Odontopediatría en el contexto de la COVID-19: publicaciones científicas y práctica clínica / Odontopediatria no contexto da COVID-19: publicações científicas e prática clínica / Pediatric dentistry in the context of COVID-19: scientific publications and clinical practice

El propósito es analizar las características de los estudios y las tendencias en las publicaciones científicas y las recomendaciones clínicas relacionadas con el COVID-19 en odontopediatría. La búsqueda electrónica se realizó en las bases de datos MEDLINE, Scopus, Web of Science Core Collection y LILACS/BVS, sin restricciones. Se incluyeron estudios que usaron términos referentes a COVID-19, odontología pediátrica y niños en el título, resumen o palabras clave. Se extrajeron datos bibliométricos y características de los estudios. Cada estudio se categorizó de acuerdo con su diseño, muestra y tema principal. Se incluyeron 49 estudios, la mayoría revisiones (n=25; 51,00%), estudios observacionales (n=23; 47,00%) y estudio clínico (n=1; 2%). Los principales temas fueron urgencias odontológicas (n=9; 18,30%), bioseguridad (n= 8; 16,30%) y teleodontología (n=6; 12,20%). Las urgencias odontológicas más reportadas fueron trauma (n=12; 63,10%), edema (n=9; 47,30%) y dolor (n=9; 47,30%). Se concluyó que se realizaron pocos estudios sobre COVID-19 y odontología pediátrica, y la mayoría de las revisiones y estudios observacionales sobre emergencias dentales se publicaron en Asia.

O objetivo é analisar as características dos estudos e tendências nas publicações científicas e recomendações clínicas relacionadas ao COVID-19 em odontopediatria. A busca eletrônica foi realizada nas bases de dados MEDLINE, Scopus, Web of Science Core Collection e LILACS/BVS, sem restrições. Foram incluídos estudos que usaram termos referentes a COVID-19, odontopediatria e crianças no título, resumo ou palavras-chave. Os dados bibliométricos e as características do estudo foram extraídos. Cada estudo foi categorizado de acordo com seu desenho, amostra e tema principal. Quarenta e nove estudos foram incluídos, sendo a maioria revisões (n=25; 51,00%), estudos observacionais (n=23; 47,00%) e estudo clínico (n=1; 2%). Os principais temas foram emergências odontológicas (n=9; 18,30%), biossegurança (n= 8; 16,30%) e teleodontologia (n=6; 12,20%). As emergências odontológicas mais relatadas foram trauma (n=12; 63,10%), edema (n=9; 47,30%) e dor (n=9; 47,30%). Concluiu-se que poucos estudos sobre COVID-19 e odontopediatria foram realizados, com a maioria das revisões e estudos observacionais sobre emergências odontológicas publicados na Ásia

The purpose is to analyze the characteristics of the studies and trends in scientific publications and the clinical recommendations related to COVID-19 in pediatric dentistry. Electronic search was performed on MEDLINE, Scopus, Web of Science Core Collection, and LILACS/VHL databases, without restrictions. Studies that used terms referring to COVID-19, pediatric dentistry, and children in the title, abstract, or keywords were included. Bibliometric data and studies' characteristics were extracted. Each study was categorized according to its design, sample, and main subject. Forty-nine studies were included, most of them reviews (n=25; 51.00%), observational studies (n=23; 47.00%), and clinical study (n=1; 2%). The main topics were dental emergencies (n=9; 18.30%), biosafety (n= 8; 16.30%) and teledentistry (n=6; 12.20%). The most reported dental emergencies were trauma (n=12; 63.10%), edema (n=9; 47.30%), and pain (n=9; 47.30%). It was concluded that few studies on COVID-19 and pediatric dentistry were conducted, and most reviews and observational studies regarding dental emergencies were published in Asia.

In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets

ABSTRACT Objective: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. Material and Methods: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). Results: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. Conclusion: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

RESUMO Objetivo: Avaliar in-vitro o efeito de uma aplicação única de cremes dentais de CPP-ACP e diferentes soluções fluoretadas na prevenção da cárie dentária ao redor de braquetes ortodônticos Material e Métodos: O conjunto dentes/braquetes (n=65) foi imerso em saliva artificial (1h em 37°C) randomizado e submetido a tratamento único (100µL; 1 min) de emulsão de fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) e CPP-ACP associado ao flúor (CPP-ACPF); soluções de tetrafluoreto de titânio (TiF4) e fluoreto de sódio (NaF); e ausência de tratamento (GC). Biofilmes multiespécie (5 x 105 CFU/mL) foram formados na presença de sacarose a 2%. Após 24h, o pH e a concentração de fluoreto solúvel total (FST) foram analisados pelo meio de cultura. Foram avaliadas a presença de lesões de mancha branca (LMB), por meio da análise de macroscopia visual, e a porcentagem de perda de dureza (%PD). Também foi verificada a topografia do esmalte, usando microscopia eletrônica de varredura (MEV). Os dados foram analisados pelos testes Qui-quadrado, Kruskal-Wallis e Mann-Whitney (p < 0,05). Resultados: Os compostos contendo flúor levaram a uma redução do pH menor do que o CPP-ACP e GC (p<0,05). Houve diferença no FST entre os grupos (p <0,05), sendo TiF4> NaF > CPP-ACPF > CPP-ACP > GC. Quanto à presença de LMB e à %PD, o grupo NaF obteve os menores valores (p<0,05), enquanto TiF4 e CPP-ACPF foram semelhantes (p> 0,05). A MEV demonstrou que os grupos sem flúor tiveram uma dissolução superficial maior. Conclusão: Os grupos fluoretados, incluindo soluções e CPP-ACPF, foram mais eficazes do que o CPP-ACP sem flúor na redução da desmineralização do esmalte ao redor dos braquetes ortodônticos após uma única aplicação.

