Evaluation of the remineralizing capacity of silver diamine fluoride on demineralized dentin under pH-cycling conditions

Abstract Objective (1) to determine the effects of the silver diamine fluoride (SDF) and sodium fluoride (NaF) in demineralized dentin exposed to an acid challenge by pH-cycling, (2) to evaluate the remineralizing capacity of SDF/NaF products based on the physicochemical and mechanical properties of the treated dentin surfaces. Methodology In total, 57 human molars were evaluated in different stages of the experimental period: sound dentin - negative control (Stage 1), demineralized dentin - positive control (Stage 2), and dentin treated with SDF/NaF products + pH-c (Stage 3). Several commercial products were used for the SDF treatment: Saforide, RivaStar, and Cariestop. The mineral composition and crystalline and morphological characteristics of the dentin samples from each experimental stage were evaluated by infrared spectroscopy (ATR-FTIR), X-ray diffraction, and electron microscopy (SEM-EDX) analytical techniques. Moreover, the mechanical response of the samples was analyzed by means of the three-point bending test. Statistics were estimated for ATR-FTIR variables by Wilcoxon test, while the mechanical data analyses were performed using Kruskal-Wallis and Mann Whitney U tests. Results Regarding the chemical composition, we observed a higher mineral/organic content in the SDF/NaF treated dentin + pH-c groups (Stage 3) than in the positive control groups (Saforide p=0.03; Cariestop p=0.008; RivaStar p=0.013; NaF p=0.04). The XRD results showed that the crystallite size of hydroxyapatite increased in the SDF/NaF treated dentin + pH-c groups (between +63% in RivaStar to +108% in Saforide), regarding the positive control. SEM images showed that after application of the SDF/NaF products a crystalline precipitate formed on the dentin surface and partially filled the dentin tubules. The flexural strength (MPa) values were higher in the dentin treated with SDF/NaF + pH-c (Stage 3) compared to the positive control groups (Saforide p=0.002; Cariestop p=0.04; RivaStar p=0.04; NaF p=0.02). Conclusions The application of SDF/NaF affected the physicochemical and mechanical properties of demineralized dentin. According to the results, the use of SFD/NaF had a remineralizing effect on the dentin surface even under acid challenge.

Manejo de la caries dental en tiempos de covid-19: Revisión de literatura / Management of dental caries in times of covid-19: A literature review

Antecedentes: En la odontología siempre se ha buscado la implementación de alternativas más conservadoras para el manejo de la caries dental, siendo en este caso una de las opciones el uso de Fluoruro Diamino de Plata más Yoduro de Potasio, el cual es un producto que de fácil aplicación que permite la inactivación de la Caries Dental.Objetivo:Determinar si es viable uso de Fluoruro Diamino de Plata más Yoduro de Potasio para la inactivación de lesiones cariosas. Materiales y Métodos:Estudio descriptivo cualitativo transversal para el cual se realizó una revisión de la literatura reciente asociada a revistas con bases de datos indexadas. Resultados:Se obtuvieron un total de 103 artículos, los cuales fueron analizados y seleccionados 40, siendo excluidos 63 por no cumplir los criterios de inclusión. Conclusión:El uso de Fluoruro Diaminode Plata más Yoduro de Potasio para la inactivación de lesiones cariosas, resulta ser una alternativa eficaz para evitar la emisión de partículas de aerosol, reduciendo en gran medida el riesgo de contagio del COVID-19 durante el tratamiento dental

Background: In dentistry, the implementation of more conservative alternatives for the management of dental caries has always been sought. One option is the use of Silver Diamine Fluoride plus Potassium Iodide, which is a product easy to apply and allows the inactivation of dental caries.Aim:To determine if it is feasible to use Silver Diamine Fluoride plus Potassium Iodide for the inactivation of carious lesions. Materials and methods:This is a retrospective cross-sectional documentary qualitative descriptive study for which a review of recent literature associated with journals with indexed databases was carried out. Results:A total of 103 articles were obtained, which were analyzed and 40 of the 103 were selected, for the reason that the remaining 63 did not meet the inclusion criteria. Conclusion:The use of Silver Diamine Fluoride plus Potassium Iodide for the inactivation of carious lesions, turns out to be an effective and viable alternative, that reduce the emission of aerosol particles, thus reducing the risk of infection of N-COVID-19 during dental treatment

