Effect of Water and Chlorhexidine with Different Pressures of Oral Irrigation Device on the Surface Roughness and Topography of Giomer

Abstract Objective: To evaluate the effect of different pressures of an oral irrigation device (OID) and the irrigation solution type on the surface roughness of the giomer restorative material. Material and Methods: In this in vitro study, disk-shaped giomer samples were fabricated and assigned to 5 groups (n=23): Group 1, storage in distilled water (control); Group 2, OID #7 pressure/ water; Group 3, OID #10 pressure/ water; Group 4, OID #7 pressure/ 0.05% CHX; Group 5, OID #10 pressure/ 0.05% CHX. The samples' treatment simulated a one-year application of OID. Surface roughness (Ra) and topography of the giomer were evaluated using profilometry and scanning electron microscopy. The data were analyzed with Paired t-test, Tukey, and ANOVA tests (α=0.05). Results: The Ra of the samples increased significantly after treatment with OID (p<0.001). The roughness increase in groups with a pressure of 10 was higher than those with a pressure of 7 (p<0.001). The effect of pressure on surface changes was significant (p<0.001). However, the solution type and the cumulative effect of these two factors were insignificant (p=0.08 and p=0.43, respectively). Conclusion: Oral irrigation device with both solutions significantly increased the surface roughness and topographic changes of the giomer. The severity of these changes was related to the device's pressure.

Comparación en el uso de Peróxido de Hidrógeno y de Clorhexidina contra SARS-CoV-2 en la cavidad bucal / Comparison in the use of hydrogen peroxide and chlorhexidine against SARS-COV-2 in the oral cavity

La pandemia de COVID-19 originada por el virus SARS-CoV-2 ha impactado en la atención profesional de los pacientes en la práctica odontológica. Se generan bioaerosoles por el odontólogo o por el propio paciente, que aumentan la posibilidad de diseminación del virus. Ante la urgente necesidad de establecer protocolos estrictos y efectivos de control de infecciones, decidimos investigar la efectividad de dos enjuagues bucales en la saliva de pacientes con diagnóstico positivo de SARS-CoV-2.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted on the professional care of patients. In dentistry, the generation of bioaerosols generated by the dentist or by the patient himself increases the possibility of the spread of the virus. Given the urgent need to establish strict and effective infection control protocols, we decided to investigate the effectiveness of two mouthwashes in the saliva of positive patients.

Antimicrobial activity of violacein against oral bacteria associated with halitosis: an in vitro study

Introduction: violacein is a natural purple pigment produced by environmental bacteria that presents antimicrobial activity, particularly against Gram-positive bacteria. Intraoral halitosis (IOH) is a condition defined by the unpleasant odor emanating from the mouth, whose main source are volatile sulfur compounds, produced by Gram-negative oral bacteria on the tongue coating. In IOH treatment, antimicrobials have been indicated as chemical adjuncts, including natural products. Objective: thus, this study tested the antimicrobial activity of a violacein extract on key IOH-related bacteria (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, Prevotella intermedia, Solobacterium moorei). Materials and Methods: bacteria were cultured in fastidious anaerobe blood agar in anaerobiosis, and 109 cells/ml suspensions were plated. Crude extract of violacein obtained from Chromobacterium violaceum was diluted in a 25% ethanol aqueous solution to 8, 4, 2, 1, 0.5 and 0.25 mg/ml. Using the disk agar diffusion method, 10 µl aliquots of each dilution were deposited on the seeded plates. Chlorohexidine (0.1%) and 25% ethanol solution were used as controls. Plates were incubated in anaerobiosis at 37°C for 72h, and the inhibition halos were recorded. Results: although chlorhexidine showed higher inhibition halos than the violacein extract, most species were inhibited at 4 and 8 mg/ml concentrations (p<0.05). P. gingivalis followed by F. nucleatum were the most affected species in relation to the other bacteria, although statistical significance was only reached for P. gingivalis (p<0.05). Conclusion: crude violacein extract from C. violaceum demonstrated antimicrobial activity against IOH-associated oral bacteria, being a potential antimicrobial to be studied as an adjunct in the control of IOH.

Introdução: a violaceína é um pigmento roxo natural produzido por bactérias ambientais que apresenta ação antimicrobiana, particularmente contra bactérias Gram-positivas. A halitose intraoral (HIO) é uma condição definida pelo odor desagradável que emana da boca, cuja principal fonte são os compostos sulfurados voláteis produzidos por bactérias Gram-negativas da saburra lingual. No tratamento da HIO, antimicrobianos têm sido indicados como adjuvantes, incluindo produtos naturais. Objetivo: assim, este estudo avaliou o potencial antimicrobiano de um extrato de violaceína em patógenos-chave da HIO (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, Prevotella intermedia, Solobacterium moorei). Materiais e Métodos: bactérias foram cultivadas em meio ágar sangue para fastidiosos, em anaerobiose, e suspensões de 109 células/ml foram semeadas. O extrato bruto de violaceína obtido de Chromobacterium violaceum foi diluído em solução aquosa com 25% de etanol nas concentrações de 8, 4, 2, 1, 0,5 e 0,25 mg/ml. Através do método de disco difusão, 10 µl de cada diluição foram depositados nas placas semeadas. A clorexidina (0,1%) e a solução etanólica a 25% foram usadas como controles. As placas foram incubadas em anaerobiose a 37°C por 72h, e os halos de inibição foram registrados. Resultados: embora a clorexidina tenha apresentado os maiores halos de inibição do do que o extrato, a maioria das espécies foi inibida nas concentrações de 4 e 8 mg/ml (p<0,05). P. gingivalis e F. nucleatum foram as espécies mais afetadas em relação às outras bactérias, porém só foi observada significância estatística para P. gingivalis (p<0,05). Conclusão: o extrato bruto de violaceína de C. violaceum demonstrou atividade antimicrobiana contra bactérias orais associadas a HIO, sendo um potencial antimicrobiano a ser estudado como adjuvante no controle da HIO.