Fatores comportamentais e socioeconômicos são fortes preditores de cárie dentária em pré- escolares: um estudo transversal / Behavioral and socioeconomic factors are strong predictors of dental caries in preschoolers: a cross-sectional study

Avaliaram-se possíveis preditores para a cárie dentária em pré-escolares sem experiência odontológica prévia, que buscaram a clínica de odontopediatria de uma universidade pública. Analisaram-se 191 prontuários, dos quais 87 foram incluídos. Coletaram-se dados demográficos, socioeconômicos, histórico de cárie da mãe, orientação prévia sobre cárie, frequência de escovação, uso de dentifrício fluoretado, consumo de doces/biscoitos e/ou líquidos açucarados, ceo-d e a presença ou ausência de defeitos de desenvolvimento do esmalte. Análises descritivas e de regressão logística binária foram realizadas para investigar quais variáveis prediziam um ceod>0. O modelo múltiplo incluiu consumo de doces/biscoitos, dados socioeconômicos, histórico de cárie na mãe e orientação prévia sobre cárie. Das crianças (2,69±1,18 anos), a maioria (67,8%) apresentava ceod>0 (3,78±3,82), sendo 50,6% meninas e 73,3% da classe baixa. A maioria (56,5%) das mães tinha 12 anos de estudos completos, histórico de cárie (78,6%) e receberam orientação prévia sobre cárie (52,9%). A maior parte (80,6%) escova os dentes pelo menos 2 vezes ao dia, utiliza dentifrício fluoretado (75,9%) e consome líquidos açucarados (90,8%), além de doces/biscoitos (86,9%) entre as refeições. Pertencer à classe baixa aumentou em 7 vezes a chance de ceod>0 (OR=7,354; IC 95%=1,951-27,723), histórico de cárie na mãe em 4 vezes (OR=4,131; IC 95%=1,042-16,369) e consumo de doces/biscoitos em quase 2 vezes (OR=1,786; IC 95%=1,072-2,976). Classe econômica baixa, histórico de cárie da mãe e consumo de doces/biscoitos entre as refeições mostraram-se fatores associados ao ceod>0 nos pacientes sem experiência prévia odontológica de uma clínica de odontopediatria de uma universidade pública.

Possible predictors of dental caries in preschool children without previous dental experience, who sought a pediatric dentistry clinic at a public university, were evaluated. Medical records (n=191) were analyzed; 87 were included. Demographic, socioeconomic data, mother's history of caries, previous orientation on caries, brushing frequency, use of fluoridated toothpaste, consumption of sweets/cookies and/or sugary liquids, dmft and the presence or absence of enamel development defects were collected. Descriptive and binary logistic regression analyzes were performed to investigate which variables predicted a dmft>0. The multiple model included consumption of sweets/cookies, socioeconomic data, mother's history of caries and previous orientation on caries. Of the children (2.69±1.18 years), most (67.8%) had dmft>0 (3.78±3.82), with 50.6% girls and 73.3% from the lower class. Most mothers had completed 12 years of schooling (56.5%), reported history of caries (78.6%) and received previous orientation on caries (52.9%). Most of children brush their teeth at least twice a day (80.6%), use fluoridated toothpaste (75.9%) and consume sugary liquids (90.8%), in addition to consumption of sweets/cookies (86 .9%) among the meals. Belonging to the lower class increased the chance of having dmft>0 by 7 times (OR=7,354; 95% CI=1,951-27,723), mother's history of caries by 4 times (OR=4,131;95% CI=1,042-16,369) and consumption of sweets/cookies by almost twice (OR=1,786;95% CI=1,072-2,976). Low economic class, mother's history of caries and consumption of sweets/cookies between meals were factors associated with dmft>0 in the patients without previous dental experience in a pediatric dentistry clinic at a public university.

