Enfermedad injerto contra huesped: sus manifestaciones bucales / Graft-versus-host disease: its oral manifestations

La enfermedad injerto contra huésped es la principal complicación que sufren los pacientes que han recibido trasplante alogénico. Se produce como consecuencia de una reacción inflamatoria exagerada mediada por los linfocitos del donante y estimulada por aquellos tejidos que han sido lesionados por la enfermedad de base, por las infecciones previas o por el tratamiento de acondicionamiento. El diagnóstico es clínico e histopatológico. Los pacientes presentan rash maculopapular pruriginoso y doloroso que puede extenderse por toda la superficie corporal, fiebre, vómito, náuseas, diarrea y anorexia. En la mucosa bucal se observan erosiones ulceradas, extremamente dolorosas y pueden ser la primera o la única manifestación detectable clínicamente de esta enfermedad. El objetivo es presentar un caso de enfermedad de injerto contra huésped. Se trata de una mujer de 54 años de edad con linfoma no-Hodgking, que recibió tratamiento con quimioterapia, radioterapia y trasplante de células madre hematopoyéticas en el 2009. Tres meses después, presentó lesiones en la piel diagnosticadas como enfermedad injerto contra huésped y tratadas con corticoesteroides, a los seis meses fue remitida al odontólogo porque se quejaba de ardor en la boca, xerostomía y dificultad para masticar, tenía úlceras en la mucosa bucal y en la lengua. En la ocasión recibió tratamiento con corticoesteroides, clorhexidina, orientaciones de higiene bucal y controles clínicos permanentes. Aunque existen protocolos para la prevención y el tratamiento de la enfermedad injerto contra el huésped, su frecuencia ha aumentado en los últimos años debido al incremento en el número de trasplantes. Por esta razón, es fundamental que el odontólogo forme parte del grupo multidisciplinario que asiste al paciente y que esté familiarizado con los signos y síntomas de esta enfermedad en la mucosa bucal, pues las manifestaciones clínicas pueden ser las únicas para realizar el diagnóstico(AU)

Graft-versus-host disease is the main complication following an allogeneic tissue transplant. It is caused by an exaggerated inflammatory reaction mediated by donor lymphocytes and stimulated by tissues lesioned by the underlying disease, by previous infection or by the conditioning treatment. The diagnosis is clinical and histopathological. Patients have itchy and painful maculopapular rash that can spread throughout the entire body surface, fever, vomiting, nausea, diarrhea and anorexia. Extremely painful ulcerated erosions occur in the oral mucosa, which may be the first or the only clinically detectable manifestation of the disease. The objective is to report a case of graft-versus-host disease. A 54 year-old woman with non-Hodgkin lymphoma was treated with chemotherapy, radiation therapy and hematopoietic cell transplantation in 2009. After three months, she presented skin lesions diagnosed as graft-versus-host disease and received corticosteroids. Six months later, she was referred to the dentist because of complaints of xerostomia, a burning sensation in her mouth and difficulty chewing. She also had ulcers in the oral mucosa and tongue. This time she received topical corticosteroid therapy, chlorhexidine, oral hygiene instructions and permanent clinical control. Despite some protocols for the prevention and treatment of graft-versus-host disease, its frequency has recently risen due to the increasing number of transplants. For this reason, it is essential for the dentist to be part of the multidisciplinary team treating the patient, and familiar with the signs and symptoms of the disease, since clinical manifestations may be the only ones at hand to make the diagnosis(AU)

Prevalencia de gingivitis y factores asociados en estudiantes de la Universidad Autónoma de Guerrero, México / Prevalence of gingivitis and associated factors among students from the Autonomous University of Guerrero, Mexico

Introducción: la gingivitis es la enfermedad más común del periodonto, la medida profiláctica más efectiva y económica es la higiene bucal. Objetivos: estimar la prevalencia de gingivitis e identificar factores de riesgo asociados en universitarios de primer ingreso. Métodos: se realizó un estudio transversal de septiembre a diciembre de 2012. Se encuestó a 1 387 estudiantes de licenciatura de la Universidad Autónoma de Guerrero en Acapulco, México. No se estimó tamaño de la muestra porque se encuestó a todos los inscritos. Los instrumentos para la recolección de datos fue un cuestionario autoadministrado, formatos para inspección bucal y levantamiento de índice de higiene oral de Green y Vermillion simplificado, e índices de placa y gingivitis de Löe y Silness simplificados. El diagnóstico de gingivitis se hizo con los valores clínicos del índice de Löe y Silness considerando los puntajes de 0 a 0,09 como sano. La variable resultado fue gingivitis y las de causa: placa dentobacteriana, mala higiene bucal, tártaro, detritos, diastemas, aparatos de ortodoncia, apiñamiento dental y desgastes cervicales. Resultados: la prevalencia de gingivitis ponderada por conglomerado de escuelas fue 74,5 por ciento, de la cual 62,8 por ciento fue leve, 11,5 por ciento moderada, y 0,2 por ciento intensa. El 16 por ciento de los estudiantes, según el índice de Green y Vermillion, tuvo mala higiene y 87,3 pore ciento tuvo placa según criterio de Löe y Silness. Ajustando por conglomerados y los demás factores, cuatro factores fueron asociados a gingivitis: mala higiene bucal (OR 2,58 IC 95 por ciento 1,32-5,05), detritos (OR 2,62 IC 95 por ciento 1,49-4,58), diastemas (OR 1,72; IC 95 por ciento 1,13-2,64) y desgastes en cervical (OR 0,49; IC 95 por ciento 0,24-1,00). Conclusiones: la prevalencia de gingivitis se encontró dentro del rango reportado en otros estudios. La mala higiene bucal, detritos y diastemas fueron los factores de riesgo asociados a gingivitis(AU)