Protocolos de higiene oral e a prevenção à pneumonia aspirativa por ventilação mecânica / Oral hygiene protocols and prevention of aspiration pneumonia by mechanical ventilation / Protocolos de higiene bucal y prevención de la neumonía por aspiración mediante ventilación mecánica

Objetivo: Este trabalho teve como objetivo revisar a literatura sobre a eficiência dos protocolos de higienização oral que utilizaram digluconato de clorexidina como agente antimicrobiano de escolha em pacientes internados em Unidades de Terapia Intensiva. Métodos: Para o levantamento dos protocolos, foram analisadas as plataformas de dados científicos Scientific Electronic Library Online e National Library of Medicine, utilizando descritores específicos em português e em inglês, respectivamente. Resultados: Dos 59 trabalhos inicialmente analisados, 27 artigos foram lidos na íntegra e seis destes foram selecionados para o estudo. Os estudos utilizaram digluconato de clorexidina em concentrações variando de 0,05% a 2%. Os dispositivos utilizados para higiene oral variaram entre escovas de dentes, cotonete e gaze. A frequência de higienização apresentou variação, sendo realizada duas ou três vezes ao dia. Conclusão: Devido à heterogeneidade dos protocolos de higiene oral utilizando digluconato de clorexidina em Unidades de Terapia Intensiva, apresentados na literatura, não foi possível compará-los em relação à sua eficiência na redução da pneumonia aspirativa por ventilação mecânica. (AU)

Objective: This study aimed to review the literature on the efficiency of oral hygiene protocols that used chlorhexidine digluconate as an antimicrobial agent in patients admitted to Intensive Care Units. Methods: To research the protocols, the scientific data platforms Scientific Electronic Library Online and National Library of Medicine were analyzed, using specific descriptors in Portuguese and in English, respectively. Results: Of the 59 studies initially analyzed, 27 articles were read in full and six of these were selected for the study. The studies used chlorhexidine digluconate in different concentrations, 0.05% to 2%. The devices used for oral hygiene varied between toothbrushes, cotton swabs, and gauze. The frequency varied, being performed two or three times a day. Conclusion: Due to the heterogeneity of oral hygiene protocols using chlorhexidine digluconate in Intesive Care Units, presented in the literature, it was not possible to compare them in relation to their efficiency in ventilator-associated pneumonia reduction. (AU)

Objetivo: Este estudio tuvo como objetivo revisar la literatura sobre la eficacia de los protocolos de higiene bucal que utilizan digluconato de clorhexidina como agente antimicrobiano en pacientes ingresados en unidades de cuidados intensivos. Métodos: Para investigar los protocolos, se analizaron las plataformas de datos científicos Scientific Electronic Library Online y National Library of Medicine, utilizando descriptores específicos en portugués y en inglés, respectivamente. Resultados: De los 59 estudios inicialmente analizados, se leyeron 27 artículos en su totalidad y seis de estos fueron seleccionados para el estudio. Los estudios utilizaron digluconato de clorhexidina en concentraciones que van desde 0.05% a 2%. Los dispositivos utilizados para la higiene bucal variaron entre cepillos de dientes, hisopos de algodón y gasas. La frecuencia de la limpieza varió, realizándose dos o tres veces al día. Conclusión: Debido a la heterogeneidad de los protocolos de higiene oral que utilizan el digluconato de clorhexidina en las Unidades de Cuidados Intensivos, presentados en la literatura, no fue posible compararlos en relación con su eficiência en la reducción de la neumonía asociada al ventilador. (AU)

Wound healing effect of a one-week Aloe Vera mouthwash: a pilot study / Efeito de reparação tecidual de uma semana de enxaguante bucal de Aloe Vera: um estudo piloto

Aloe Vera, a perennial Liliaceae plant, has medical, cosmetic, and wound-healing properties. Aloe vera has antioxidant, anti-cancer, anti-diabetic, and regenerative effects. Glucommannan increases collagen synthesis and aids healing after ginivectomy treatment. Natural mouthwashes may offer gingival wound healing efficacy with reduced side-effects when compared to Chlorhexidine. Objective: the objective of this clinical study was to compare the effects on wound healing of a one-week Aloe vera mouthwash with chlorhexidine mouthwash before gingivectomy surgical therapy. Material and Methods:a total of 45 individuals experiencing inflammatory gingival enlargement were included in the study. They underwent professional mechanical plaque removal and were then randomly divided into three groups. In group I, comprising 15 patients, participants were advised to utilize 100% Aloe vera juice as a mouthwash twice daily. Group II, also consisting of 15 patients, was instructed to use Chlorhexidine (0.2%) mouthwash twice daily. The Control group, which consisted of 15 patients, was recommended to use a placebo mouth rinse in addition to mechanical plaque removal. During the second visit, which occurred one week after the initial visit, the enlarged gingival tissue was surgically removed through scalpel gingivectomy. Immunohistochemical (IHC) analysis was performed on the excised tissue to measure the l evels of fibroblast growth factor-2. Results: when compared to the control group, Aloe vera showed significant differences regarding the expression of fibroblast growth factor-2(FGF-2), and highly significant differences in angiogenesis. At the same time, there were substantial differences in angiogenesis w ith no significant differences in the expression of FGF2 between Chlorhexidine and control groups. Conclusion: aloe vera has exhibited potential wound-healing effects as i t s ignificantly affected the IHC expression of FGF2 and angiogenesis when used as an adjunct to plaque control before gingivectomy surgical therapy (AU)

Aloe Vera, uma planta perene de Liliaceae, tem propriedades médicas, cosméticas e cicatrizantes. Aloe vera tem efeitos antioxidantes, anticancerígenos, antidiabéticos e regenerativos. O glucomanano aumenta a síntese de colágeno e auxilia na cicatrização a pós o tratamento de gengivectomia. Enxaguatórios bucais naturais podem oferecer efi cácia na reparação de feridas gengivais com efeitos colaterais reduzidos quando comparados à clorexidina. Objetivo:O objetivo deste estudo clínico foi comparar os efeitos na cicatrização de feridas de uma semana de enxaguatório bucal de Aloe vera com clorexidina antes da terapia cirúrgica de gengivectomia. Material e Métodos: um total de 45 indivíduos com aumento gengival inflamatório foram incluídos no estudo. Eles foram submetidos à remoção mecânica profissional da placa e foramdivididos aleatoriamente em três grupos. No grupo I, composto por 15 pacientes, os participantes foram orientados a utilizar 100% de suco de Aloe vera como enxaguante bucal duas vezes ao dia. O grupo II, também composto por 15 pacientes, foi instruído a usar enxaguante bucal com clorexidina (0,2%) duas vezes ao dia. O grupo controle, composto por 15 pacientes, foi recomendado o uso de enxaguatório bucal placebo além da remoção mecânica da placa. Durante a segunda visita, que ocorreu uma semana após a visita inicial, o tecido gengival aumentado foi removido cirurgicamente por meio de gengivectomia com bisturi. A análise imuno-histoquímica (IHC) foi realizada no tecido excisado para medir os níveis do fator de crescimento de fibroblastos-2 (FGF-2). Resultados: quando comparado ao grupo controle, o Aloe vera apresentou diferenças significativas em relação àexpressão do FGF-2, e diferenças altamente significativas na angiogênese. Ao mesmo tempo, houve diferenças substanciais na angiogênese, sem diferenças significativas na expressão de FGF-2 entre a clorexidina e os grupos controle. Conclusão: Aloe vera exibiu potenciais efeitos de cicatrização de feridas, pois afetou significativamente a expressão IHC de FGF-2 e a angiogênese quando usada como adjuvante no controle de placa antes da terapia cirúrgica de gengivectomia (AU)