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety

Abstract This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

The Xylitol Applicability and its Effects in Health Area Worldwide: A Bibliometric Analysis Based on Randomized Controlled Trials

ABSTRACT Objective To describe and evaluate the xylitol products' applicability and its effects in the health area worldwide utilizing a bibliometric analysis from randomized controlled trials (RCT) with humans. Material and Methods Electronic searches were carried out in Medline/PubMed, Scopus, Cochrane Library, Web of Science, and VHL databases. The main data extracted were: year, area of applicability, type of treatment, country, journal, xylitol posology and concentration, presentation form, outcomes, and effects. Results From 1476 studies, 257 were included. These studies were published between 1973-2021. The majority was carried out in dentistry (73.9%) and under preventive treatment (67.4%). These studies were developed in the USA (15.4%) and published in Caries Research (6.6%). The posology and concentration ranged between 0.004-67 g/day and 0.002-100%, respectively. The xylitol is usually used in the chewing gum form (44.0%), and for antimicrobial activity evaluation (38.5%). A positive effect was observed in 204 studies (79.3%) and was associated with xylitol concentration ≥ 15(p=0.007). Side effects were reported in 8.2and were associated with posology ≥ 5 g/day (p=0.03). Conclusion Most studies with xylitol were conducted to prevent diseases in the dentistry field. The chewing gum form and antimicrobial activity evaluation were more frequent. Most xylitol products have a positive effect, and few studies report side effects.

Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review / Conhecimento de profissionais de saúde sobre amamentação e fatores que levam ao desmame: uma revisão de escopo

Abstract This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists' knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals' endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists' knowledge and education measures for HP are necessary since they are frequently questioned about these issues.

Resumo Esta revisão avaliou o conhecimento dos profissionais de saúde (PS) sobre amamentação e fatores que levam ao desmame. Realizou-se buscas em quatro bancos de dados eletrônicos e literatura cinzenta. A estratégia de busca incluiu termos Mesh e sinônimos. Não se adotou restrição de idioma ou data. Estudos avaliando o conhecimento dos PS sobre amamentação e desmame foram elegíveis. Estudos recuperados pelas buscas foram avaliados por dois examinadores independentes. Dos 1.417 estudos recuperados, 35 foram incluídos. Muitos países e PS de diferentes áreas foram analisados. Nenhum estudo avaliou o conhecimento dos dentistas. Embora os PS conheçam os benefícios da amamentação, a duração recomendada pela Organização Mundial da Saúde, exclusiva ou não, não está alinhada com o endosso de todos os PS. Considerando o desmame, a informação é escassa. No entanto, os PS estão atentos às principais causas potenciais do desmame precoce. O conhecimento dos PS é conflitante sobre amamentação e incomum sobre o desmame. Não foram encontrados estudos que apresentassem dados sobre o conhecimento de dentistas sobre a temática. Investigações quanto ao conhecimento dos mesmos e medidas de educação para todos os PS são necessárias, considerando que são frequentemente questionados sobre o tema.

Research Trends on Preventive and Therapeutic Use of TIF4 for Dental Caries and Erosion

Abstract Objective: To evaluate TIF4 preventive and therapeutic use in caries and erosive lesions. Material and Methods: Searches were performed in six databases. Studies evaluating TiF4 use in vitro, in situ, and in vivo in caries and erosive lesions were included and imported into VantagePoint™ (VP). Data about publication year, authors, country, journal, study design, outcomes, TIF4 vehicles, application and intervention time, cariogenic challenge, erosive cycles, effects (positive/ negative /null) and approach (preventive/therapeutic) were analyzed through VP and Excel. Results: 93 published studies were included and an increase in publications was observed between 2010 and 2021. Forty-three authors published three or more articles, of which 67.4% were developed in Brazil and published in Caries Research (22.6%). 69.9% were in vitro studies with erosion assays (59.1%) and with preventive approaches (67.4%). The principal vehicle was a solution (69.9%) with a 1-min single application (58.0%) and with an intervention time of 5-7 days (22.6%). The principal cariogenic challenge in vitro was pH cycling (11.8%); in situ was sucrose + biofilm (6.2%); and in vivo, biofilm (6.2%). The most used erosive cycle was 4× per day in in vitro studies (20.4%) and 1× in vivo (2.1%). A positive effect was observed in prevention (41.9%) and treatment (24.7%) studies. Conclusion: TIF4 has shown a positive effect in prevention and therapeutic treatments for dental caries and erosion (AU).

Analysis of congenital syphilis notifications in a university hospital in the city of Niterói from 2016 to 2020 / Análise das notificações de sífilis congênita em um hospital universitário na cidade de Niterói de 2016 a 2020