Introduction: gingivitis is the most common periodontal disease. The most effective prophylactic measure against this condition is oral hygiene. Objectives: estimate the prevalence of gingivitis and identify associated risk factors among first year university students. Methods: across-sectional study was conducted from September to December 2012 based on a survey applied to 1 387 students from the Autonomous University of Guerrero in Acapulco, Mexico. Sample size was not estimated because all the students registered were surveyed. The data collection tools used were a self-applied questionnaire, oral examination forms, the simplified Green and Vermillion oral hygiene index, and the simplified Löe and Silness plaque and gingivitis indices. Gingivitis was diagnosed with values on Löe and Silness indices, where scores from 0 to 0.09 were considered healthy. The result variable studied was gingivitis. Cause variables were dental plaque, poor oral hygiene, tartar, detritus, diastema, orthodontic appliances, dental crowding and cervical wear. Results: prevalence of gingivitis estimated by school cluster was 74.5 percent, of which 62.8 percent was mild, 11.5 percent was moderate and 0.2 percent was severe. According to the Green and Vermillion index, 16 percent of the students had poor hygiene, and according to the Löe and Silness indices 87.3 percent had plaque. Adjustment by clusters and other variables revealed four factors associated with gingivitis: poor oral hygiene (OR 2.58; CI 95 percent; 1.32-5.05), detritus (OR 2.62; CI 95 percent; 1.49-4.58), diastema (OR 1.72; CI 95 percent; 1.13-2.64) and cervical wear (OR 0.49; CI 95 percent; 0.24-1.00). Conclusions: prevalence of gingivitis was found to be within the range reported by other studies. Poor oral hygiene, detritus and diastema were the risk factors associated with gingivitis(AU)

Comportamento de risco para bulimia nervosa, hábitos alimentares e de higiene bucal como fatores associados ao desgaste dentário erosivo e cárie dentária em adolescentes / Bulimia nervosa risk behavior, dietary habits and oral hygiene practices as associated factors for erosive tooth wear and dental caries among adolescents

Os distúrbios alimentares possuem uma etiologia multifatorial, composta de predisposições socioculturais, genéticas e vulnerabilidades biológicas e psicológicas. Entre os fatores predisponentes, destacam-se os padrões de interação presentes no ambiente familiar e o contexto sociocultural, caracterizado pela extrema valorização do corpo. A presença de algumas condições bucais, como o desgaste dentário erosivo e a cárie dentária, pode estar relacionada à ocorrência de distúrbios alimentares, como a bulimia nervosa (BN). Pesquisas sobre fatores de risco favorecem a análise oportuna de possíveis sinais e sintomas e, consequentemente, o estabelecimento de condutas preventivas. Este trabalho objetivou comparar a ocorrência do desgaste dentário erosivo e da cárie dentária em adolescentes com e sem comportamento de risco para BN, e investigar a influência de hábitos alimentares e de higiene bucal na ocorrência de desgaste dentário erosivo e da cárie dentária. Aprovação ética e termos de consentimento foram obtidos. A amostra foi composta por 225 escolares do sexo feminino, na faixa etária de 15 a 18 anos, oriundas de escolas das redes pública e particular de ensino de Belo Horizonte, no sudeste do Brasil. O comportamento de risco para BN foi avaliado segundo as subescalas de sintomas e gravidade dos sintomas da versão brasileira do Teste de Investigação Bulímica de Edinburgh (BITE) sendo categorizado em: hábito alimentar normal, comportamento de risco clinicamente significante e grave comportamento de risco. Os hábitos alimentares e de higiene bucal foram avaliados através de questionários autoaplicáveis. O desgaste dentário erosivo e a cárie dentária foram avaliados através dos índices de O'Sullivan e ICDAS II, respectivamente, por uma examinadora previamente calibrada (Kappa intra-examinador: 0,90 e 0,81; Kappa inter-examinadores: 0,88 e 0,83, referentes à erosão e à cárie dentária). Os dados foram analisados de forma descritiva e inferencial, através do software SPSS 18.0 (p<0,05). Através do modelo de regressão logística constatou-se que o grave comportamento de risco para a BN foi associado com o desgaste dentário erosivo (OR = 8,31; IC 95% = 3,91-16,91), e com adolescentes provenientes de escolas privadas (OR = 3,11 IC 95% = 1,44-6,45), mas não com a cárie dentária (OR = 1,13, IC 95% = 0,72-1,73). O comportamento de risco clinicamente significante para bulimia não foi associado às condições bucais avaliadas (p>0,05). Com relação aos hábitos alimentares, o desgaste dentário erosivo foi associado ao consumo diário de frutas cítricas (p<0,009) e refrigerantes com açúcar (p<0,046), enquanto a cárie dentária foi associada ao consumo diário de biscoitos recheados (p<0,049). O hábito de escovar os dentes imediatamente após as refeições foi estatisticamente associado à ocorrência de desgaste dentário erosivo no grupo com grave comportamento de risco para BN (p=0,047). O comportamento de risco para BN, caracterizado como clinicamente significante, não foi associado com implicações dentárias, mas o grave comportamento de risco para BN foi associado com a ocorrência de desgaste dentário erosivo. Hábitos alimentares e de higiene bucal foram associados à presença de desgaste dentário erosivo e cárie dentária