Establishment of a saliva donor selection for in vitro biofilm growth / Seleção de doadores de saliva para crescimento de biofilme in vitro

Introdução: O emprego de biofilmes polimicrobianos, utilizando a saliva como inóculo, é um modelo promissor para o estudo de biofilmes cariogênicos in vitro. Entretanto, ainda não existe uma padronização para seleção de doadores de saliva. Objetivo: O objetivo deste estudo foi estabelecer uma metodologia para seleção de doadores de saliva utilizando fatores salivares microbianos e características in vitro do biofilme. Material e método: Para doação de saliva foram selecionados vinte voluntários. Os voluntários permaneceram 24 horas sem escovar os dentes e ficaram em jejum por 2 horas antes da coleta da saliva. Foram avaliados os seguintes parâmetros: viabilidade das bactérias anaeróbias totais e mutans streptococci; concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) da clorexidina; capacidade de formação de biofilme por meio da biomassa; e a suscetibilidade dos biofilmes à clorexidina. Resultado: A viabilidade bacteriana da saliva, a capacidade de formação de biofilme e a suscetibilidade do biofilme à clorexidina foram apresentadas como média e intervalo de confiança (95%). A diferença entre a viabilidade do biofilme (mutans streptococci e bactérias totais) após tratamento com NaCl 0,9% e diacetato de clorexidina 0,2% foi comparada pelo teste t de Student com nível de significância estabelecido em 5%. A viabilidade total de bactérias anaeróbias (mediana) foi de 7,28 log 1+UFC/mL (unidades formadoras de colônia/mL). A viabilidade dos mutans streptococci na saliva apresentou mediana de 5,47 log 1+UFC/mL. Para capacidade de formação de biofilme a mediana da biomassa foi de 0,1172 A570. Conclusão: O tratamento com clorexidina reduziu significativamente os mutans streptococci e a viabilidade total das bactérias. A metodologia para seleção do doador de saliva foi estabelecida com sucesso.

Introduction: The utilization of polymicrobial biofilms, with saliva as an inoculum, represents a promising model for in vitro studies on cariogenic biofilms. However, there is still no standardization for selecting saliva donors. Objective: The aim of this study is to establish a methodology for the selection of saliva donors using microbial salivary factors and in vitro biofilm characteristics. Material and method: For saliva donation, twenty volunteers were selected. Volunteers remained 24 h without brushing their teeth and fasted for 2 h before saliva collection. The following parameters were evaluated: total anaerobic bacteria and mutans streptococci viability; minimum inhibitory concentration (MIC) and minimum bactericide concentration (MBC) of chlorhexidine; biofilm forming capacity by biomass assessment; and the susceptibility of biofilms to chlorhexidine. Result: Saliva bacterial viability, biofilm forming capacity and biofilm susceptibility to chlorhexidine were presented as mean and confidence interval (95%). The difference between biofilm (mutans streptococci and Total bacteria) viability after treatment with NaCl 0.9% and 0.2% chlorhexidine diacetate was compared using the Student t-test with a significance level established at 5%. Total anaerobic bacteria viability (median) was 7.28 log 1+CFU/mL (colony forming units/ mL). Mutans streptococci viability in the saliva showed a median of 5.47 log 1+CFU/mL. Biofilm forming capacity showed that biomass had a median of 0.1172 A570. Conclusion: Treatment with chlorhexidine significantly reduced mutans streptococci and total bacteria viability. The methodology for the selection of the saliva donor was successfully established.

Antibacterial effect of low-temperature plasma on Enterococcus faecalis in dentinal tubules in vitro / 北京大学学报(医学版)

OBJECTIVE@#To construct a model of Enterococcus faecalis (E. faecalis) infection in dentinal tubules by gradient centrifugation and to evaluate the antibacterial effect of low-temperature plasma on E. faecalis in dentinal tubules.@*METHODS@#Standard dentin blocks of 4 mm×4 mm×2 mm size were prepared from single root canal isolated teeth without caries, placed in the E. faecalis bacterial solution, centrifuged in gradient and incubated for 24 h to establish the model of dentinal tubule infection with E. faecalis. The twenty dentin blocks of were divided into five groups, low-temperature plasma jet treatment for 0, 5 and 10 min, calcium hydroxide paste sealing for 7 d and 2% chlorhexidine gel sealing for 7 d. Scanning electron microscopy and confocal laser scanning microscope were used to assess the infection in the dentinal tubules and the antibacterial effect of low-temperature plasma.@*RESULTS@#The results of scanning electron microscopy and confocal laser scanning microscopy showed that after 24 h of incubation by gradient centrifugation, E. faecalis could fully enter the dentinal tubules to a depth of more than 600μm indicating that this method was time-saving and efficient and could successfully construct a model of E. faecalis infection in dentinal tubules. Low-temperature plasma could enter the dentinal tubules and play a role, the structure of E. faecalis was still intact after 5 min of low-temperature plasma treatment, with no obvious damage, and after 10 min of low-temperature plasma treatment, the surface morphology of E. faecalis was crumpled and deformed, the cell wall was seriously collapsed, and the normal physiological morphology was damaged indicating that the majority of E. faecalis was killed in the dentinal tubules. The antibacterial effect of low-temperature plasma treatment for 10 min exceeded that of the calcium hydroxide paste sealing for 7 d and the 2% chlorhexidine gel sealing for 7 d. These two chemicals had difficulty entering deep into the dentinal tubules, and therefore only had a few of antibacterial effect on the bacterial biofilm on the root canal wall, and there was also no significant damage to the E. faecalis bacterial structure.@*CONCLUSION@#Gradient centrifugation could establish the model of E. faecalis dentin infection successfully. Low-temperature plasma treatment for 10 min could kill E. faecalis in dentinal tubules effectively, which is superior to the calcium hydroxide paste sealing for 7 d and the 2% chlorhexidine gel sealing for 7 d.

