendidos no Departamento de Odontologia para Pacientes Especiais da Universidade Cruzeiro do Sul entre 2012 e 2018. Dados sobre sexo, idade, diagnóstico da condição debilitante, motivo da consulta, uso continuado de medicamentos, imagens radiográficas e tratamentos odontológicos prestados foram todos coletados e posteriormente submetidos à análise estatística descritiva e inferencial (teste do qui-quadrado) ao nível de significância de 5%. Resultados: Quanto aos tipos de procedimentos odontológicos avaliados no presente estudo, dos 210 pacientes, 24% necessitaram de tratamentos curativos dentários em que a terapia periodontal foi o tipo mais prevalente, enquanto os tratamentos endodônticos tiveram a menor prevalência, representando apenas 4%. Houve alta prevalência de doenças crônicas sistêmicas, acometendo 56% dos casos, cuja faixa etária era superior a 40 anos. Conclusão: Check-ups odontológicos regulares devem ser priorizados em pacientes com necessidades especiais para evitar intervenções mais invasivas como em nosso grupo (AU)

Objective: Patients with special needs are those individuals who need special care for an undetermined period of time or for lifetime. The present study is aimed to address the dental care of special needs patients at a private higher education institute in the city of São Paulo. Material and Methods: A descriptive, retrospective study was performed for analysis of 210 dental records of special needs patients who were treated at the Dental Department for Special Patients of the Cruzeiro do Sul University between 2012 and 2018. Data on gender, age, diagnosis of the debilitating condition, reason of the consultation, continued use of medications, radiographic images and dental treatments provided were all collected before being submitted to descriptive and inferential statistical analysis (chi-square test) at a significance level of 5%. Results: As for the types of dental procedures assessed in the present study, of the 210 patients, 24% needed dental curative treatments in which periodontal therapy was the most prevalent type, whereas endodontic treatments had the lowest prevalence, representing 4% only. There was a high prevalence of chronic systemic diseases, affecting 56% of the dental records, whose age group was above 40 years old. Conclusion: Regular dental check-ups should be prioritized in patients with special needs to avoid more invasive interventions as found in our group (AU)

Effect of Xylitol Varnishes on the Inhibition of Demineralization in Vitro

Abstract Objective: To evaluate the efficacy of xylitol varnishes in the inhibition of enamel demineralization in vitro. Material and Methods: Bovine enamel blocks (n=120) were randomly allocated to four groups (n = 30), and the surface hardness (SH) was measured at baseline. The blocks were treated with the following varnishes: 20% xylitol, 20% xylitol plus F (5% NaF), Duraphat™ (5% NaF, positive control), and placebo (no-F/xylitol, negative control). The varnishes were applied and removed after 6 h of immersion in artificial saliva. The blocks were subjected to pH cycles (demineralization and remineralization for 2 and 22h/day, respectively, for 8 days). Surface and cross-sectional hardnesses were measured to calculate the percentage of SH loss (%SHL) and the integrated loss of the subsurface hardness (ΔKHN). Data were statistically analyzed using Kruskal-Wallis and Tukey's tests (p<0.05). Results: %SHL was significantly decreased by 20% xylitol plus F, Duraphat™, and 20% xylitol varnishes compared to placebo. The use of 20% xylitol plus F varnish led to a significantly lower percentage of SH loss compared to the use of 20% xylitol varnish without F. However, the experimental and commercial varnishes led to significantly lower subsurface demineralization compared to placebo and did not differ from each other. Conclusion: Xylitol varnishes, especially when combined with F, effectively prevent enamel demineralization (AU).