Eating disorders have a multifactorial etiology, composed of sociocultural and genetic predispositions as well as biological and psychological vulnerabilities. Among the predisposing factors, it is important to highlight the interaction patterns present in the family environment and the sociocultural context characterized by the overvaluation of the body and beauty standards. The presence of some dental implications such as erosive tooth wear and dental caries may be related to the occurrence of eating disorders such as bulimia nervosa (BN). Research on eating disorders' risk factors favors the timely analysis of possible signs and symptoms and, consequently, the establishment of preventive measures. This study aimed to compare the occurrence of erosive tooth wear and dental caries in adolescents with and without risk factor for BN, and investigate the influence of dietary habits and oral hygiene practices with the occurrence of erosive tooth wear and dental caries. Ethical approval and written consent forms were obtained. The sample consisted of female students, aged 15-18 years, from private and public schools in Belo Horizonte, southeastern Brazil. Risk behavior for BN was evaluated according to the subscales of symptoms and severity of the Brazilian version of the Bulimic Investigatory Test of Edinburgh (BITE) and classified in normal eaten behavior, clinically significant bulimic risk behavior and severe bulimic risk behavior. Eating habits and oral hygiene practices were assessed using validated self-report questionnaires. Erosive tooth wear and dental caries were evaluated by the O'Sullivan index and the ICDAS-II index, respectively, by a previously calibrated examiner (intraexaminer Kappa: 0.90 and 0.81, Kappa inter-examiner: 0.88 and 0.83, related to tooth erosion and dental caries). The data were analyzed descriptively and inferentially, using SPSS 18.0 software (p <0.05). Through the logistic regression model it was found that the severe risk behavior for BN was associated with erosive tooth wear (OR = 8.31; 95% CI = 3.91-16.91), and adolescents from private schools (OR = 3.11 95% CI = 1.44- 6.45), but not with dental caries (OR = 1.13, 95% CI = 0.72-1.73). The clinically significant risk behavior for BN was not associated with the assessed oral conditions (p> 0.05). With regard to eating habits, erosive tooth wear was associated with daily consumption of citric fruits (p<0.009), and soft drinks with sugar (p<0.046), while dental caries was associated with the daily consumption of cream biscuits (p<0.049). The habit of brushing the teeth shortly after eating was statistically associated with the occurrence of erosive tooth wear in the group with severe risk behavior for BN (p = 0.047). The risk behavior for BN, classified as clinically significant, was not associated with dental implications, but the severe risk behavior for BN was associated with the occurrence of erosive tooth wear. Dietary and oral hygiene habits were associated with the presence of erosive tooth wear and dental caries.

Combined effect of end-rounded versus tapered bristles and a dentifrice on plaque removal and gingival abrasion

Abstract Two previous clinical studies evaluated the effect of end-rounded versus tapered bristles of soft manual brushes on the removal of plaque and gingival abrasion. However, the combined effect of an abrasive dentifrice on these outcomes has yet to be understood. The purpose of the present study was to compare the incidence of gingival abrasion and the degree of plaque removal obtained after the use of toothbrushes with tapered or end-rounded bristles in the presence or absence of an abrasive dentifrice. The study involved a randomized, single-blind, crossover model (n = 39) with a split-mouth design. Subjects were instructed to refrain from performing oral hygiene procedures for 72 hours. Quadrants were randomized and subjects brushed with both types of toothbrushes using a dentifrice (relative dentin abrasion = ± 160). Plaque and gingival abrasion were assessed before and after brushing. After 7 days, the experiment was repeated without the dentifrice. The average reduction in plaque scores and the average increase in the number of abrasion sites were assessed by repeated-measures ANOVA and Bonferroni's post-hoc tests. End-rounded bristles removed significantly more plaque than tapered bristles, regardless of the use of a dentifrice. The dentifrice did not improve plaque removal. In the marginal area (cervical free gingiva), no difference in the incidence of gingival abrasion was detected between toothbrush types when used with a dentifrice (p ≥ 0.05). However, the dentifrice increased the incidence of abrasion (p < 0.001), irrespective of the toothbrush type tested. End-rounded bristles therefore removed plaque more effectively without causing a higher incidence of gingival abrasion when compared with tapered bristles. An abrasive dentifrice can increase the incidence of abrasion, and should be used with caution by individuals who are at risk of developing gingival recession.