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

ABSTRACT Objective: To study the effect of chlorhexidine on elastomeric orthodontic separators (EOS) bacterial-colonisation and gingival-health in Hall technique (HT) patients. Material and Methods: Prospective in-vivo pilot clinical study of EOS bacterial colonisation and primary-molar gingival health assessment in 20 patients (mean age 5.45±1.27 years) requiring bilateral HT crowns (40 teeth). One side received 1-minute 0.12% chlorhexidine-soaked-EOSs (Chx-EOSs), and the other side dry-EOSs (NoChx-EOSs). The EOSs were removed five-days later and underwent a bacterial enumeration technique. Plaque (PI) and Gingival (GI) indices were assessed pre-, five-days and three-months post-treatment. Wilcoxon-Signed-Rank/McNemar-Chi-square statistics were used (p<0.05). Results: Baseline unused/packaged EOSs' sterility check yielded zero colony-forming-units (CFU) per millilitre, but 100% of the used EOSs became colonised by oral-microorganisms. An overall trend of lower mean CFU count in Chx-EOSs (3.415± 0.78 x105 CFU/ml) compared to NoChx-EOSs (6.157±1.48 x105 CFU/ml) was observed (p=0.009). Both NoChx-EOSs and Chx-EOSs insertion sites showed evidence of gingivitis with no difference between PI and GI indices by site over time. Conclusion: There was a lower trend of bacterial colonization in chlorhexidine treated EOSs and an occurrence of gingivitis pre/post HT-treatment regardless of EOS type. The lack of difference in the gingival health may be inconclusive due to this pilot's low power suggesting the need for robust large scale studies.

Influence of chlorhexidine 2% and sodium hypochlorite 5. 25% on micro-tensile bond strength of Universal adhesive system (G-Premio Bond)

Aim One of the reasons for the failure of adhesion in composite restorations and secondary caries may be the chemical irrigants used during the endodontic treatment. NaOCl is widely used for the biomechanical preparation of root canals due to its antimicrobial properties and capacity to dissolve organic material. In addition, another very effective decontamination solution is chlorhexidine 2%. There are few studies about the effect of root canal irrigation solutions on bond strength of universal adhesives therefore, in this study we have investigated the influence of CHX 2% and NaOCl 5.25% on micro-tensile bond strength of G-Premio Bond. Methods Twenty-four human teeth were randomly allocated to the following groups: G1, immersion in saline solution 0.9% for 30 minutes (control); G2, immersion in CHX 2% for 30 minutes; G3, immersion in NaOCl 5.25% for 30 minutes. After restoration, the dentin/resin interface was tested by micro-tensile bond strength. The surfaces morphology was analyzed by Scanning Electron Microscopy. Data were analyzed by ANOVA followed by Tukey test in SPSS software Version 24. Results There was a statistically significant difference between G3 and G1 (P < 0.05). There were no statistically significant differences among G1 and G2, G2 and G3. Conclusion Root canal irrigation with NaOCl 5.25% significantly reduced the micro-tensile bond strength in the G-Premio Bond at self-etch mode, but the use of CHX did not make a significant difference.

Comparação da propriedade antimicrobiana da clorexidina e do hipoclorito de sódio como irrigantes endodônticos: revisão integrativa / Comparison between the antimicrobial properties of chlorhexidine and sodium hypochlorite as endodontic irrigants: an integrative review / Comparación de la propiedad antimicrobiana de la clorhexidina y el hipoclorito de sodio como irrigantes endodónticos: revisión integradora

Introdução:Durante o tratamento endodôntico, devido às complexidades anatômicas dos canais radiculares, a ação mecânica dos instrumentos não é suficiente para a completa desinfecção dos condutos. Dessa forma, se faz necessário o uso de soluções irrigadoras que possampotencializar a desinfecção do sistema de canais radiculares. Objetivo:Realizar uma revisão integrativa da literatura para comparar as propriedades antimicrobianas da clorexidina com o hipoclorito de sódio.Metodologia:A busca na literatura foi realizada no período de setembro de 2019 a agosto de 2021, nas seguintes bases de dados: PUBMED/MEDLINE, LILACS e SCIELO. Utilizando os descritores: clorexidina, hipoclorito de sódio, irrigante do canal radicular e limpeza. Utilizou-se como critérios de busca, trabalhos experimentais laboratoriais in vitro, publicados entre os anos de 2017 e 2021.Resultados:Foram encontrados 165 artigos, dos quais 15 foram selecionados ao final do processo. 8 trabalhos não encontraram diferença estatisticamente significativa entre a clorexidina e o hipoclorito,5 artigos apresentaram resultados superiores dohipoclorito de sódioem 2 a clorexidina foi superior. Conclusões:Após análise da literatura, observamos semelhança entre a ação antimicrobiana do hipoclorito de sódioe da clorexidina, e podemos concluir que ambas apresentam boa ação antimicrobiana, justificando seu uso clinicamente (AU).

Introduction:During endodontic treatment, due to the anatomical complexities of the root canals, the mechanical action of the instruments is not sufficient for the complete disinfection of the canals. Thus, it is necessary to use irrigating solutions that can makethe disinfection of the root canal system.Objective:Conduct an integrative literature review to compare the antimicrobial properties of chlorhexidine with sodium hypochlorite.Methodology:The literature search was carried out from September 2019 to August 2021, in the following databases: PUBMED/MEDLINE, LILACS and SCIELO. Using the descriptors: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. As search criteria, in vitro laboratory experimental works published between 2017 and 2021 were used.Results:A total of 165 articles were found, of which 15 were selected at the end of the process. 8 studies did not find a statistically significant difference between chlorhexidine and hypochlorite, 5 articles showed superior results for NaOCl and in 2 chlorhexidine was superior.Conclusions:After analyzing the literature, we observed a similarity between the antimicrobial action of sodium hypochlorite and chlorhexidine, and we can conclude that both have good antimicrobial action, justifying their clinical use (AU).

Introducción:Durante el tratamiento endodóntico, debido a las complexidades anatómicas de los conductos radiculares, la acción mecánica de los instrumentos no es suficiente para la desinfección completa de los conductos. Por lo tanto, es necesario utilizar soluciones de irrigación que puedan mejorar la desinfección del sistema de conductos radiculares.Objetivo: Realice una revisión integradora de la literatura para comparar las propiedades antimicrobianas de la clorhexidina con el hipoclorito de sodio.Metodología: La búsqueda bibliográfica se realizó desde septiembre de 2019 hasta agosto de 2021, en las siguientes bases de datos: PUBMED/MEDLINE, LILACS y SCIELO. Usando los descriptores: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. Como criterio de búsqueda se utilizaron trabajos experimentales de laboratorio in vitro publicados entre 2017 y 2021.Resultados: Se encontraron un total de 165 artículos, de los cuales 15 fueron seleccionados al final del proceso. 8 estudios no encontraron diferencia estadísticamente significativa entre clorhexidinae hipoclorito, 5 artículos mostraron resultados superiores para NaOCl y en 2 la clorhexidina fue superior.Conclusiones: Después de analizar la literatura, observamos una similitud entre la acción antimicrobiana del hipoclorito de sodio y la clorhexidina,y podemos concluir que ambos tienen una buena acción antimicrobiana, lo que justifica su uso clínico (AU).