Infección de sitio operatorio en herida abdominal sucia / Operative site infection in dirty abdominal wounds

Introducción. La infección del sitio operatorio (ISO) es la causa más común de infección en pacientes quirúrgicos. La curación en el periodo posquirúrgico parece tener gran impacto en este resultado. Objetivo. Evaluar la disminución de infección posoperatoria superficial o profunda en pacientes con heridas abdominales sucias, al realizar curaciones con apósitos de hidrofibra con plata o apósitos de gasa. Asimismo, evaluar la satisfacción y la presencia de dolor durante las curaciones, identificar eventos adversos y cambios en la estancia hospitalaria. Métodos. Es un ensayo clínico aleatorizado abierto, realizado en pacientes mayores de 18 años operados por alguna urgencia quirúrgica abdominal y con herida clasificada como sucia en el Hospital Universitario San Vicente Fundación o la IPS Universitaria entre diciembre de 2016 y enero de 2018. Durante el seguimiento se tomaron datos de consultas al servicio de urgencias y consulta externa, y así, se evaluaron los reingresos, la ISO y la mortalidad. Resultados. De 78 pacientes elegibles, se incluyeron 69 en el análisis final: a 34 se les hizo curación con gasa y, a 35, curación con apósitos de hidrofibra. No se encontraron diferencias estadísticamente significativas para el desarrollo de ISO, entre la curación con gasa y aquella con hidrofibra, tampoco en cuanto a la presencia de dolor o la duración de la estancia hospitalaria. Conclusión. El uso de apósitos de hidrofibra con plata en las curaciones de heridas sucias abdominales, puede tener beneficios. Sin embargo, en este estudio no se encontró ninguna diferencia al compararla con la gasa

Introduction: Surgical site infection (SSI) is the most common cause of infection in surgical patients. Post-surgical wound care treatment seems to have a great impact on this outcome. Objective: To evaluate the decrease of superficial or deep SSI in patients with an abdominal surgical wound managing wound care with silver hydrofiber or gauze. Likewise, to evaluate the satisfaction and presence of pain during care of the wound, and to identify adverse events and changes during the hospital stay. Methods: Open-label randomized clinical trial carried out in patients older than 18 years with an abdominal surgical emergency at Hospital San Vicente Fundación and IPS Universitaria, Medellín, Colombia, and wound classified as dirty between December 2016 and January 2018. Follow-up of the data of the consultations to the emergency service and external consultations, evaluate readmissions, SSI and mortality associated. Results: 78 eligible patients, 69 in the final analysis, 34 had wound care treatment with gauze and 35 with hydrofiber dressing. We did not find statistically significant differences for the development of SSI between the wound care treatment with gauze and with hydrofiber, neither in terms of the presence of pain or in the hospital length of stay. Conclusion: The use of iconic silver hydrofiber in the healing of the dirty abdominal surgical wounds may have benefits, however in this study no difference was found when compared with gauze

General treatment and wound management in hereditary epidermolysis bullosa: indication and experience using silver hydrofiber dressing / Tratamento geral e das feridas na epidermólise bolhosa hereditária: indicação e experiência usando curativo de hidrofibra com prata