Introduction: The elimination of congenital syphilis is a challenge in the field of public health worldwide. The failure of previous global plans forces authorities to rethink detection and control strategies, with compulsory notification being an important tool for obtaining data. Objective: To analyze the notifications of congenital syphilis made by Departamento de Vigilância Epidemiológica do Hospital Universitário Antônio Pedro (Department of Epidemiological Surveillance at Antônio Pedro University Hospital), between January 2016 and August 2020. Methods: Retrospective, descriptive, and quantitative study of data from congenital syphilis notification forms in Hospital Universitário Antônio Pedro from January 2016 to August 2020. In the descriptive analysis of categorical variables, absolute and relative frequencies were used; for numerical measures, central tendency and dispersion measures were used. Spearman correlation, Mann-Whitney test and Fisher's exact test were performed in the R software (version 4.0.3). Hills' criteria for causality were also considered. Results: Of the 67 forms examined, two were excluded due to duplication, and 48 variables were analyzed. No form was completely filled out, and some data were missing on more than 90% of them. According to maternal data, patients were mostly from Niterói (60%), had an average age of 23.09 years, and were brown (32.31%), while 13.85% did not finish 5th to 8th grade and 80% had prenatal care, but less than half had appropriate treatment indicated. As for the children: 55.38% were female, 40% brown, with an average age of 90.98 days. The great majority (72.31%) of them were born at Hospital Universitário Antônio Pedro, and not being born at this hospital was significant when it came to being asymptomatic (69.23%, p=0.001); the most frequent symptom was jaundice. Conclusion: Improvement in the follow-up and investigation of the reported cases can significantly decrease this high percentage of missing information, improving the quality of the data. The vast majority of patients underwent prenatal care, and therefore, they were avoidable cases, since the maternal diagnosis in the peripartum period occurs when the chance for vertical transmission has already occurred and caused consequences for the child's life.

Introdução: A eliminação da sífilis congênita é um desafio para a saúde pública mundial. A falha de planos de controle anteriores força as autoridades a repensar as estratégias, sendo a notificação compulsória ferramenta importante na obtenção de dados. Objetivo: Analisar as notificações de sífilis congênita pelo Departamento de Vigilância Epidemiológica do Hospital Universitário Antônio Pedro no período entre janeiro de 2016 e agosto de 2020. Métodos: Estudo retrospectivo, descritivo e quantitativo. Na análise descritiva das variáveis categóricas, foram utilizadas as frequências absolutas e relativas; já para numéricas, foram utilizadas as medidas tendência central e dispersão. Foram feitos correlação de Spearman, teste de Mann-Whitney e teste exato de Fisher com o software R (versão 4.0.3). Foram considerados os critérios de Hills para causalidade. Resultados: Das 67 fichas examinadas, duas foram excluídas por duplicidade. Foram analisadas 48 variáveis. Nenhuma ficha estava completamente preenchida, e alguns dados estavam ausentes em mais de 90%. De acordo com os dados maternos, 60% das pacientes são de Niterói, com idade de 23,09 anos em média, pardas (32,31%), 13,85% não terminou os estudos da 5ª a 8ª série e 80% fez pré-natal, porém menos da metade teve tratamento adequado indicado. Quanto às crianças, 55,38% eram do sexo feminino, 40% pardas, com idade média de 90,98 dias; 72,31% nasceram no Hospital Universitário Antônio Pedro. Quanto às que não nasceram nesse hospital, o local de nascimento foi significativo para que fossem assintomáticas (69,23%, p=0,001); já o sintoma mais comum foi a icterícia. Conclusão: A melhora do seguimento e investigação dos casos notificados pode diminuir significativamente essa alta porcentagem de informações ausentes, melhorando a qualidade da informação. A maioria das gestantes fez acompanhamento pré-natal e, portanto, trata-se de caso evitável, já que o diagnóstico materno no período periparto acontece quando a chance de transmissão vertical já ocorreu e já há consequências para a criança.

Suplementação de Vitamina D Induz Remodelação Cardíaca em Ratos: Associação com a Proteína de Interação com a Tiorredoxina e a Tiorredoxina / Vitamin D Supplementation Induces Cardiac Remodeling in Rats: Association with Thioredoxin-Interacting Protein and Thioredoxin

Resumo Fundamento: A vitamina D (VD) tem um importante papel na função cardíaca. No entanto, a vitamina exerce uma curva "dose-resposta" bifásica na fisiopatologia cardiovascular e pode causar efeitos deletérios, mesmo em doses não tóxicas. A VD exerce suas funções celulares ligando-se ao seu receptor. Ainda, a expressão da proteína de interação com a tiorredoxina (TXNIP) é positivamente regulada pela VD. A TXNIP modula diferentes visa de sinalização celular que podem ser importantes para a remodelação cardíaca. Objetivos: Avaliar se a suplementação com VD leva à remodelação cardíaca, e se a TXNIP e a tiorredoxina (Trx) estão associadas com esse processo. Métodos: Duzentos e cinquenta ratos Wistar machos foram alocados em três grupos: controle (C, n=21), sem suplementação com VD; VD3 (n = 22) e VD10 (n=21), suplementados com 3,000 e 10,000 UI de VD/ kg de ração, respectivamente, por dois meses. Os grupos foram comparados por análise de variância (ANOVA) com um fator e teste post hoc de Holm-Sidak (variáveis com distribuição normal), ou pelo teste de Kruskal-Wallis e análise post-hoc de Dunn. O nível de significância para todos os testes foi de 5%. Resultados: A expressão de TXNIP foi mais alta e a atividade do Trx foi mais baixa no grupo VD10. Os animais que receberam suplementação com VD apresentaram aumento de hidroperóxido lipídico e diminuição de superóxido dismutase e glutationa peroxidase. A proteína Bcl-2 foi mais baixa no grupo VD10. Observou-se uma diminuição na β-oxidação de ácidos graxos, no ciclo do ácido tricarboxílico, na cadeia transportadora de elétrons, e um aumento na via glicolítica. Conclusão: A suplementação com VD levou à remodelação cardíaca e esse processo pode ser modulado por TXNIP e Trx, e consequentemente por estresse oxidativo.