Antibacterial and antifungal capacity of three commercially available mouthwashes with different concentrations of chlorhexidine / Efecto antibacteriano y antifúngico de tres enjuagues bucales comerciales con diferentes concentraciones de clorhexidina

Abstract Chlorhexidine was introduced almost seven decades ago and has a myriad of applications in dentistry. Few studies have evaluated the antimicrobial and antifungal capacity of different concentrations of chlorhexidine mouthwashes. Therefore, the aim of this study, was to evaluate in vitro, the antibacterial and antifungal capacity of three commercially available mouthwashes in Costa Rica, with different concentrations of chlorhexidine, 0.12%, 0.06%, and 0.03%. The experimental method selected was the Kirby-Bauer method to evaluate the antibacterial and antifungal effect of each compound by measuring the inhibitory effect on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Candida albicans strains, exposed to the antiseptic solutions. All samples showed some degree of antibacterial and antifungal effect. Even though we provide in vitro results, our findings are of relevance since all the species used in our experiment are microorganisms that may be present in dental plaque. Our results further support evidence that oral hygiene regimens may include mouthwashes with low doses of chlorhexidine and maintain reasonable antibacterial and antifungal efficacy.

Resumen La clorhexidina se introdujo hace casi siete décadas y tiene una gran variedad de aplicaciones en odontología. Pocos estudios han evaluado la capacidad antimicrobiana y antifúngica de diferentes concentraciones de enjuagues bucales con clorhexidina. Por lo tanto, el objetivo de este estudio fue evaluar in vitro, la capacidad antibacteriana y antifúngica de tres enjuagues bucales disponibles comercialmente en Costa Rica, con diferentes concentraciones de clorhexidina, 0.12%, 0.06% y 0.03%. El método experimental seleccionado fue el método Kirby-Bauer para evaluar el efecto antibacteriano y antifúngico de cada compuesto midiendo el efecto inhibidor sobre Staphylococcus aureus, Enterococcus faecalis, Escherichia coli y Candida albicans, expuestos a la solución antiséptica. Todas las muestras mostraron algún grado de efecto antibacteriano y antifúngico. Aunque proporcionamos resultados in vitro, nuestros hallazgos son de relevancia, ya que todas las especies utilizadas en nuestro experimento son microorganismos que pueden estar presentes en la placa dental. Nuestros resultados respaldan aún más la evidencia de que los regímenes de higiene bucal pueden incluir enjuagues bucales con dosis bajas de clorhexidina y mantener una eficacia antibacteriana y antifúngica razonable.

Effectiveness of chlorhexidine oral rinse in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment- a systematic review and meta analysis / Eficacia del enjuague oral de clorhexidina en la prevención de la acumulación de placa y la gingivitis en pacientes en tratamiento de ortodoncia: una revisión sistemática y metaanálisis

Aim: The aim of this review was to systematically assess and report the effectiveness of chlorhexidine (CHX) mouthwash in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment. Material and Methods: The review was prepared according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and registered under PROSPERO database (CRD42020170776). Four electronic databases were systematically searched along with a complimentary manual search of orthodontic journals until June 2022. Only Randomized Control Trials (RCTs) reporting on antiplaque and antigingivitis efficacy of Chlorhexidine mouthwash compared with placebo or control in orthodontic patients were included. Risk of bias assessment was done using Cochrane ROB-2. Quantitative analysis (Random-Effects Model and Standard Mean Difference (SMD)) with 95 % confidence interval was used. Results: Six RCTs were included for qualitative analysis and four were included for quantitative analysis with a total of 211 participants. Out of six studies, 3 were judged to have a low risk of bias, two had some concerns and one of them had high risk of bias. Random effects meta-analysis performed for anti-plaque effect reported a significant reduction of -1.2 SMD for CHX at 4 to 6 weeks with low heterogeneity (I2-35%). The anti-gingivitis effect at 4 to 6 weeks was significant for CHX with a SMD of -1.03 and a moderate heterogeneity (I2-65%). Conclusion: On analyzing the available evidence a moderate level of certainty supports a short-term reduction in plaque accumulation and gingivitis in orthodontic patients subjected to rinsing with chlorhexidine oral rinse.

Objetivo: El objetivo de esta revisión fue evaluar e informar sistemáticamente la efectividad del enjuague bucal con clorhexidina (CHX) para prevenir la acumulación de placa y la gingivitis en pacientes que reciben tratamiento de ortodoncia. Material y Métodos: La revisión se preparó de acuerdo con las pautas de Preferred Reporting Items for Systematic Reviews (PRISMA) y se registró en la base de datos PROSPERO (CRD42020170776). Se realizaron búsquedas sistemáticas en cuatro bases de datos electrónicas junto con una búsqueda manual gratuita de revistas de ortodoncia hasta junio de 2022. Solo se incluyeron ensayos controlados aleatorios (ECA) que informaron sobre la eficacia antiplaca y antigingivitis del enjuague bucal con clorhexidina en comparación con placebo o control en pacientes de ortodoncia. La evaluación del riesgo de sesgo se realizó mediante Cochrane ROB-2. Se utilizó un análisis cuantitativo (modelo de efectos aleatorios y diferencia de medias estándar (SMD)) con un intervalo de confianza del 95 %. Resultados: Se incluyeron seis ECA para el análisis cualitativo y cuatro para el análisis cuantitativo con un total de 211 participantes. De los seis estudios, se consideró que tres tenían un bajo riesgo de sesgo, dos tenían algunas preocupaciones y uno de ellos tenía un alto riesgo de sesgo. El metanálisis de efectos aleatorios realizado para el efecto antiplaca informó una reducción significativa de -1,2 SMD para CHX a las 4 a 6 semanas con baja heterogeneidad (I2-35%). El efecto antigingivitis a las 4 a 6 semanas fue significativo para CHX con una SMD de -1,03 y una heterogeneidad moderada (I2-65%). Conclusión: Al analizar la evidencia disponible, un nivel de certeza moderado apoya una reducción a corto plazo en la acumulación de placa y gingivitis en pacientes ortodóncicos sometidos a enjuague con enjuague bucal con clorhexidina.

Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Estudio de la actividad antimicrobiana de Xenophyllum poposum sobre microorganismos de la cavidad bucal por el método de difusión radial / Study of the antimicrobial activity of Xenophyllum poposum on microorganisms of the oral cavity by the radial diffusion method

Resumen En este estudio se evaluó la actividad antimicrobiana in vitro de extractos de Xenophyllum poposum sobre microorganismos bucales como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans y Veillonella sp. Se empleó el método de difusión radial en agar y como controles negativo y positivo de inhibición se emplearon etanol y clorhexidina al 0,12% (Plac out NF®) respectivamente. Los extractos con mayor actividad antimicrobiana fueron el etanólico y el clorofórmico. La diferencia entre ambos no fue estadísticamente significativa (p≥0,05). Tampoco se observó diferencia significativa con respecto a la clorhexidina, excepto sobre Veillonella sp., ya que el extracto etanólico presentó halos de inhibición significativamente menores sobre este microorganismo. Esto es importante ya que Veillonella se considera indicador de salud en relación a la caries dental. En base a esto, el extracto etanólico de Xenophyllum poposum podría ser usado como control químico de la biopelícula dental.

Abstract In this study, the in vitro antimicrobial activity of Xenophyllum poposum extracts on oral microorganisms such as Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans, Veillonella sp. was evaluated. The radial diffusion method in agar was used and 0.12% ethanol and chlorhexidine (Plac out NF®) were used as negative and positive inhibition controls, respectively. The extracts with the highest antimicrobial activity were the ethanolic and chloroform extracts. The difference between the two was not statistically significant (p≥0.05). No significant difference was observed with respect to chlorhexidine, except on Veillonella sp., since the ethanolic extract presented significantly lower inhibition halos on this microorganism. This is important as Veillonella is considered an indicator of health in relation to dental caries. Based on this, the ethanolic extract of Xenophyllum poposum could be used as chemical control of dental biofilm.

Resumo Neste estudo, a atividade antimicrobiana de extratos de Xenophyllum poposum sobre microrganismos orais como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans e Veillonella sp. Foi utilizado o método de difusão radial em ágar e etanol 0,12% e clorexidina (Plac out NF®) como controles de inibição negativa e positiva, respectivamente. Os extratos com maior atividade antimicrobiana foram os extratos etanólico e clorofórmio. A diferença entre os dois não foi estatisticamente significativa (p≥0,05). Não foi observada diferença significativa em relação à clorexidina 0,12%, exceto em Veillonella sp., uma vez que o extrato etanólico apresentou halos de inibição significativamente menores neste microrganismo. Isso é importante, pois a Veillonella é considerada um indicador de saúde em relação à cárie dentária. Com base nisso, o extrato etanólico de Xenophyllum poposum pode ser utilizado como controle químico do biofilme dental.

Eficácia da Clorexidina na Higiene Bucal para Prevenção de Pneumonia Associada a Ventilação Mecânica / Effectiveness of Chlorexidine in Bucal Hygiene for the Prevention of Pneumonia Associated with Mechanical Ventilation / Eficacia de la Clorhexidina en la Higiene Bucal para la Prevención de Neumonía Asociada a la Ventilación Mecánica: Revisión Narrativa

Objetivo: Analisar as evidências disponíveis sobre a eficácia da clorexidina na higiene bucal para prevenção de pneumonia associada a ventilação mecânica (PAVM). Método: estudo de revisão de literatura, tipo narrativa, no qual foram avaliadas as publicações referentes ao período de 2008 a 2021, indexados na Biblioteca Virtual em Saúde (BVS) no State National Library of Medicine (PubMed/MEDLINE). Resultados: Seleção de 18 artigos, categorizados em duas amostras de acordo com o controle do biofilme bucal, classificados em nível de evidência e sumarizados. Conclusão: Apesar das pesquisas sobre os cuidados orais e PAVM serem abundantes, existe uma falta de consenso em relação a frequência, aos dispositivos mecânicos e a concentração da clorexidina. Quanto ao controle químico, a clorexidina, seja na forma de gel ou como enxaguante nas concentrações de 0,12% ou 0,2%, administrados a cada doze horas reduziram a ocorrência da PAVM. Enquanto os métodos mecânico/químico mais adequados são aqueles que oferecem a escovação associada a sucção, em um mesmo dispositivo, seja escova ou esponja de sucção, ambas associadas ao uso da clorexidina.

Objective: to analyse the available evidences on the efficacy of chlorhexidine in oral hygiene aiming to prevent cases of ventilator-associated pneumonia (VAP). Method: study of literature review, narrative type, in which papers from 2008 to 2021, published in the Virtual Health Library (VHL) in the State National Library of Medicine (PubMed/MEDLINE) were analysed. Results: Selection of 18 papers, categorized in two samples according to the control of oral biofilm, then classified by level of evidence and summarized. Conclusion: In spite of research on oral care and VAP being plenty, it lacks consensus regarding mechanical devices and concentration of chlorhexidine. As for chemical control, chlorhexidine, whether given as gel or mouthwash in concentration levels of 0.12% or 0.2%, being given every twelve hours, has decreased the ocurrence of VAP, while the most suitable mechanical/chemical methods are those that provide brushing and succion in the same device, whether by brush or suction sponge, both associated with the use of chorexidine.

Objetivo: analizar las evidencias disponibles sobre la eficacia de la clorhexidina en la higiene bucal para prevención de neumonía asociada a ventilación mecánica (NAVM). Métodos: estudio de revisión de la literatura, tipo narrativa, en el cual fueron evaluadas las publicaciones que hacen referencia al periodo de 2008 a 2021, indexados en la Biblioteca Virtual en Salud (BVS) de la Biblioteca Nacional Estatal de Medicina (PubMed/MEDLINE). Resultados: Selección de 18 artículos, categorizados en dos muestras de acuerdo con el control de biopelícula oral, clasificados por nivel de evidencia y sumariados. Conclusión: A pesar de que las investigaciones sobre los cuidados orales y NAVM son abundantes, hay una falta de consenso en lo que concierne a la frecuencia, los dispositivos mecánicos y la concentración de clorhexidina. Respecto al control químico, la clorhexidina, sea en la forma de gel sea como enjuague en las concentraciones de 0,12% o 0,2%, administrados a cada doce horas redujeron la ocurrencia de NAVM. Mientras los métodos mecánicos/químicos más adecuados son los que ofrecen el cepillado asociado a la succión, en un mismo dispositivo, por cepillo o esponja de succión, ambos asociados al uso de clorhexidina.