Introduction: Hereditary epidermolysis bullosa (EB) is a rare disorder characterized by cutaneomucous fragility, with formation of blisters during minimal trauma. Treatment consists of clinical and nutritional support and management of pain and skin lesions. Silver hydrofiber (Aquacel Ag®) is a type of carboxymethylcellulose fiber dressing with silver that can be used in selected cases of EB. Objective: To review the literature on the general treatment and management of cutaneous lesions in congenital EB and evaluate the indication and experience of using silver hydrofiber dressing. Methods: The review included original articles and systematic reviews published between 2009 and 2014. We also selected two patients with congenital EB treated at the Plastic Surgery Division of Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto at the University of São Paulo. Results: There is a shortage of scientific evidence related to the treatment of skin lesions in congenital EB, with most recommendations being based on expert opinions. Hydrofiber is indicated in most consensuses for wounds with some exudation and has been shown to be more absorbent than alginate. In our experience, there was apparent improved control of pain, bleeding, and hypothermia with the use of hydrofiber, which has the advantage of not requiring daily changes and can remain on the wound for up to two weeks. Conclusions: The general and lesion treatments in EB are challenging. Hydrofiber with silver is a treatment option for wounds in hereditary EB, without the need for daily dressing changes.

Introdução: Epidermólise bolhosa (EB) hereditária é uma desordem rara caracterizada pela fragilidade cutaneomucosa, com formação de bolhas ao mínimo trauma. O tratamento consiste em suporte clínico, nutricional, manejo da dor e das lesões cutâneas. A hidrofibra com prata (Aquacel Ag®) é um tipo de curativo de fibra de carboximetilcelulose e prata que pode ser utilizada em casos selecionados de EB. Objetivo: Revisão da literatura sobre o tratamento geral e o manejo das lesões cutâneas na EB congênita, além de avaliar a indicação e experiência usando curativo de hidrofibra com prata. Métodos: A revisão incluiu artigos originais e revisões sistemáticas, publicados entre 2009 e 2014. Selecionamos ainda dois pacientes com EB congênita tratados na Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Resultados: Há escassez de evidências científicas relacionadas ao tratamento das lesões cutâneas na EB congênita, sendo a maioria das recomendações baseadas em opiniões de especialistas. A hidrofibra está indicada na maioria dos consensos para feridas com alguma exsudação e mostrou-se mais absorvente que o alginato. Em nossa experiência, houve aparente melhor controle da dor, do sangramento e da hipotermia com o uso da hidrofibra, que apresenta a vantagem de não necessitar de trocas diárias, podendo permanecer na ferida por até duas semanas. Conclusões: O tratamento geral e das lesões na EB é um desafio. A hidrofibra com prata é uma opção de tratamento para as feridas na EB hereditária, sem necessidade de trocas diárias de curativo.

Argyria - Case report / Argiria - Relato de caso

A 70-year-old male rural worker was referred to our clinic with widespread grey pigmentation of the skin and nails. The condition had been asymptomatic for its entire duration (5 years). He reported past intranasal application of 10% Silver Vitellinate. A skin biopsy was performed and histology corroborated the clinical diagnosis of Argyria. This case represents a currently rare dermatological curiosity. Although silver colloids and salts have been withdrawn and/or banned by some drug surveillance agencies, they continue to be freely sold and unregulated as food supplements and as ingredients in alternative medicines, thereby risking the emergence of new cases of silver poisoning.

Um homem de 70 anos, trabalhador rural, foi referenciado à nossa consulta por dermatose assintomática, com 5 anos de evolução, caracterizada pela pigmentação acinzentada generalizada da pele, mais evidente em áreas fotoexpostas, e das lâminas ungueais. Relatava no passado o uso prolongado de Vitelinato de Prata a 10%, por via nasal. Foi efetuado exame histológico de biopsia cutânea que corroborou o diagnóstico clínico de Argiria. O caso representa uma curiosidade dermatológica, atualmente rara. Apesar de abandonados e/ou proibidos por algumas instituições de farmacovigilância, a prata coloidal e sais de prata continuam a ser comercializados como suplementos alimentares, como parte de medicinas alternativas e sem regulação, podendo fazer ressurgir os casos associados à toxicidade pela prata.

