Effect of the intra-alveolar administration of dexamethasone on swelling, trismus, and pain after impacted lower third molar extraction: a randomized, double-blind clinical trial

Background: To evaluate the efficacy of intra-alveolar administration of dexamethasone 4 mg in the control of edema, trismus, and pain resulting from the extraction of impacted lower third molars and the drug permeability through the oral mucosa by in silico prediction. Material and Methods: The randomized, double-blind, split-mouth clinical trial included patients who had both impacted lower third molars in equivalent positions. Hemiarches were divided into control side when dexamethasone was administered orally and experimental side when dexamethasone was administered using the intra-alveolar route. Patients were evaluated considering edema, trismus, and pain. The permeability of dexamethasone through the oral mucosa was assessed by in silico prediction. Student’s t-test was selected for comparative analysis of edema and trismus, and the chi-square test analyzed the distribution of postoperative pain between the sides. Results: There were no significant differences between the routes of administration in measuring symptoms between the pre and postoperative times (p>0.05). In silico prediction suggested that dexamethasone molecular characteristics facilitate intra-alveolar administration. Conclusions: Intra-alveolar administration had similar efficacy to oral administration in controlling symptoms of post-surgical inflammation of impacted lower third molars.(AU)

Salivary biomarkers for caries susceptibility and mental stress in individuals with facial pain.

Objective: To assess salivary biomarkers for dental caries susceptibility and mental stress in young adults with perceived facial pain.Methods: Males and females who reported facial pain and pain-free controls participated in this study. Facial pain was investigated using the RDC/TMD. Unstimulated saliva was then collected for the evaluation of salivary flow rate (SFR), pH, Streptococcus mutans counts, morning cortisol, and S-IgA.Results: Women with facial pain had significantly lower SFR values, and the facial pain group showed different correlations among biomarkers for caries susceptibility and cortisol levels when compared to controls. Notably, higher SFR values were associated with a lower likelihood of having facial pain.Conclusion: Differences in SFR values, particularly in women, and markedly distinct interactions among the salivary biomarkers analyzed were observed between individuals with facial pain and pain-free controls. Hence, a connection between the dynamics of saliva, stress response, and facial pain perception might exist.

Effect of photobiomodulation therapy as an adjunct to scaling and root planing in a rat model of ligature-induced periodontitis: a histological and radiographic study.

This study aimed to histologically and radiographically evaluate the effectiveness of low-intensity laser irradiation of different wavelengths (660 or 808 nm) as an adjunct to scaling and root planing in the treatment of experimental periodontitis in rats. Periodontitis was induced by placing a ligature around the mandibular first molar of the rats. In total, 40 Wistar rats were randomly divided into five groups (n = 8 each): control (CG), periodontal disease (PD), scaling and root planing (SRP), SRP + 660 nm laser (GL660) and SRP + 808 nm laser (GL808). Groups with laser use received radiation at 6 points in the first molar. The animals were euthanized at baseline and at 7 and 14 days after the interventions. Mandibles were surgically removed for histomorphometric and radiographic assessment of periodontal tissues. The GL660 group showed lesser bone loss than the PD group (P < 0.05) and greater alveolar bone margin after 14 days, indicating a better long-term treatment response (P < 0.05). These findings suggest that SRP with the 660 nm laser as an adjunct results in more favorable radiographic and histological responses than the 808 nm laser.

Effect of TiF4 varnish on microbiological changes and caries prevention: in situ and in vivo models.