Procedimentos regenerativos endodônticos com clorexidina a 2% e hidróxido de cálcio: relato de caso / Endodontic regenerative procedures with 2% chlorhexidine and calcium hydroxide: case report

Introdução: Muitas substâncias têm sido utilizadas como irrigantes e curativos intracanal nos tratamentos de dentes com rizogênese incompleta, visando obter a regeneração pulpar. A clorexidina a 2% em associação com hidróxido de cálcio P.A. pode ser uma alternativa. Métodos: No presente caso clínico, o dente #45 com periodontite apical, em um paciente com 13 anos de idade, foi tratado com solução de clorexidina a 2% como irrigante. A clorexidina na forma de gel a 2% foi utilizada como auxiliar da instrumentação e, em associação com o hidróxido de cálcio, foi utilizada como curativo durante 14 dias. Após esse período, o canal foi irrigado com solução fisiológica e, sob anestesia alveolar mandibular, uma lima K #70 foi utilizada ultrapassando levemente o ápice, para causar sangramento. Após observar que o sangue dentro dos canais alcançou a porção cervical, o cimento biocerâmico MTA Branco foi colocado na porção cervical do canal. Resultados: A apicificação e o desenvolvimento da raiz em comprimento e largura puderam ser observados já no controle de três meses, e continuaram até a última revisão, no controle de um ano. Alterações de cor não foram observadas nese período de acompanhamento. Conclusões: A clorexidina associada ao hidróxido de cálcio pode ser uma alternativa aos procedimentos de regeneração pulpar (AU).

Introduction: Many substances have been used as irrigating solutions to promote pulp regeneration and root development in teeth with incomplete rhizogenesis. The use of 2% chlorhexidine as an irrigating solution in association with Calcium Hydroxide could be an alternative. Methods: In the case of the patient, a 13-year-old boy, here presented, tooth 45 with apical periodontitis was treated with 2% Chlorhexidine solution as irrigant adjuvant to instrumentation, in association with Calcium Hydroxide used as a dressing for 14 days. After this period, the canal was cleaned with a physiological solution and under mandibular alveolar anesthesia, a # 70 K file was used slightly over the apex to cause bleeding. After observing that blood inside the canals had reached the cervical portion. White MTA was placed in the cervical portion of the canal. Results: Induced apexification and development of increasing root length and width could already be observed in the three-month control exam, and this continued until the last review in the one-year control exam. No color changes were observed in this follow-up period. Conclusions: Chlorhexidine and calcium hydroxide could be used as an alternative to pulp regeneration procedures (AU).

Relación del uso de colutorios bucales con la disminución de la carga viral del SARS-CoV-2 en la práctica odontológica: tema de revision / Relationship of the use of mouthwashes with the decrease in the viral load of SARS-CoV-2 in dental practice: review topic

Resumen Actualmente, el odontólogo es uno de los profesionales de la salud con mayor riesgo de contagio de la COVID-19 debido a su contacto directo con la cavidad bucal. La alta exposición a los aerosoles, generados por los instrumentos rotatorios, en pacientes con la COVID-19, eleva el contacto con la carga viral del SARS-CoV-2 en los procedimientos de rutina. Se ha descrito que los colutorios bucales, previos a la atención odontológica, podrían ser soluciones efectivas para la reducción del contagio pese a su poca evidencia clínica. Los colutorios con cloruro de cetilpiridinio (CPC), peróxido de hidrógeno (H2O2), povidona yodada (PVP-I) y gluconato de clorhexidina (CHX) muestran un gran potencial para reducir la carga viral del SARS- CoV-2 en los aerosoles generados a partir de la saliva durante la consulta odontológica. Por lo expuesto, el presente artículo tuvo por objetivo hacer una revisión de la información científica actual sobre la relación del uso de los colutorios bucales con la disminución de la carga viral del SARS-CoV-2.

Abstract It is currently known that the dentist is one of the health professionals with the highest risk of contagion of COVID-19 due to its direct contact with the oral cavity. High exposure to aerosols generated by rotating instruments in COVID-19 patients increases contact with the SARS-CoV-2 viral load in routine procedures. It has been described that mouthwashes prior to dental care could be effective solutions to reduce contagion despite their little clinical evidence. Mouthwashes with cetylpyridinium chloride (CPC), hydrogen peroxide (H2O2), povidone-iodine (PVP-I) and chlorhexidine gluconate (CHX) show great potential to reduce the viralload of SARS-CoV-2 in the aerosols generated from saliva during the dental visit. Therefore, the objective of this article was to review the current scientific information on the relationship of the use of mouthwashes with the decrease in the viral load of SARS-CoV-2.

Estudo ex vivo da elevação do pH em superfície radicular externa após agitação ultrassônica de diferentes pastas de hidróxido de cálcio / Assessment of pH increase in the external root surface after ultrasonic agitation of different calcium hydroxide pastes: Ex vivo study

Objetivo: O presente estudo teve por objetivo avaliar, ex vivo, a capacidade de elevação do pH da superfície radicular externa de diferentes pastas de hidróxido de cálcio (HC) utilizadas como medicação intracanal, além da influência da ativação ultrassônica (AUS) durante aplicação no interior do canal radicular. Métodos: Foram utilizados 100 incisivos humanos superiores unirradiculares, que tiveram os canais radiculares modelados e divididos aleatoriamente em seis grupos experimentais (n=15), de acordo com a pasta de HC, tendo como variáveis as medicações utilizadas e a ativação da pasta com AUS no momento da aplicação, além de um grupo controle (n=10): Pasta Calen; HC+clorexidina 2% gel (CX2%); e HC + água destilada. Os dentes foram mantidos imersos em água deionizada e as medidas do pH, verificadas nos períodos de 7, 14, 21 e 28 dias, com auxílio de pHmetro. Resultados: De acordo com os dados obtidos, verificou-se elevação do pH nos períodos de 7 e 14 dias em todos os grupos. Apenas os grupos em que foi utilizada a associação do HC com CX2% apresentou evolução com aumento significativo do pH ao longo dos períodos analisados (p<0,05). A ativação das pastas com AUS proporcionou incremento significativo dos valores de pH (p<0,05). Conclusão: De acordo com a metodologia empregada, pode-se concluir que todas as pastas utilizadas promovem elevação do pH no tecido dentinário, e a ativação das pastas com AUS influencia significativamente na elevação do pH no tecido dentinário (AU).