Effect of dentifrices with different pH and fluoride concentrations on fluoride levels in biofilm and nails: an RCT

Abstract: Purpose: to evaluate the effect of dentifrice pH and fluoride concentration ([F]) on fluoride uptake on the biofilm and nails of children from a non-fluoridated area. Methods: two hundred and twenty-eight two- to four-year-old children were randomly allocated into 3 groups according to the type of dentifrice: G1: 1100 μg F/g, pH 4.5 (n = 76); G2: 750 μg F/g, pH 4.5 (n = 74); and G3: 1100 μg F/g, pH 7.0 (n = 78). Nails were collected at 4, 8, and 12 months after starting dentifrice use and biofilm was collected 5 and 60 minutes after toothbrushing. The concentrations of F in nails and biofilm were analyzed by HMDS facilitated diffusion. Data were analyzed by Kruskal-Wallis/Mann-Whitney's test and the comparison between biofilm collection times was done using Wilcoxon test (p £ 0.05). Results: a significant reduction of [F] in biofilm was observed 60 minutes after toothbrushing, regardless of the dentifrice used. However, 5 minutes after toothbrushing, G1 had a significantly higher [F] compared to G2 and G3, and 60 minutes after toothbrushing, [F] was significantly higher for G1 and G2 compared to G3. G1 and G3 had significantly higher [F] in the nails compared to G2. Conclusion: a lower dentifrice concentration is a relevant factor for the reduction of excessive fluoride intake. The use of a low-F acidified dentifrice combines the reduction of fluoride uptake with caries prevention by leading to greater incorporation of F into the biofilm over time.

Effect of the cranberry ( Vaccinium macrocarpon ) juice on reducing dentin erosion: an in vitro study

Abstract Vaccinium macrocarpon (cranberry) is a fruit that has an inhibitory effect on matrix metalloproteinases (MMPs) present in dentin and saliva. The inhibition of MMPs has been shown to prevent dentin erosion. The aim of this study was to analyze the effect of cranberry juice on the reduction of dentin erosion in vitro. Specimens of bovine dentin (4×4×2 mm) were randomized and divided into 4 groups (n = 17/group): distilled water (C-control, pH 7.2); green tea extract solution containing 400 µm epigallo-catechin-gallate (EGCg, positive control, pH 4.5); 10% cranberry extract (CrE, pH 3.9), and cranberry juice (CrJ, Cranberry JuxxTM, pH 2.8). Specimens were submitted to erosive pH cycles for 5 days. Each day, four demineralizations were carried out with 0.1% citric acid (90 s). After the acid challenges, specimens were rinsed and kept in treatment solutions for 1 min; afterwards, they were rinsed and stored in artificial saliva for 1 h at 37°C (or overnight at the end of each day). After the experimental period of 5 days, dentin loss was evaluated by contact profilometry. Data were analyzed by ANOVA and Tukey's test (p < 0.05). Dentin loss (µm ± SD) was significantly lower for all treatments (EGCg = 9.93 ± 2.90; CrE = 12.10 ± 5.44; CrJ = 11.04 ± 5.70) compared to control (21.23 ± 11.96), but it did not significantly differ from each other. These results indicate that the commercial cranberry juice, despite its low pH, is able to reduce dentin erosion, which might be due to the ability of cranberry components to inhibit MMPs.

Cone Beam Computed Tomography Based Sex Estimation by Volume of Odontoid Process of The Second Cervical Vertebra / Estimativa sexual baseada em tomografia computadorizada de feixe cônico pelo volume do processo odontóide da segunda vértebra cervical

Objective: The aim of this study was to evaluate whether the volume of odontoid process of the second cervical vertebra on CBCT images can be used for sex estimation. Material and Methods: The volume of odontoid process on CBCT images of 138 subjects was measured. In addition, the patients were classified into five age groups. The comparisons between the groups in relation to sex and age were performed by using Mann-Whitney's test and Kruskal-Wallis' test, respectively. The ROC curve was used to assess the sensitivity and specificity of the volume to determine the sex. Results: No statistically significant difference was observed between age and volume. Males had significantly larger volumes than females. Values of volume equal to or greater than 1.254 mm3 have sensitivity of 68.2% and specificity of 68.1% to determine male sex. Conclusion: The volume of the odontoid process tends to be larger in males than in females and can be used as sex estimation (AU)