OBJECTIVE: The aim of this study was to evaluate microbiological changes, oral soft tissue toxicity, and caries-preventive effect of an experimental titanium tetrafluoride (TiF4) varnish compared with a commercially available fluoride varnish (NaF), using in situ and in vivo models. MATERIALS AND METHODS: The treatment groups were the following: TiF4 varnish (experimental varnish), Duraphat® (fluoride positive control), placebo varnish (no fluoride), and no treatment (negative control). The varnishes were applied once over the enamel surface using a microbrush. For the in vivo study, 48 Wistar rats were infected with Streptococcus sobrinus 6715, received a treatment, and were submitted to a cariogenic challenge. After 4 weeks, S. sobrinus, oral soft tissue toxicity, presence, and severity of caries were evaluated. For the in situ study, 12 volunteers took part in this randomized crossover, double-blind study performed in four phases of 14 days each. They used intraoral appliances containing four enamel specimens that received the varnish according treatment group. After 24 h, the varnish was removed and plaque accumulation was allowed. A 20% sucrose solution was dripped over the enamel blocks (10×/day for 5 min each). Total streptococci, S. mutans, Lactobacillus, Candida spp. counts, and presence of white spot lesions were evaluated. Lesion depth was also quantified by micro-CT. RESULTS: For the in vivo study, the fluoride (F-varnishes) showed a statistically significant reduction in the percentage of S. sobrinus compared to the negative control (p < 0.05). Toxicological analysis revealed no abnormalities in oral tissues of rats from all groups, and both F-varnishes reduced the number and severity of caries lesions, without significant differences (p < 0.05). No statistical differences in microbiological counts were seen for the in situ experiment (p > 0.05). However, the specimens treated with TiF4 exhibited lower percentage of white spot lesions and the lesion depth was significantly reduced by F-varnishes (p < 0.05). CONCLUSIONS: F-varnishes showed reduction in the percentage of S. sobrinus in vivo, no oral soft tissue toxicity, and a caries-preventive effect in vivo and in situ. CLINICAL RELEVANCE: NaF varnish is largely used due its capacity to form CaF2-like layer on enamel. Therefore, development of studies focused on other fluoride compounds such as a TiF4 varnish, which may have greater efficacy than NaF against tooth demineralization, is important.

Effect of Combining Erythrosine with a High-Power Dental Curing Light Appliance on the Viability of a Planktonic Culture of Streptococcus mutans.

Objective: The aim of this in vitro study was to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) composed of the association of the photosensitizer (PS) erythrosine irradiated by a high-intensity dental light source against a culture of Streptococcus mutans, comparing this effect with that of a 0.12% chlorhexidine solution. Materials and methods: For this purpose, planktonic suspensions of S. mutans were subjected to experimental conditions in which three different concentrations of erythrosine (E) (2, 4, and 8 µM) associated with three different doses emitted by the light source (L) (48, 96, and 144 J/cm2) were crossed, corresponding to the exposure times of 40, 80, and 120 sec, respectively, delivered in pulsed mode. The following experimental conditions were evaluated: G1-treatment with dye and light source (E+L+); G2-treatment with the dye only (E+L-); G3-treatment with the light source only (E-L+); G4-absence of dye and light (negative control); and G5-0.12% chlorhexidine (positive control). After treatment, aliquots of each group were plated on blood agar, then the colony forming units per milliliter (CFU/mL) later counted. The results were subjected to ANOVA and Tukey tests, considering the level of significance of 5%. Results: Group aPDT showed complete eradication of microorganisms as from the concentration of 4 µM irradiated for 40 sec, demonstrating statistically significant difference in comparison with the negative control group (p ≤ 0.05) and efficacy similar to that of the 0.12% chlorhexidine group (p ≥ 0.05). Conclusions: The authors concluded that the light-polymerizing appliance used in pulsed mode, associated with the PS erythrosine, was efficient for the control of S. mutans in a planktonic suspension in a short period of irradiation time.

Sex Differences in Salivary Parameters of Caries Susceptibility in Healthy Individuals.

PURPOSE: To investigate salivary parameters of caries susceptibility in men and women in order to identify potential variations due to sexual dimorphism. MATERIALS AND METHODS: A total of 46 female and 24 male patients, aged 18-40 years, participated in this study. Unstimulated saliva was collected for the evaluation of flow rate, pH, secretory IgA, Snyder test scores, and Streptococcus mutans counts (confirmed by PCR assay). Statistical analysis included the Mann-Whitney, Kruskal-Wallis and Bonferroni tests, one-way ANOVA, and the Spearman correlation at a 5% significance level, followed by a general linear model and multiple linear regressions. RESULTS: Female participants presented lower salivary pH values compared to males (p < 0.05), and different patterns of correlation among salivary parameters were found in men (p < 0.05) and women (p < 0.001). When comparing the variables according to Snyder test scores in men and women, there was a significant difference for S. mutans levels in the male group, and for pH and IgA in the female group (p < 0.05). Gender was found to be a predictor of salivary flow (R2 = 0.05; p < 0.05) and pH (R2 = 0.16; p < 0.001). In the female group, multiple regression showed several predictors for salivary flow rate, pH, IgA and Snyder test scores (p < 0.05), whereas no predictor was found in the male group (p > 0.05). CONCLUSION: Different salivary patterns were observed in men and women, thus the implications of such findings for caries susceptibility require further investigation.