Objective: The aim of the present study was to evaluate, ex-vivo, the pH elevation capacity on the external root surface of different calcium hydroxide (HC) pastes, utilized as intracanal medication, it was also evaluated the influence of the ultrasonic activation at the application within the root canal. Methods: 100 human single root superior incisors were used, which had their root canals shaped and randomly divided into 6 experimental groups (n=15) according to the following HC pastes: Calen; HC + Chlorhex- idine 2% gel (CX2%); HC + distilled water, utilizing the medications and the ultrasonic activation of the paste at the time of the application as variables and 1 control group (n=10). The teeth were kept immersed in deionized water and the pH parameters were verified in 7, 14, 21 and 28 days with a pH measurement machine. Results: According to the data obtained, pH was elevated in the first week in all groups. Only the groups which the association of HC with CX2% was made, did show a significant increase in the pH level over the analyzed periods (p < 0,05). The activation of the pastes with US provided a significant increase in pH values (p < 0,05). Conclusion: According to the methodology used, we can conclude that all the HC pastes used, promote pH elevation in dentin tissue. And the acti- vation of the pastes with US significantly influences the pH increase in dentin tissue

Ação da clorexidina e do hipoclorito de sódio sobre a microdureza dentinária / Action of chlorhexidine and sodium hypochlorite over dentin microhardness

Objetivo: Avaliar a microdureza do tecido dentinário bovino após a exposição a soluções irrigantes em Endodontia. Métodos: Amostras de dentina bovina foram divididas aleatoriamente em seis grupos (n=10) e submetidas aos seguintes tratamentos: soro (60 min); NaOCl a 2,5% (hipoclorito de sódio) (60 min); CHX gel a 2% (clorexidina) (60 min); EDTA a 17% (ácido etilenodiaminotetracético) (1 min); NaOCl a 2,5% + EDTA a 17% (60 + 1 min) e CHX gel a 2% + EDTA a 17% (60 + 1 min). A microdureza Knoop foi utilizada para as medidas. Os dados foram avaliados pelo teste ANOVA, seguido pelo método de Duncan, com nível de significância de 5%. Resultados: A solução de NaOCl a 2,5%, seguida ou não de EDTA a 17%, reduziu significativamente a microdureza dentinária (p<0,05). A exposição à clorexidina gel a 2%, seguida ou não de EDTA a 17%, não resultou em alterações na microdureza dentinária (p>0,05). Conclusão: NaOCl a 2,5% reduziu significativamente a microdureza da dentina bovina após 60 minutos de exposição (AU).

Objective: Evaluate the microhardness of bovine den- tin tissue after exposure to endodontic irrigating solu- tions. Methods: Bovine dentin samples were randomly divided into 6 groups (n = 10) and submitted to the following treatments: saline (60 min); 2.5% NaOCl (sodium hypochlorite) (60 min); 2% gel CHX (chlorhexidine) (60 min); 17% EDTA (Ethylenediamine tetraacetic acid) (1 min); 2.5% NaOCl + 17% EDTA (60 + 1 min) and 2% gel CHX + 17% EDTA (60 + 1 min). Knoop microhardness was used for the measurements. Data were evaluated by ANOVA test followed by Duncans Method at 5% signifi- cance level. Results: The 2.5% NaOCl solution, followed or not by 17% EDTA, significative reduced the dentin microhardness (p <0.05). Exposures to 2% gel chlorexidine, followed or not by 17% EDTA, did not result in alterations at dentin tissue microhardness (p>0.05). Conclusion: 2.5% NaOCl significatively reduces the microhardness of bovine dentin after 60 minutes of exposure (AU).

Clinical effectiveness of pre-treatment with chlorhexidine in adhesive dental restorations: systematic review and meta-analysis / Eficacia clínica del pretratamiento con clorhexidina en restauraciones dentales adhesivas: revisión sistemática y metanálisis

Objective: To determine, by means of a systematic review and meta-analysis, the clinical effectiveness of pre-treatment with chlorhexidine (CHX) in adhesive dental restorations. Material and Methods: A literature search was conducted until February 2020, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, Scopus, SIGLE, LILACS, Google Scholar and the Cochrane Central Registry of Clinical Trials. The selection criteria of the studies were defined, which were: randomized and controlled clinical trials, without language and time restrictions, and reporting the clinical effects (retention, marginal discoloration, marginal adaptation, postoperative sensitivity and secondary caries) of pre-CHX treatment in adhesive dental restorations. Study risk of bias was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions. Results:The search strategy resulted in six articles of which five entered a meta-analysis. The studies reported that there was no difference in retention, marginal discoloration, marginal adaptation, postoperative sensitivity, and secondary caries from pre-treatment with CHX in adhesive dental restorations. Conclusion: The reviewed literature suggests that pretreatment with CHX does not influence the clinical effectiveness in adhesive dental restorations.

Resumen: Antecedentes: la pandemia de COVID-19 ha desatado un ataque sin precedentes contra la humanidad en todo el mundo. El escenario en Bangladesh empeora día a día, y todos los aspectos de la sociedad están observando su impacto. Los profesionales de la salud corren un mayor riesgo de contraer la enfermedad mientras atienden a los pacientes. Objetivo: El objetivo de la investigación es explorar el conocimiento, la conciencia y las prácticas de los dentistas registrados con respecto a la epidemiología y transmisión de COVID-19 durante el rápido brote de este virus altamente contagioso en Bangladesh. Material y Métodos: Se realizó una encuesta transversal basada en la web entre los dentistas inscritos con su número de registro único válido del Consejo Médico y Dental de Bangladesh (BMDC). Se distribuyó un cuestionario estructurado entre los dentistas a través de diferentes plataformas de redes sociales. Un total de 184 dentistas participaron en la encuesta entre marzo y abril de 2020. Se realizó tanto análisis descriptivo como análisis de regresión logística multivariable. Resultados: La edad media de los odontólogos fue de 31,75 años, con una desviación estándar de 6,5 años. Aproximadamente el 29,3% de los dentistas habían completado su título de posgrado y el 76% de ellos se dedicaba a la práctica privada en el momento de la recopilación de datos. En comparación con los dentistas con educación universitaria, los dentistas con educación de posgrado tienen tres veces (OR = 3,1, IC del 95%: 1,2 - 7,9 y más de 5 veces (OR = 5,3, IC del 95%: 1,2 - 23,3) más probabilidades de tener) mejores conocimientos y prácticas hacia COVID-19 respectivamente. Los dentistas de 26 a 30 años tienen menos probabilidades de tener buenas prácticas que los dentistas más jóvenes (OR: .1; IC del 95%: .01 - .5). Sin embargo, los dentistas con menos de cinco años de experiencia tienen 10,3 (1,6 - 68,9) veces más probabilidades de tener buenas prácticas en comparación con los dentistas con más experiencia. Conclusión: La mayoría de los dentistas de Bangladesh han demostrado un buen conocimiento, conciencia y práctica con respecto a COVID-19. Recomendamos que las autoridades sanitarias, las organizaciones profesionales y los hospitales coordinen y lleven a cabo una formación avanzada obligatoria sobre enfermedades infecciosas para todos los dentistas en ejercicio del país.