Introdução: O objetivo deste estudo foi avaliar se o volume do processo odontóide da segunda vértebra cervical em imagens de TCFC pode ser usado para estimativa do sexo. Material e Métodos: O volume do processo odontóide em imagens CBCT de 138 indivíduos foi medido. Além disso, os pacientes foram classificados em cinco faixas etárias. As comparações entre os grupos em relação ao sexo e idade foram realizadas por meio dos testes de Mann-Whitney e Kruskal-Wallis, respectivamente. A curva ROC foi utilizada para avaliar a sensibilidade e especificidade do volume para determinar o sexo. Resultados: Não foi observada diferença estatisticamente significativa entre idade e volume. Os machos tiveram volumes significativamente maiores do que as fêmeas. Valores de volume igual ou superior a 1,254 mm3 apresentam sensibilidade de 68,2% e especificidade de 68,1% para determinação do sexo masculino. Conclusão: O volume do processo odontóide tende a ser maior no sexo masculino do que no feminino e pode ser usado como estimativa do sexo. (AU)

Atypical odontalgia: pathophysiology, diagnosis and management / Odontalgia atípica: fisiopatologia, diagnóstico e tratamento

ABSTRACT BACKGROUND AND OBJECTIVES: Atypical odontalgia, a subtype of persistent idiopathic facial pain, is characterized by continuous pain in one tooth or more, or inside the alveolus after exodontia, with no apparent clinical causes. These patients run the risk of going through unnecessary dental/surgical procedures which would worsen their pain. Since the pathophysiology, diagnosis, and management of atypical odontalgia are not clear, this article aims to present an integrative literature review about these aspects. CONTENTS: A review of articles related to the topic was conducted on the Pubmed database using the keywords "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Applying the inclusion criteria (publications in the last ten years, in English, as clinical trials, multicenter studies, case reports, reviews, integrative and systematic reviews, 114 articles were found, and 39 were selected after the application of the exclusion criteria (articles with no relation to the topic). CONCLUSION: Although studies suggest the involvement of strong neuropathic mechanism, the psychological/psychiatric aspects might be considered not as a primary cause, but as an aggravator of the patient´s pain. Knowledge of other pathologies is recommended in order to determine the differential diagnosis. Also, complementary image tests, qualitative somatosensorial test, and reference to an orofacial pain specialist should be considered. In case of uncertain diagnosis, it is recommended to avoid any dental procedures because the pain can get worse.

RESUMO JUSTIFICATIVA E OBJETIVOS: A odontalgia atípica, um subtipo da dor facial idiopática persistente, se caracteriza por dor contínua em um ou mais dentes, ou no alvéolo, após exodontia sem qualquer causa aparente e é um desafio para o dentista. O desconhecimento por parte do profissional pode levar a procedimentos odontológicos desnecessários e mutiladores, piorando e/ou cronificando a dor do paciente. Diante desse panorama, o objetivo deste estudo foi apresentar informações referentes à fisiopatologia, diagnóstico e tratamento da odontalgia atípica através de uma revisão integrativa da literatura. CONTEÚDO: A busca na base de dados Pubmed foi realizada com os termos: "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Aplicando-se critérios de inclusão (publicações nos últimos 10 anos, de língua inglesa, tipo ensaio clínico, estudo multicêntrico, relato de caso, revisão, revisão integrativa científica e sistemática) foram encontrados 114 artigos, dos quais 39 foram selecionados após aplicação do critério de exclusão (trabalhos sem relação com o tema). CONCLUSÃO: Embora os estudos apontem forte envolvimento de mecanismos neuropáticos, aspectos psicogênicos/psiquiátricos devem ser levados em consideração como agravante do estado de dor do paciente. Sugere-se conhecimento sobre as outras doenças existentes para se realizar um diagnóstico diferencial, exames complementares de imagem, realização do teste somatossensorial qualitativo, encaminhamento a um especialista em dor orofacial e neurologista, e em casos de dúvida, não realizar nenhum procedimento a fim de não piorar a sua dor.