Estimación cualitativa del peso de la crema dental en niños / Qualitative estimate of the weight of the toothpaste in children

Introducción: para el control de la fluorosis dental, se realizan estudios en la población para investigar la cantidad de crema dental que se utiliza en el cepillado de forma fácil y rápida. Este es un indicador importante para identificar posibles factores que se estén relacionando con la fluorosis. Objetivo: diseñar un instrumento cualitativo para estimar el peso de la crema dental que utilizan los niños entre dos y seis años durante el cepillado y describir el uso y manejo de la crema dental de los niños. Métodos: se realizó un estudio descriptivo transversal. La muestra estuvo conformada por el total de niños que asistieron a las clínicas durante seis meses (N=143); se evaluó variables sociodemográficas y el manejo de la crema dental. Se le pidió al padre/acudiente o el niño, según quien dispensa la crema, colocarla en un cepillo dental y se determinó el peso de la crema dental, luego se seleccionó una de las cuatro figuras del cepillo dental con crema. Resultados: el promedio de edad fue de 4,8 años. El 76,9 por ciento de los padres no conocen sobre la cantidad de crema dental que deben utilizar los niños. La cantidad promedio de crema que utilizan los niños fue de 0,514g ± 0,27g. El modelo utilizado para la estimación del peso de la crema dental, resultó estadísticamente adecuado (p=0,000). La estimación de la crema dental por medio del diagrama explica un 31 por ciento (R2) la variabilidad de la cantidad de crema dental que utilizan los niños. Conclusiones: los niños utilizan el doble de la cantidad de crema dental recomendada. Los esquemas gráficos con cuatro figuras de cepillos dentales con diferentes cantidades de crema, es un buen instrumento de medición para estimar la cantidad de crema dental real que utilizan los niños en edad de riesgo de fluorosis(AU)

Introduction: it has been necessary to perform population studies where indicated the amount of toothpaste used in brushing quickly and easily in the control of the fluorosis, considering that the amount of toothpaste is an important factor to identify the possible factors associated with fluorosis. Objectives: designing a qualitative tool to estimate the weight of toothpaste used by children between 2 and 6 years during brushing and describe the use and management of children's toothpaste. Methods: a cross sectional descriptive study was made; the sample consisted of the total number of children who attended the clinic for 6 months (N = 143), it was evaluated sociodemographic variables and the toothpaste handling. The parents or children were asked to dispense the normal among of toothpaste in the toothbrush, the weight was determined, and then they had to select one of the 4 figures of the toothbrush with toothpaste in a diagram. Results: the mean of age was 4, 8 years. The 76, 9 percent of the parents don't know the proper amount of tooth paste that they should use. The average of toothpaste weight was 0,514 g ± 0,27g, the selected weight estimation model was statistically significant (p=0.000). The toothpaste weight estimation through diagram represents in the 31 percent of the cases with the real amount of tooth paste used. Conclusions: children use twice the amount of recommended toothpaste. The graphic diagrams with 4 toothbrushes with different toothpaste amounts is considered a good measurement tool to estimate the real amount of tooth paste used by risk aged children, with statistical correlation(AU)

Condição bucal de pacientes cardiopatas internados no Hospital Santa Catarina de Blumenau / Buccal condition of cardiopatic patients admitted at Santa Catarina Hospital in Blumenau

Atualmente, têm-se enfatizado a relação das doenças bucais com as sistêmicas, principalmente as cardiopatias. A higiene bucal dos pacientes internados também é essencial para evitar a proliferação de bactérias e fungos, que, além de prejudicar a saúde bucal e o bem-estar do paciente, pode propiciar outras infecções e doenças sistêmicas. Objetivo: O objetivo desta pesquisa foi analisar a condição bucal de pacientes cardiopatias internados no Hospital Santa Catarina, de Blumenau/SC, no período de abril de 2011 a janeiro de 2012. Métodos: A condição clínica foi avaliada mediante os seguintes indicadores: presença ou ausência de cálculo e placa visível clinicamente, situação de edentulismo (parcial ou total), presença de sinais clínicos visíveis de inflamação da mucosa gengival, presença de cárie dental e próteses fixas ou removíveis. Resultados: Foram avaliados 150 pacientes, cujas idades variaram entre 21 e 85 anos, sendo 52% do gênero masculino e, destes, 56% apresentaram a cardiopatia fluter atrial. Entre os pacientes, 98% apresentaram algum tipo de edentulismo, parcial ou total. Apenas 2% dos pacientes informaram que realizavam higienização oral três vezes ao dia, sendo observada inflamação gengival em 47,3%, presença de cálculo em 90% e placa visível em 96,66% dos pacientes. Quanto ao uso de próteses, 98% faziam uso de algum tipo: Conclusão: Concluiu-se que a condição de saúde bucal dos pacientes avaliados pode ser considerada alarmante, Com isso, constata-se como é importante a presença de uma equipe de profissionais da odontologia no ambiente hospitalar.