Abstract Background: Vitamin D (VD) has been shown to play an important role in cardiac function. However, this vitamin exerts a biphasic "dose response" curve in cardiovascular pathophysiology and may cause deleterious effects, even in non-toxic doses. VD exerts its cellular functions by binding to VD receptor. Additionally, it was identified that the thioredoxin-interacting protein (TXNIP) expression is positively regulated by VD. TXNIP modulate different cell signaling pathways that may be important for cardiac remodeling. Objective: To evaluate whether VD supplementation lead to cardiac remodeling and if TXNIP and thioredoxin (Trx) proteins are associated with the process. Methods: A total of 250 Male Wistar rats were allocated into three groups: control (C, n=21), with no VD supplementation; VD3 (n = 22) and VD10 (n=21), supplemented with 3,000 and 10,000 IU of VD/ kg of chow respectively, for two months. The groups were compared by one-way analysis of variance (ANOVA) and Holm-Sidak post hoc analysis, (variables with normal distribution), or by Kruskal-Wallis test and Dunn's test post hoc analysis. The significance level for all tests was 5%. Results: TXNIP protein expression was higher and Trx activity was lower in VD10. The animals supplemented with VD showed increased lipid hydroperoxide and decreased superoxide dismutase and glutathione peroxidase. The protein Bcl-2 was lower in VD10. There was a decrease in fatty acid β-oxidation, tricarboxylic acid cycle and electron transport chain with shift to increase in glycolytic pathway. Conclusion: VD supplementation led to cardiac remodeling and this process may be modulated by TXNIP and Trx proteins and consequently oxidative stress.

In vitro effect of experimental nanocomposites solutions on the prevention of dental caries around orthodontic brackets

Abstract This study aimed to evaluate the in vitro effect of a single application of experimental nanocomposite solutions on the prevention of dental caries around orthodontic brackets. The specimens were exposed to mesoporous silica (MS) nanocomposites containing fluoride by association with titanium tetrafluoride (TiF4) or sodium fluoride (NaF). Nanocomposites also could contain calcium and groups were described as MSCaTiF4, MSTiF4, MSCaNaF, MSNaF, and controls (TiF4, and NaF). Specimens were subjected to the formation of a multispecies biofilm to generate a cariogenic challenge. After 24h, both pH and total soluble fluoride concentration of the culture medium were assessed. Mineral loss was evaluated by percentage of surface mineral loss (%SML), mineral volume variation (ΔZ) of inner enamel and polarized light microscopy (PL). Linear (Ra) and volumetric (Sa) surface roughness and scanning electronic microscopy (SEM) were used to assess enamel topography. Statistical analyses were conducted considering p<0.05. MSNaF had the highest value of culture medium pH after cariogenic challenge, similarly to MSTiF4. All nanocomposite solutions released less fluoride than their controls NaF and TiF4 (p<0.05). All nanocomposite solutions presented lower %SML compared to their respective control groups (p<0.05). Lower Ra, Sa and ΔZ were observed for experimental groups compared to TiF4 (p<0.05). The results were confirmed by PL and SEM analysis. The experimental nanocomposite solutions contributed for lower enamel demineralization around orthodontic brackets.

RESUMO Este estudo teve como objetivo avaliar o efeito in vitro de uma única aplicação de soluções experimentais de nanocompósitos na prevenção de cárie dentária em braquetes ortodônticos. Os espécimes foram expostos a nanocompósitos de sílica mesoporosa (MS) contendo fluoreto por associação com tetrafluoreto de titânio (TiF4) ou fluoreto de sódio (NaF). Os nanocompósitos também podem conter cálcio e os grupos foram descritos como MSCaTiF4, MSTiF4, MSCaNaF, MSNaF e controles (TiF4 e NaF). Os espécimes foram submetidos à formação de um biofilme multiespécie para gerar um desafio cariogênico. Após 24h, o pH e a concentração de flúor solúvel total do meio de cultura foram avaliados. A perda mineral foi avaliada pela porcentagem de perda mineral superficial (% SML), variação do volume mineral (ΔZ) do esmalte interno e microscopia de luz polarizada (PL). A rugosidade superficial linear (Ra) e volumétrica (Sa) e a microscopia eletrônica de varredura (MEV) foram utilizadas para avaliar a topografia do esmalte. As análises estatísticas foram realizadas considerando p <0,05. MSNaF apresentou o maior valor de pH do meio de cultura após o desafio cariogênico, semelhante ao MSTiF4. Todas as soluções de nanocompósitos liberaram menos flúor do que seus controles NaF e TiF4 (p <0,05). Todas as soluções de nanocompósitos apresentaram% SML menor em comparação com seus respectivos grupos de controle (p <0,05). Ra, Sa e ΔZ menores foram observados para os grupos experimentais em comparação ao TiF4 (p <0,05). Os resultados foram confirmados por análises PL e SEM. As soluções experimentais de nanocompósitos contribuíram para a menor desmineralização do esmalte ao redor dos braquetes ortodônticos.