Preventive effect of toothpastes with MMP inhibitors on human dentine erosion and abrasion in vitro

ABSTRACT The use of gels and mouthrinses with MMP inhibitors (chlorhexidine, and green tea extract) was shown to prevent erosive wear. The aim of this study was to analyze the protective effect of toothpastes containing MMP inhibitors on dentine loss induced by erosion in vitro. Material and Methods Five groups each containing 12 specimens of human root dentine were prepared. The specimens were subjected to 1 min erosion by immersion in a cola drink, 4 times a day, for 5 d. Each day, after the first and last erosive challenges, the specimens were brushed for 15 s with a slurry of dentifrice and water (1:3) containing placebo, 1,100 ppm fluoride, 0.61% green tea extract, 0.12% chlorhexidine or 0.004% chlorhexidine (commercial toothpaste). Between the acid challenges, the specimens were stored in artificial saliva with remineralizing potential until the next treatment. Dentine loss was determined using profilometry. Data were analyzed using one-way ANOVA after log transform (p<0.05). Results The mean wear values (μm) were as follows: placebo 1.83±0.53; 0.61% green tea extract 1.00±0.21; fluoride 1.27±0.43; 0.12% chlorhexidine 1.19±0.30; and 0.004% chlorhexidine 1.22±0.46. There was a significant difference in wear between placebo and all the treatment toothpastes, which did not differ from each other. Conclusion The results suggest that toothpastes containing MMP inhibitors are as effective as those based on NaF in preventing dentine erosion and abrasion.

TiF4 and NaF varnishes as anti-erosive agents on enamel and dentin erosion progression in vitro

Objective This study assessed the effect of fluoride varnishes on the progression of tooth erosion in vitro. Material and Methods: Forty-eight enamel and 60 root dentin samples were previously demineralized (0.1% citric acid, pH 2.5, 30 min), leading to a baseline and erosive wear of 12.9 and 11.4 µm, respectively. The samples were randomly treated (6 h) with a 4% TiF4 varnish (2.45%F-, pH 1.0), a 5.42% NaF varnish (2.45%F-, pH 5.0), a placebo varnish and no varnish (control). The samples were then subjected to erosive pH cycles (4x90 s/day in 0.1% citric acid, intercalated with artificial saliva) for 5 days. The increment of the erosive tooth wear was calculated. In the case of dentin, this final measurement was done with and without the demineralized organic matrix (DOM). Enamel and dentin data were analyzed using ANOVA/Tukey’s and Kruskal-Wallis/Dunn tests, respectively (p<0.05). Results The TiF4 (mean±s.d: 1.5±1.1 µm) and NaF (2.1±1.7 µm) varnishes significantly reduced enamel wear progression compared to the placebo varnish (3.9±1.1 µm) and control (4.5±0.9 µm). The same differences were found for dentin in the presence and absence of the DOM, respectively: TiF4 (average: 0.97/1.87 µm), NaF (1.03/2.13 µm), placebo varnish (3.53/4.47 µm) and control (3.53/4.36 µm). Conclusion The TiF4 and NaF varnishes were equally effective in reducing the progression of tooth erosion in vitro. .

Efeito do pH e da concentração de fluoreto presente em dentifrícios líquidos no controle de cárie em área fluoretada: estudo clínico randomizado / Effect of liquid dentifrices pH and fluoride concentration on caries control in a region with fluoridated water: randomized clinical trial