Currently it has been emphasized the link between oral and systemic disease, mainly the heart disease. The oral care of hospitalized patients is also essential to avoid the proliferation of bactéria and fungi, which, in addition to affecting the oral health and well-being of the patient, may provide other infections and systemic diseases. Objective: The purpose of this research was to analyze the buccal condition of cardiac patients at Santa Catarina Hospital of Blumenau - Santa Catarina. Methods: The clinical condition was evaluated using the following indicators: dental plaque and calculus clinically visible, edentulism sistuation (partial or complete), clinical inflammation signs of the gingival mucosa, presence of dental caries and removable and fixed dental prosthesis. Results: 150 patients between 21 and 85 years-old were ealuated, 52% were male and 56% of those had the atrial flutter heart disease. Among the patients, 98% had some kind of partial or complete edentulism. Only 2% of the patients informed that oral hygiene was performed three times a day, gingival inflammation was detected in 47.3%, calculus were detected in 90% and visible plaque in 96.66% of the patients. Regarding the use of dental prothesis, 98% were using some type. It may be concluded that theses patients have na oral health conditions which is very concerning. Conclusion: According to these results it is clear how importante the presence of a dental professional team is in the hospital.

Lesiones periapicales agudas en pacientes adultos / Acute periapical lesions in adult patients

Se realizó un estudio analítico de corte transversal en el área de salud del Policlínico 27 de Noviembre del municipio Marianao, La Habana, en el periodo correspondiente de enero a diciembre de 2009. Se incluyeron todos los pacientes que acudieron al servicio de urgencia y que presentaron lesiones periapicales agudas. Se recogió información de las variables edad, sexo, grupo dentario, causa de la enfermedad, características clínicas e higiene bucal. Esta última se clasificó en las categorías eficiente y deficiente según el índice simplificado de higiene bucal. Se utilizó el X² para estimar la relación entre las variables, y la comparación de proporciones para contrastar la hipótesis de que existieran diferencias entre las lesiones periapicales para las categorías de las variables grupo dentario, causa de la enfermedad y características clínicas. Se encontró un predominio del absceso periapical agudo en un 84,7 por ciento del grupo de edad de 35 a 59 años y del sexo masculino, aunque no se encontraron diferencias significativas para estas variables, ni en los grupos dentarios con respecto a la enfermedad. La higiene bucal resultó estar relacionada con las lesiones periapicales. Se encontraron diferencias significativas en las lesiones periapicales respecto a todas las causas estudiadas, con excepción de las enfermedades periodontales. Respecto a las características clínicas hubo significación en cuanto al aumento de volumen del fondo del surco vestibular y la movilidad dentaria(AU)

A cross-sectional and analytical study was conducted in the health area of the 27 de Noviembre of Marianao municipality, La Habana, from January to December, 2009 including all patients came to emergency service presenting with acute periapical lesions. Information on following variables was available: age, sex, dental group, cause of disease, clinical features and oral hygiene. This latter was classified in the efficient and deficient categories according to the simplified index of oral hygiene. To estimate the relation between the variables and the comparison of ratios to contrast the hypothesis on potential differences among periapical lesions for the category of variables of dental group, cause of disease and clinical features. The was predominance of the acute periapical abscess in a 84,7 percent of the 35-39 age group and of male sex, although there were not significant differences for these variables neither in dental groups regarding the disease. The oral hygiene was related to periapical lesions. There were significant differences in periapical lesions regarding all the study causes, except for the periodontal diseases. Regarding the clinical features there was significance as regards the increase of volume of the vestibular groove fundus and tooth mobility(AU)

Periodontitis-associated risk factors in pregnant women

OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth > 4 mm and an attachment loss > 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11 percent. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.

Avaliação in Vitro da citotoxicidade de enxaguatórios bucais com agente branqueador / Evaluation in Vitro cytotoxicity mouthwash with bleaching agent

O objetivo do presente trabalho foi avaliar a citotoxicidade de enxaguatórios bucais com agente branqueador em sua formulação. Avaliou-se os enxaguatórios Plax Whitening e Listerine Whitening em diferentes tempos: 1, 15, 30, 45, 60 e 120 segundos quanto seu efeito citotóxico em fibroblastos gengivais L929. Utilizou-se 3 grupos controle: positivo (C+) detergente celular Tween 80, negativo (C-) PBS, e controle de célula (CC) onde as células não foram expostas a nenhum material. O ensaio de citotoxicidade foi realizado utilizando cultura celular de fibroblasto de camundongo (L929). Após contato do enxaguatório com as células, as mesmas foram colocadas em contato com o corante vital vermelho neutro utilizando-se a técnica (“dye uptake”). Os valores da quantidade de células viáveis, foram submetidos à análise da variância (ANOVA) para determinar se havia diferenças estatísticas entre os grupos, e posteriormente ao teste de Tukey (p<0.05). Os resultados demonstraram citotoxicidade dos enxaguatórios em todos períodos de tempo, os resultados entre esses apresentaram diferenças estatísticas com os grupos controle de células e negativo (p<0.05). A citotoxicidade foi diretamente proporcional ao tempo de exposição às culturas de células. Dessa forma pode-se concluir que os enxaguatórios branqueadores são altamente citotóxicos à fibroblastos gengivais