Retrato da atenção básica no Brasil: gastos e infraestrutura em municípios brasileiros / A portrait of Brazilian primary care: municipal expenditure and infrastructure in Brazilian municipalities

Resumo O trabalho apresenta a relação entre a alocação de recursos financeiros e a tipologia da infraestrutura básica local de saúde em amostra inicial de 5.570 municípios do Brasil. Trata-se de uma pesquisa explicativa com uso da análise de correspondência múltipla e regressão quantílica entre variáveis de gastos/controle e a tipologia da estrutura das Unidades Básicas de Saúde. As correspondências entre a tipologia e variáveis representativas dos gastos mostram que tipologias inferiores estão relacionadas com menores gastos per capita nessas variáveis, e vice-versa. A regressão quantílica apresentou relação positiva com a tipologia da infraestrutura nos dois ciclos avaliados. Há evidência das variáveis de gasto estarem relacionadas, de maneira positiva, à infraestrutura, permitindo entender que alocar mais recursos leva a melhor infraestrutura. No entanto, há a necessidade de melhoria na governança dos recursos financeiros da saúde, pois municípios com indicadores socioeconômicos inferiores têm infraestrutura nas categorias inferiores. Conclui-se que há grande multiplicidade de atores e os múltiplos critérios para alocação e descentralização de recursos trazem dificuldades de coordenação e integração entre os entes, restringindo a adequada priorização na alocação dos recursos.

Abstract The paper presents the relationship between the allocation of financial resources and the type of local basic health infrastructure in an initial sample of 5,570 Brazilian municipalities. This is an explanatory research using multiple correspondence analysis and quantile regression between expenditure/control variables and the type of structure of PHC Units. The correspondence between the type and the representative variables of expenditure shows that inferior typologies are related to lower per capita expenditure in these variables, and vice versa. Quantile regression showed a positive relationship with the type of infrastructure in the two cycles evaluated. There is evidence that expenditure variables are positively related to infrastructure, which allows us to understand that allocating more resources leads to better infrastructure. Results point to the need to improve the governance of financial resources for health, as municipalities with lower socioeconomic indicators have an infrastructure in the lower categories. We can conclude that there are multiple actors, and the various criteria for allocating and decentralizing resources bring about difficulties of coordination and integration between the entities, restricting the appropriate prioritization in the distribution of resources.

The effect of a chemomechanical protocol to eliminate microorganisms from pulpectomized primary teeth: three case reports

Introduction: Description of the bacterial community before and after chemomechanical preparation (CP) with the removal of a smear layer (SL) in pulpectomized primary teeth has been little reported. Objective: These case reports describe the presence of total microorganisms and Enterococcus faecalis in root canals of primary incisors before and after CP with SL removal. Case Reports: Microbiological samples were collected from the root canals of three children (3.66±0.58 years old) with necrosis (n=2) and irreversible pulpal inflammation (n=1) in maxillary primary incisors. After teeth isolation with a rubber dam and antisepsis of the operative field, the sample collections were performed with sterile absorbent paper cones before and after the CP, which included irrigation with 2.5% sodium hypochlorite followed by 6% citric acid to remove the SL. The collected samples were analysed immediately at the end of the clinical procedures. The plates were incubated anaerobically for 48 hours at 37°C. The results were expressed as colony forming units (CFU)/mL. Results: Two of the three teeth showed total microorganisms before the CP. One incisor had no microorganisms in the initial collection. No CFU was counted in the samples collected after CP. Moreover, E. faecalis was not observed any time, either before or after the CP. Conclusions: E. faecalis was not detected in any sample, yet two of the three root canals had microorganisms before CP. In cases where microorganisms were initially found, 100% elimination was observed after the applied protocol.

Introdução: A descrição da comunidade bacteriana antes e após o preparo químico-mecânico (PQM) com remoção da smear layer (SL) em dentes decíduos pulpectomizados tem sido pouco relatada. Objetivo: Esses relatos de casos descrevem a presença de microrganismos totais e Enterococcus faecalis em canais radiculares de incisivos decíduos antes e após PQM com remoção de SL. Relatos dos Casos: Amostras microbiológicas foram coletadas do canal radicular de três crianças (3,66 ± 0,58 anos) com necrose (n = 2) e inflamação pulpar irreversível (n= 1) em incisivos decíduos superiores. Após o isolamento dos dentes com dique de borracha e antissepsia do campo operatório, as coletas das amostras foram realizadas com cones de papel absorvente estéril antes e após o PQM, que incluiu irrigação com hipoclorito de sódio 2,5% seguido de ácido cítrico 6% para retirada do SL. As amostras coletadas foram analisadas imediatamente ao final dos procedimentos clínicos. As placas foram incubadas em anaerobiose durante 48 horas a 37°C. Os resultados foram expressos em unidades formadoras de colônias (UFC)/mL. Resultados: Dois dos três dentes apresentaram microrganismos totais antes do PQM. Um incisivo não apresentava microrganismos na coleta inicial. Nenhuma UFC foi contada nas amostras coletadas após o PQM. Além disso, o E. faecalis não foi observado nenhum momento, nem antes, nem depois do PQM. Conclusão: Não foi detectado E. faecalis em nenhuma amostra, porém dois dos três canais radiculares apresentavam microrganismos antes do PQM. Nos casos em que foram encontrados microrganismos inicialmente, observou-se 100% de eliminação após o protocolo aplicado.