Os dentifrícios de baixa concentração de fluoreto têm sido sugeridos como alternativa para reduzir o risco de fluorose dentária, embora não haja consenso quanto a sua eficácia clínica, a qual pode ser aumentada quando o pH é ácido. Este estudo clínico randomizado teve como objetivo avaliar o efeito anti-cárie do pH e da concentração de fluoreto presente em dentifrícios líquidos, em crianças com diferentes status de atividade cariosa. Crianças de 2-4 anos de idade residentes em uma área fluoretada (0,6-0,8 ppm F), com (A) e sem (I) lesões de cárie ativa foram distribuídas aleatoriamente em três grupos de acordo com o tipo de dentifrício utilizado: Grupo 1 (n=48-A/56-I): 550 ppm F pH 4,5, Grupo 2 (n=56-A/48-I) 1100 ppm F pH 7,0, Grupo 3 (n=52-A/55-I): 550 ppm F pH 7,0. O número de lesões tornando-se ativas/cavidades ou inativas, respectivamente, foi avaliado clinicamente após 12 meses, podendo-se determinar se as lesões progrediram ou regrediram. Além disso, as lesões de mancha branca foram avaliadas através da técnica de quantificação de fluorescência induzida por luz (Quantitative Light-Induced Fluorescence - QLF) em uma subamostra de 75 crianças. A concentração de fluoreto nas unhas dos pés e no biofilme dentário também foi avaliada após 6 meses de uso dos dentifrícios. A progressão de cárie seguiu um padrão decrescente de acordo com o dentifrício utilizado (G3>G2>G1), independentemente da atividade de cárie da criança, mas diferenças significativas foram detectadas apenas para a progressão e o incremento de cárie (G1 < G3) no grupo de crianças cárie-ativas, quando avaliadas por inspeção visual. Para a regressão de cárie, os valores encontrados para os 3 grupos foram mais parecidos entre si, não havendo diferenças significativas entre osgrupos. Por outro lado, a análise com o QLF não detectou diferença significativa entre os Grupos 1 e 2, mas eles tiveram um desempenho significativamente melhor que o Grupo 3. Concentrações de fluoreto...

Low-F dentifrices have been suggested as an alternative to reduce the risk of dental fluorosis, although there is no consensus on their clinical efficacy, which may be increased when the pH is acidic.The present randomized clinical trial evaluated the anticaries effect of low-F acidic liquid dentifrice in children at different caries activity status. Two-to-four-year-old schoolchildren living in a fluoridated area (0.6 0.8 ppm F), with (A) or without (I) active caries lesions were randomly allocated into 3 groups differing according to the type of dentifrice used over 12 months: Group 1 (n=48-A/56-I): 550 ppm F pH 4.5, Group 2 (n=56-A/48-I) 1100 ppm F pH 7.0, Group 3 (n=52-A/55-I): 550 ppm F pH 7.0. The number of lesions becoming active/cavities or inactive was clinically evaluated determining progression or regression. Additionally, the white spot lesions were evaluated by the quantitative light-induced fluorescence (QLF) method in a subsample of 75 children. Toenail and plaque fluoride concentration were also evaluated 6 months after the use of the dentifrices. Plaque samples were collected 5 and 60 minutes after the last use of the dentifrices. Caries net increment followed a decreasing pattern according to the dentifrice used (G3>G2>G1) regardless caries activity, but significant differences were detected only for caries progression and net increment (G1 < G3) for the cariesactive group when evaluated through visual inspection. For the regression, the values found for the three groups were more similar, without significant differences. QLF analysis detected no significant difference between Groups 1 and 2, but they performed significantly better than Group 3. Toenail fluoride concentration significantly lower was observed when children used the low-fluoride dentifrices. Plaque F concentration was significantly higher for Group 2 compared to group 3, egardless the time, while Group 1 did not significantly differ Group 2, but was...

Efeito do pH e da concentração de fluoreto presente em dentifrícios líquidos no controle de cárie em área fluoretada: estudo clínico randomizado / Effect of liquid dentifrices pH and fluoride concentration on caries control in a region with fluoridated water: randomized clinical trial