The aim of this study was to evaluate the cytotoxicity of mouthwash with a bleaching agent in their formulation. This study evaluated Plax Whitening mouthwash Listerine Whitening and at different times: 1, 15, 30, 45, 60 and 120 seconds as their cytotoxic effect on gingival fibroblasts L929. We used three control groups: positive (C +) cell detergent Tween 80 was negative (C-), PBS, and cell control (CC) where the cells were not exposed to any material. The cytotoxicity assay was performed using cell culture of mouse fibroblast (L929). After contacting the mouthwash with the cells, they were placed in contact with the vital dye neutral red using the technique (dye uptake). The values of the amount of viable cells, were subjected to analysis of variance (ANOVA) to determine whether there were statistical differences between groups, and subsequently Tukey test (p <0.05). The results showed cytotoxicity of mouthrinses in all time periods, the results showed statistical differences between these groups with the control cells and negative (p <0.05). Cytotoxicity was directly proportional to exposure time to cell cultures. Thus we can conclude that the whitening rinses are highly cytotoxic to gingival fibroblasts

Eritema multiforme mayor desencadenado por antimicrobianos / Big multiform erythema triggered by antimicrobials

El eritema multiforme, aparece como una enfermedad sistémica con la participación de la piel y las membranas mucosas en relación con varios factores como las infecciones bacterianas o virales, y en particular la administración de drogas, analgésicos y antibióticos en general. Se presenta un paciente masculino de 29 años de edad con eritema multiforme mayor desencadenado por antimicrobianos con la aparición de lesiones vesiculares-bulloso-ulcerosas en las regiones de los labios, encías, la lengua y la mucosa genital en tratamiento de una infección del tracto urinario con norfloxacino 400 mg por una semana. Fue realizado un tratamiento de soporte con el uso de colutorios para la higienización bucal y pomada a base de corticoide para protección de las úlceras, antihistamínicos y orientación nutricional de dieta líquida hipercalórica e hiperproteica. Este síndrome está caracterizado como un proceso eruptivo buloso agudo que compromete la calidad de vida del paciente y no hay pruebas de laboratorio específicas por lo que su diagnóstico debe estar basado en la revisión minuciosa de la anamnesis y en los hallazgos clínicos(AU)

The multiform erythema appears as a systemic disease where skin and the mucous membranes have participation in relation to some factors such as bacterial or viral infections and in particular the drugs administration, analgesics and antibiotics in general. The aim of present paper was the presentation of case of big multiform erythema triggering by antimicrobials. Authors present the case of a male patient aged 29 with appearance of ulcerous bullous-vesicular lesions in lips, gums, tongue and genital mucosa under treatment with 400 mg norfloxacin due to urinary tract infection for a week. We made support treatment using mouthwashes for oral hygiene and corticoids ointment for ulcer protection, antihistaminics and nutritional guiding of a hypercaloric and hyperprotein liquid diet. This syndrome is characterized as an acute bullous eruptive process involving the patient's quality of life and there are not specific laboratory tests thus its diagnosis must to be based on a highly detailed review of anamnesis and the clinical findings(AU)

Enfermedad gingival: Resultados obstétricos / Gingival disease: Obstetric results

OBJETIVO: determinar los resultados obstétricos en las gestantes con enfermedad gingival, vincular la enfermedad gingival con los posibles resultados obstétricos en cuanto a: tiempo que terminó la gestación, peso del producto, Apgar y eventos sépticos obstétricos (sepsis ovular, rotura prematura de membrana y sepsis puerperal).También conocer el grado de conocimiento por las pacientes de las medidas de higiene bucal. MÉTODOS: Se realizó un estudio observacional analítico de cohorte a todas las gestantes pertenecientes al policlínico docente "Luis Li Trejent" del municipio Güines que se encontraban en el tercer trimestre de embarazo, en el mes de agosto del año 2006. Nos auxiliamos para la selección de esta muestra del registro de embarazadas existente en el centro. Se aplicó una planilla recopiladora de datos con el objetivo de investigar la presencia o no de enfermedad gingival y ver sus resultados obstétricos. RESULTADOS: La forma leve y moderada de la enfermedad gingival fue la más encontrada. Esta enfermedad es inversamente proporcional a la escolaridad. Se observó mayor aparición del parto pretérmino y el bajo peso al nacer en las gestantes enfermas, una relación directa entre la presencia de enfermedad gingival y los eventos sépticos estudiados durante la gestación, parto y puerperio, así como los estados de nutrición desfavorable. CONCLUSIONES: Al hacer un análisis de cómo influyó la enfermedad gingival en los resultados obstétricos pudimos concluir que en las gestantes investigadas fue considerable la aparición de la malnutrición, asma bronquial y el deficiente conocimiento de la higiene bucal por lo que no se logra el alta estomatológica en la mayoría de las gestantes, todo lo cual favorece la aparición de la enfermedad gingival(AU)