Tratamento ambulatorial de queimaduras com prata nanocristalina em malha flexível: uma alternativa terapêutica / Ambulatory treatment of burns with nanocrystalline silver in flexible mesh: an alternative therapeutic

Objetivo: Avaliar a eficácia e o tempo de tratamento de pacientes em tratamentoambulatorial com prata nanocristalina em malha flexível na Unidade de Tratamento de Queimados do Hospital Regional de Sorocaba. Método: Série de casos na qual foram selecionados pacientes vítimas de queimadura emmembros superiores, que não possuíam critérios de internação no período entre junho de 2011 e junho de 2012. Foram incluídos oito pacientes. Todos apresentavam queimaduras de 2º grau, sem sinais de infecção local, acometendo membros superiores. A média de idade foi de 24,87 anos. A porcentagem de área queimada foi calculada segundo a tabela de Lund e Browder. Os pacientes foram submetidos à lavagem do curativo com soro fisiológico e desbridamento se necessário. Em seguida, foi aplicada uma malha de poliéster flexível contendo prata nanocristalina, recoberta por gaze e faixa tipo crepe. Os pacientes eram examinados a cada três dias e, se necessário, um novo curativo foi realizado. Todos os pacientes foram acompanhados até a cicatrização total da queimadura. Resultados: A maioria das lesões foi causada por escaldo, seguido por fogo econtato. A média de dias dos curativos contendo a malha de poliéster com prata nanocristalina foi de 13 dias. Conclusão: A malha de poliéster flexível mostrouse eficaz na cicatrização de queimaduras e uma boa alternativa terapêutica.

Purpose: Evaluate the efficacy and time of treatment of patientes in ambulatory treatment with nanocrystalline silver in flexible mesh in the Unit of Treatment of Burns int the Regional Hospital in Sorocaba. Methods: Series of cases in which were selected patients victms of burns in upper limbs, that had no criterion of internment in the period between June 2011 and June 2012. In the study eight patients were included. All of them have second degree burn, with no local infection in the upper limbs. The mean of age was 24,87 years. The burn area was calculated by the Lund and Browder table. The patients had their wounds washed with saline sodium chloride solution and debridement if necessary. After that, was apllied a flexible polyester mesh with nanocrystalline silver, and covered with gaze and band. The patients were examined every three days and if it necessary a new dressing was made. All the patients were monitored until the total healing. Results: The most of burns was caused by skald, followed by fire and contact. The mean of days with the mesh with nanocrystalline silver was 13 days. Conclusion: The polyester mesh with nanocrystalline silver was effective in the healing of burns and a good alternative therapeutic.

Biocompatibility test of polymethylmethacrylate denture base resin containing silver-supported antimicrobial agent STR-1 at nanometer level / 北京大学学报(医学版)

Objective: To evaluate the biocompatibility of polymethylmethacrylate(PMMA) denture base resin containing silver-supported antimicrobial agent STR-1 of nanometer level in vitro. Methods: According to the national standards for biological evaluation of dental materials, the cytotoxicity of denture base resin containing STR-1 at concentrations of 5 g/L and 10 g/L was examined by molecular filtrating method, and the hemolysis of STR-1, denture base resin containing STR-1 at concentrations of 5 g/L and 10 g/L was also surveyed. Results: The control denture base resin without containing STR-1 and the denture base resins containing STR-1 at concentrations of 5 g/L and 10 g/L were not cytotoxic to L929 cells. Two hours and 24 hours after cell culturing, the filter membranes of the control and experimental groups were stained evenly with blue color. The staining intensity was not decreased and the fading areas were 0 mm~2 during the culturing. The cytotoxicity grades were 0. The hemolysis rates of the antimicrobial agent STR-1 and the denture base resins containing STR-1 at concentrations of 5 g/L and 10 g/L were 1.7%, 3.5% and 3.7% respectively. They were less than the national guild standard 5% which represent no hemolysis. Conclusion: The PMMA denture base resins containing silver-supported antimicrobial agents STR-1 of nanometer level at concentrations of 5 g/L and 10 g/L exhibit good biocompatibility.