Euterpe Oleracea Mart. (Açaí) Reduces Oxidative Stress and Improves Energetic Metabolism in Myocardial Ischemia-Reperfusion Injury in Rats / Euterpe Oleracea Mart. (Açaí) Reduz o Estresse Oxidativo e Melhora o Metabolismo Energético da Lesão de Isquemia-Reperfusão Miocárdica Em Ratos

Abstract Background: Euterpe oleracea Mart. (açaí) is a fruit with high antioxidant capacity and could be an adjuvant strategy to attenuate ischemia-reperfusion injury. Objective: To evaluate the influence of açaí in global ischemia-reperfusion model in rats. Methods: Wistar rats were assigned to 2 groups: Control (C: receiving standard chow; n = 9) and Açaí (A: receiving standard chow supplemented with 5% açaí; n = 10). After six weeks, the animals were subjected to the global ischemia-reperfusion protocol and an isolated heart study to evaluate left ventricular function. Level of significance adopted: 5%. Results: There was no difference between the groups in initial body weight, final body weight and daily feed intake. Group A presented lower lipid hydroperoxide myocardial concentration and higher catalase activity, superoxide dismutase and glutathione peroxidase than group C. We also observed increased myocardial activity of b-hydroxyacyl coenzyme-A dehydrogenase, pyruvate dehydrogenase, citrate synthase, complex I, complex II and ATP synthase in the A group as well as lower activity of the lactate dehydrogenase and phosphofructokinase enzymes. The systolic function was similar between the groups, and the A group presented poorer diastolic function than the C group. We did not observe any difference between the groups in relation to myocardial infarction area, total and phosphorylated NF-kB, total and acetylated FOXO1, SIRT1 and Nrf-2 protein expression. Conclusion: despite improving energy metabolism and attenuating oxidative stress, açai supplementation did not decrease the infarcted area or improve left ventricular function in the global ischemia-reperfusion model.

Resumo Fundamento: Euterpe oleracea Mart. (açaí) é uma fruta com alta capacidade antioxidante e pode ser uma estratégia adjuvante para atenuar a lesão de isquemia-reperfusão. Objetivo: Avaliar a influência do açaí no modelo global de isquemia-reperfusão em ratos. Metodologia: Ratos Wistar foram divididos em 2 grupos: Controle (C: recebendo ração padrão; n = 9) e Açaí (A: recebendo ração padrão suplementada com 5% de açaí; n = 10). Após seis semanas, os animais foram submetidos ao protocolo global de isquemia-reperfusão e a estudo do coração isolado para avaliar a função ventricular esquerda. Nível de significância adotado: 5%. Resultados: Não houve diferença entre os grupos quanto ao peso corporal inicial e final, e a ingestão diária de ração. O grupo A apresentou menor concentração miocárdica de hidroperóxido lipídico e maior atividade de catalase, superóxido dismutase e glutationa peroxidase do que o grupo C. Também observamos aumento da atividade miocárdica da b-hidroxiacil coenzima-A desidrogenase, piruvato desidrogenase, citrato sintase, complexo I, complexo II e ATP sintase no grupo A, bem como menor atividade das enzimas lactato desidrogenase e fosfofructoquinase. A função sistólica foi semelhante entre os grupos, e o grupo A apresentou função diastólica pior que C. Não foram observadas diferenças entre os grupos em relação à área de infarto do miocárdio, e expressão proteica de NF-kB total e fosforilado, e das proteínas FOXO1, SIRT1 e Nrf-2. Conclusão: apesar de melhorar o metabolismo energético e atenuar o estresse oxidativo, a suplementação de açaí não diminuiu a área infartada nem melhorou a função ventricular esquerda no modelo global de isquemia-reperfusão.

Survey of Knowledge, Attitudes and Practices of Brazilian Dentists Regarding Silver Diamine Fluoride

Abstract Objective: Current acceptability, barriers to use, and clinical/teaching practices of Silver Diamine Fluoride (SDF) among Brazilian dentists were investigated. Material and Methods: A Google forms questionnaire was sent to dentists (n=10,500) to collect information about the use of SDF and the dentists' workplace, experience, specialty, and city of practice. A logistic regression model was performed. Results: From 409 respondents, 13.2% used SDF. Working at universities increased the use of SDF by 2.29 times (p=0.018) compared to private offices. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76, p<0.001). There is no association between SDF usage and the city of practice. The majority (75.9%) indicated SDF for noncompliant patients. Dentists (75.9%) reported the exclusive use in deciduous teeth, while 24.1% also use in permanent teeth. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. Conclusion: The Silver Diamine Fluoride is not a common product used by the dentists from RJ. Its clinical applicability should be further disseminated; thus, lack of scientific knowledge would cease to be a problem in the use of SDF to arrest caries lesions.