OBJECTIVE: to determine the obstetric results in pregnant women with gingival disease; to link the gingival disease with the possible obstetric results as regards time of gestation, weight of the infant, apgar score and obstetric septic events (ovular sepsis, early membrane rupture and puerperal sepsis); and to define the knowledge degree of the patients about the oral hygiene measures. METHODS: An observational analytical cohort study of all the pregnant women belonging to "Luis Li Trejent" teaching polyclinic of Güines municipality that were in the third trimester of pregnancy in August 2006 was conducted. The registry of pregnant women of the centre was used to select this sample. A form was given to them to collect data in order to investigate the presence or not of gingival disease and to know its obstetric results. RESULTS: The mild and moderate forms of gingival disease were the most found. This disease is inversely proportional to educational level. A greater appearance of preterm delivery and low birth weight were observed in the sick pregnant women, as well as a direct relation between the presence of gingival disease and the septic events studied during gestation, delivery and puerperium, and the unfavourable nutritional states. CONCLUSIONS: On analyzing how the gingival disease influenced on the obstetric results, it was concluded that there was a considerable appearance of malnutrition and bronchial asthma and a deficient knowledge of oral hygiene in the studied pregnant women, which made difficult the stomatological discharge in most of these patients, and favored the emergence of gingival disease(AU)

Higiene bucal: su repercusión en pacientes con tratamientos ortodóncicos / Oral higiene: its impacto on patients with orthodontic treatment

El éxito de los tratamientos ortodóncicos aplicados en la adolescencia radica en mantener una higiene bucal buena, la cual favorece un buen funcionamiento y evita la aparición de complicaciones en los pacientes, asociado con un correcto cepillado de los dientes y de los aparatos ortodóncicos, lo que es un elemento esencial e importante para un tratamiento exitoso, unido al mantenimiento saludable de las encías, prevención de las caries y peridontitis. Se realizó un estudio descriptivo en 50 pacientes de uno u otro sexo y raza, con edades comprendidas entre 12-16 años, procedentes de la Consulta de Ortodoncia de la Clínica Estomatológica H y 21, en el período de marzo-agosto del 2006, los cuales reciben tratamiento ortodóncico, con el objetivo de determinar la higiene bucal durante el tratamiento. Predominó el sexo masculino y el grupo de 12-14 años. Se observó que el 92 por ciento de los pacientes estudiados se categorizó con índice de higiene bucal simplificado bueno y solo el 8 por ciento con un índice de higiene bucal simplificado regular. Finalmente el índice de higiene bucal simplificado del colectivo fue bueno. Se recomienda incrementar y fomentar aún más el mantenimiento de la higiene bucal, para obtener un buen éxito durante el tratamiento ortodóncico y por lo tanto, que el paciente pueda disfrutar de una bonita sonrisa sin afectaciones psicológica(AU)

The success of orthodontic treatment applied in adolescence lies in keeping a good oral hygiene, which favors good functioning of teeth and avoids the occurence of complications, associated to good brushing of teeth and of orthodontic appliances that is an eseential and important element for healthy conditon of gingivae, prevention of dental caries and peridontitis. A descriptive study of 50 patients of either sex and any race aged 12-16 years from Orthodontic Service of Dental Clinc H y 21 was conducted from March to August, 2006. They received orthodontic treatment to determine their oral hygiene in the course of treatment. It was observed that males and 12-14 y age group prevailed; 92 per cent and 8 per cent of patients were classified as having good and regular simplified oral hygiene index respectively. Finally, the index of the group was regarded as good. The study recommended to increase and foster oral hygiene to succeed in orthodontic treatment and thus the patient can enjoy a beatiful smile without psychological disorders(AU)

A etiologia multifatorial da recessão periodontal / The etiologic factors of periodontal recession

A literatura apresenta vários fatores relacionados na etiologia da recessão periodontal, além do processo inflamatório induzido pelo biofilme bacteriano, os quais incluem fatores externos e anatômicos locais. Por meio deste estudo, revistou-se a literatura sobre tais fatores, cujo conhecimento é de grande importância para o ortodontista, contribuindo durante o diagnóstico, planejamento e tratamento ortodôntico propriamente dito.

The literature shows that besides dental plaque, some external and anatomic local factors are still related to gingival recession etiology. This study reviewed the literature about those factors, which knownledge is of great benefit to the orthodontist, contributing during diagnostic, planning and orthodontic treatment.