Os dentifrícios de baixa concentração de fluoreto têm sido sugeridos como alternativa para reduzir o risco de fluorose dentária, embora não haja consenso quanto a sua eficácia clínica, a qual pode ser aumentada quando o pH é ácido. Este estudo clínico randomizado teve como objetivo avaliar o efeito anti-cárie do pH e da concentração de fluoreto presente em dentifrícios líquidos, em crianças com diferentes status de atividade cariosa. Crianças de 2-4 anos de idade residentes em uma área fluoretada (0,6-0,8 ppm F), com (A) e sem (I) lesões de cárie ativa foram distribuídas aleatoriamente em três grupos de acordo com o tipo de dentifrício utilizado: Grupo 1 (n=48-A/56-I): 550 ppm F pH 4,5, Grupo 2 (n=56-A/48-I) 1100 ppm F pH 7,0, Grupo 3 (n=52-A/55-I): 550 ppm F pH 7,0. O número de lesões tornando-se ativas/cavidades ou inativas, respectivamente, foi avaliado clinicamente após 12 meses, podendo-se determinar se as lesões progrediram ou regrediram. Além disso, as lesões de mancha branca foram avaliadas através da técnica de quantificação de fluorescência induzida por luz (Quantitative Light-Induced Fluorescence - QLF) em uma subamostra de 75 crianças. A concentração de fluoreto nas unhas dos pés e no biofilme dentário também foi avaliada após 6 meses de uso dos dentifrícios. A progressão de cárie seguiu um padrão decrescente de acordo com o dentifrício utilizado (G3>G2>G1), independentemente da atividade de cárie da criança, mas diferenças significativas foram detectadas apenas para a progressão e o incremento de cárie (G1 < G3) no grupo de crianças cárie-ativas, quando avaliadas por inspeção visual. Para a regressão de cárie, os valores encontrados para os 3 grupos foram mais parecidos entre si, não havendo diferenças significativas entre osgrupos. Por outro lado, a análise com o QLF não detectou diferença significativa entre os Grupos 1 e 2, mas eles tiveram um desempenho significativamente melhor que o Grupo 3. Concentrações de fluoreto...

Low-F dentifrices have been suggested as an alternative to reduce the risk of dental fluorosis, although there is no consensus on their clinical efficacy, which may be increased when the pH is acidic.The present randomized clinical trial evaluated the anticaries effect of low-F acidic liquid dentifrice in children at different caries activity status. Two-to-four-year-old schoolchildren living in a fluoridated area (0.6 0.8 ppm F), with (A) or without (I) active caries lesions were randomly allocated into 3 groups differing according to the type of dentifrice used over 12 months: Group 1 (n=48-A/56-I): 550 ppm F pH 4.5, Group 2 (n=56-A/48-I) 1100 ppm F pH 7.0, Group 3 (n=52-A/55-I): 550 ppm F pH 7.0. The number of lesions becoming active/cavities or inactive was clinically evaluated determining progression or regression. Additionally, the white spot lesions were evaluated by the quantitative light-induced fluorescence (QLF) method in a subsample of 75 children. Toenail and plaque fluoride concentration were also evaluated 6 months after the use of the dentifrices. Plaque samples were collected 5 and 60 minutes after the last use of the dentifrices. Caries net increment followed a decreasing pattern according to the dentifrice used (G3>G2>G1) regardless caries activity, but significant differences were detected only for caries progression and net increment (G1 < G3) for the cariesactive group when evaluated through visual inspection. For the regression, the values found for the three groups were more similar, without significant differences. QLF analysis detected no significant difference between Groups 1 and 2, but they performed significantly better than Group 3. Toenail fluoride concentration significantly lower was observed when children used the low-fluoride dentifrices. Plaque F concentration was significantly higher for Group 2 compared to group 3, egardless the time, while Group 1 did not significantly differ Group 2, but was...

Vacina anticárie: o estado da arte / Anti-caries vaccine: the state of the art

A cárie dentária é uma doença de rápida progressão, podendo levar a destruição dos elementos dentários. Neste artigo, os autores fazem uma revisão da literatura sobre o estado atual da vacina anticárie. São discutidos os principais mecanismos de ação da vacina anticárie em modelos animais e sua aplicabilidade em humanos, revelando qual impacto pode ser observado na prevenção da doença cárie. Estudos clínicos futuros devem ser incentivados para o total esclarecimento da vacina anticárie e do seu mecanismo de ação.