Radiopacity of endodontic materials using two models for conversion to millimeters of aluminum

Abstract The aims of the present study were to compare conventional radiography, radiographs digitized with a scanner or photographic camera, and digital radiography, used to evaluate the radiopacity of endodontic materials, and to compare the accuracy of linear and quadratic models used to convert radiopacity values to equivalent millimeters of aluminum (mm Al). Specimens of AH Plus, Endofill, Biodentine and BioMTA materials (n = 8) were radiographed next to an aluminum step-wedge using radiographic films and digital radiography systems (FONA CMOS sensor, Kodak CMOS sensor and photosensitive phosphor plate-PSP). Conventional radiographs were digitized using a scanner or photographic digital camera. Digital images of all the radiographic systems were evaluated using dedicated software. Optical density units (ODU) of the specimens and the aluminum step-wedge were evaluated by a photo-densitometer (PTDM), used in conventional radiographs. The radiopacity in equivalent mm Al of the materials was determined by linear and quadratic models, and the coefficients of determination (R2) values were calculated for each model. Radiopacity of the materials ranged from -9% to 25% for digital systems and digitized radiographs, compared to the PTDM (p < 0.05). The R2 values of the quadratic model were higher than those of the linear model. In conclusion, the FONA CMOS sensor showed the lowest radiopacity variability of the methodologies used, compared with the PTDM, except for the BioMTA group (higher than PTDM). The quadratic model showed higher R2 values than the linear model, thus indicating better accuracy and possible adoption to evaluate the radiopacity of endodontic materials.

Are Behavior Rating Scales Able to Identify Behavioral Changes in Preschool Children Undergoing a Dental Intervention? A Systematic Review

Abstract Objective: To evaluate the scientific evidence concerning the behavior rating scales efficiency to identify behavioral changes in preschool children undergoing dental treatment, through a systematic review. Material and Methods: MEDLINE/PubMed, Scopus, Cochrane Library, Web of Science, BVS databases and grey literature were searched. Also, a hand search of the included studies reference lists was conducted. Studies that evaluated healthy preschoolers' behavior before and after invasive dental treatments to observe behavioral changes were included. Two independent reviewers selected studies, extracted data and analyzed the risk of bias with a tool for before-and-after studies. The certainty of the evidence was evaluated with the GRADE approach. Results: Three studies were included. The Frankl Scale and North Carolina Behavior Scale were used in these studies. Both scales were able to identify behavioral changes in preschool children undergoing a dental intervention, although two of these included studies were considered fair with a high risk of bias, and one considered good with a low risk of bias. Conclusion: Although Frankl and North Carolina behavior scales were able to identify changes in the children`s behavior during dental treatment, these findings are not supported by strong evidence. Thus, further well-designed studies are needed to confirm this evidence.

Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017

Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country's territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

Antibacterial and Cytotoxic Potential of a Brazilian Red Propolis

Objective: To evaluate in vitro the effect of a red propolis ethanolic extract (RPE) in the prevention of growth of a cariogenic biofilm and its cytotoxic potential. Material and Methods: Minimum inhibitory and bactericidal concentrations (MIC and MBC) of RPE against Streptococcus mutans and Lactobacillus casei were determined. The cytotoxic potential of 0.4% RPE in oral fibroblasts was observed after 1, 3 and 5 min of contact. Cellulose membrane disks (13 mm, N=12) were used for biofilm formation (24 h) of S. mutans and L. casei, which were treated (1 min) with 0.4% RPE or 0.12% Chlorhexidine (CHX). The control group of biofilm formation was not submitted to any treatment. Serial dilutions were then made to evaluate microbial viability. Descriptive data analysis and, for microbial viability, Mann Whitney test were performed (p≤0.05). Results: RPE showed similar MIC and MBC (4.46 mg/mL) against S. mutans and, for L. casei, they were 8.92 mg/mL (MIC) and 17.85 mg/mL (MBC). CHX presented MIC and MBC <0.00002 mg/mL for S. mutans and 0.00047 mg/mL for L. casei. After 1, 3 and 5 min, the RPE exhibited, respectively, 69.38%, 43.91% and 40.36% of viable cells. The RPE (6.55) and CHX (6.87) presented similar efficacy to reduce the total number of viable bacteria (p>0.05). Regarding the total number of viable bacteria (Log10 CFU/mL), the RPE (6.55) and CHX (6.87) presented similar efficacy (p>0.05). Conclusion: Red propolis extract showed antibacterial activity against the tested strains, exhibited acceptable cytotoxicity and reduced the colonization of S. mutans and L. casei in a biofilm membrane model.