Caries dental en primeros molares permanentes y su relación con los factores socioeconómicos, en los estudiantes de 7°, 8° y 9° año del Colegio Ángel María Herrera de Penonomé, año 2004 / Dental decay in first molars permanents and its relation with the Socioeconomics Factors, in the Students of 7°, 8° and 9° year of the Colegio Ángel María Herrera de Penonomé, year 2004

Es un estudio de casos y controles para determinar la presencia de Caries Dental en los Primeros Molares Permanentes y su Relación con los Factores Socioeconómicos en los Estudiantes de 7°, 8° y 9° Año del Colegio Ángel María Herrera de Penonomé, año 2004. La caries dental es un proceso destructivo de los tejidos dentales, de origen multifactorial, con tratamientos cuyos costos resultan inaccesibles, cada vez más, a un gran sector de la población. En el diseño, los casos fueron los estudiantes con caries en los primeros molares permanentes, con la probabilidad de ser pobre o no pobre. Los expedientes dentales de los estudiantes y una encuesta a padres o tutores, con variables de tipo socioeconómico, fueron las fuentes de datos. Consta de introducción, planteamiento del problema, justificación, propósito y objetivos del trabajo. Cuerpo de la tesis: Marco teórico, antecedentes del tema, revisión conceptual de los términos claves, utilizando textos, revistas, entrevistas, documentos o consultas electrónicas en los diferentes buscadores de Internet, variables estudiadas e hipótesis. Como herramienta de análisis de los datos se utiliza Epi-Info 3.3.2, prueba p, para significancia estadística, DR para fuerza de asociación con un intervalo de confianza de 95 (por ciento), error œ de 5 (por ciento) y β de 20 (por ciento). La relación de casos y controles de 1 a 1 con una n = 47, Po = 80 (por ciento) y r = 19.4. Se aplicó la prueba de significancia estadística cuyo resultado justificó la aceptación de las hipótesis nulas. Se encontró en la variable hacinamiento (p = 0.03) diferencias estadísticamente significativas entre ambos grupos (casos y controles). Interpretación de resultados sobre la base de los cuales se generaron las conclusiones y se hacen las recomendaciones del autor.

Conhecimento dos fatores envolvidos na higiene bucal de crianças queimadas / Evaluation of factors related to oral hygiene for children with burns

O objetivo deste estudo foi verificar os fatores associados com a presença de placa visível em 30 crianças que sofreram queimadura e procuraram atendimento médico no Hospital Infantil Joana de Gusmão em Florianópolis, Santa Catarina. As dificuldades em relação à execução de atividades diárias tais como higienizar os dentes, abrir a boca, andar, alimentar-se foram respondidas através de entrevista dirigida aos responsáveis. Cada criança foi avaliada quanto à presença ou ausência de placa dentária visível. Os dados foram analisados através dos testes qui-quadrado ou exato de Fisher. A maioria das crianças avaliadas apresentou alguma dificuldade em realizar atividades como andar, mover os membros (braços e pernas) e comer. Verificou-se ainda que a maioria dos responsáveis tinha dificuldade de realizar a higiene bucal da criaça, principalmente devido ao uso da malha (p=0,021). Conclui-se que pacientes queimados apresentam rico de desenvolvimento de doença bucal (cárie, doença periodontal) devido à dificuldade de se realizar a higiene. Dessa forma, a orientação efetiva aos responsáveis e aos enfermeiros da criança durante o período de internação é de extrema importância

Manchas dentárias extrínsecas pretas: revisäo de literatura / Extrinsic dental black stain

O objetivo deste trabalho foi discutir, através de uma revisäo da literatura, as manchas dentárias extrínsecas pretas, elucidando o que säo e por quê removê-las. Sugestöes quanto à natureza química dos pigmentos pretos foram feitas e mostraram que este é um sal férrico, produzido pela bactéria. Prevotella melaninogênica

Atividade da própolis sobre as bactérias isoladas da cavidade bucal / Effects of propolis on bacteria isolated from oral cavity

A própolis é conhecida desde a antiguidade por suas propriedades antibacterianas, cicatrizantes, antifúngicas, entre outras. Neste estudo foi pesquisada a atividade da própolis sobre bactérias recém-isoladas da cavidade bucal: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mutans e Lactobacillus sp. As amostras foram semeadas em meio de cultura adequado a cada tipo de bactéria, e contendo própolis em concentraçöes que variavam de 1 a 10mg/ml. Foi observada atividade antibacteriana evidente sobre as bactérias citadas acima, na seguinte ordem de sensibilidade: S. mutans > Lactobacillus sp > S. aureus > S. epidermidis.

Avaliaçäo comparativa dos efeitos dos acessórios ortodônticos na saúde gengival e no índice de placa em pacientes com e sem orientaçäo sobre métodos de higiene bucal / Comparative evaluation on effects of orthodontic devices in gingival health and plaque index in patients with and without orientation about oral hygiene methods

Realizou-se uma avaliaçäo comparativa entre acessórios ortodôndicos colados e bandados em relaçäo aos índices de sangramento gengival e de placa. Foram utilizados 68 pacientes acima de 13 anos, de ambos os sexos. Os resultados mostraram que o índice Inicial de Sangramento no grupo Bandado apresentou valores maiores que nos outros dois grupos, e estatísticamente significantes quando comparado ao grupo Sem Acessório. O índice Inicial de Placa apresentou valores menores no grupo Bandado. Também foi avaliada a influência da orientaçäo quanto à higiene e à dieta e verificou-se que os índices de sangramento e de Placa melhoraram de um maneira geral nos difernetes grupos, independente da orientaçäo. O índice de Placa melhoru significativamente nos pacientes orientados dos grupos Colado e Sem Acessório.