Morning salivary cortisol with regard to gender in individuals with perceived facial pain / Cortisol salivar matutino em relação ao sexo em indivíduos com sintomas de dor facial

ABSTRACT BACKGROUND AND OBJECTIVES: Facial pain seems to be related to physiological responses to stress and sexual dimorphism. However, the relationship among facial pain, cortisol secretion and gender has been poorly investigated. This study aimed to investigate differences in morning salivary cortisol profile between males and females either with or without perceived facial pain symptoms. METHODS: Participated in the study 39 individuals reporting facial pain and 33 painless controls of both genders. Facial pain symptoms were evaluated with Axis II Research Diagnostic Criteria for Temporomandibular Disorders, which has supplied chronic pain scores. Saliva was collected in the morning to obtain cortisol peaks, being stored for further use. Salivary cortisol levels were evaluated by immunosorbent assay. Statistical analysis has included hypotheses tests and ANOVA with significance level of 5% and a binary logistic regression, which has tested the association between gender, cortisol and each facial pain symptom. RESULTS: There has been no association between facial pain and gender. Cortisol levels were similar among individuals with and without facial pain, regardless of gender. The adjusted model has shown that most symptoms were not associated to gender, regardless of cortisol levels. CONCLUSION: In individuals with and without facial pain symptoms, morning salivary cortisol levels regulation has been similar for both genders.

RESUMO JUSTIFICATIVA E OBJETIVOS: A percepção da dor facial parece estar relacionada com respostas fisiológicas ao estresse e com o dimorfismo sexual. No entanto, a relação entre dor facial, secreção de cortisol e o sexo ainda foi pouco investigada. O objetivo deste estudo foi investigar as diferenças nos perfis de cortisol salivar matutino em homens e mulheres com ou sem sintomas de dor facial. MÉTODOS: Trinta e nove indivíduos que relataram dor facial e 33 controles sem dor, de ambos os sexos, participaram deste estudo. Os sintomas de dor facial foram avaliados utilizando o Eixo II do Critério de Diagnóstico para Pesquisa das Disfunções Temporomandibulares, que forneceu os escores de dor crônica. A saliva foi coletada dos participantes no turno matutino a fim de obter os picos de cortisol, sendo armazenada até utilização posterior. Os níveis salivares de cortisol foram avaliados por ensaio imunoenzimático. A análise estatística incluiu testes de hipóteses e ANOVA com nível de significância de 5%, e uma regressão logística binária que testou a associação entre o sexo, cortisol, e cada sintoma de dor facial. RESULTADOS: Não foi observada associação entre dor facial e o sexo. Os níveis de cortisol foram semelhantes entre indivíduos com ou sem dor facial, independentemente do sexo. O modelo ajustado mostrou que a maioria dos sintomas não teve associação com o sexo, independentemente dos níveis de cortisol. CONCLUSÃO: Nos indivíduos com e sem dor facial, a regulação dos níveis de cortisol salivar matutino ocorreu de forma semelhante em ambos os sexos.

Periodontite agressiva localizada: considerações sobre etiopatogenia e tratamento / Localized aggressive periodontitis: aspects of etiopathogenesis and treatment

A periodontite agressiva localizada (PAL) é uma doença caracterizada pela destruição periodontal agressiva em dentes específicos, de agregação familiar, geralmente afetando a população jovem, principalmente os afrodescendentes. Apesar da baixa prevalência, o diagnóstico precoce desta doença é difícil, especialmente na dentição decídua, o que geralmente resulta em sua rápida progressão e eventual perda precoce de importantes dentes da cavidade oral. Até o presente momento, a maior parte dos estudos realizados tem envolvido populações pequenas, devido à dificuldade em se obter grandes populações com esta doença. Entretanto, há evidências científicas de espécies bacterianas e vírus associados à PAL, bem como de respostas imunológicas específicas associadas com indivíduos ou famílias de indivíduos afetados pela doença. Há evidências, ainda, da efetividade de antibióticos associados ao debridamento mecânico, quando se compara com a terapia mecânica isolada em PAL. No entanto, mais estudos são necessários para esclarecer mecanismos específicos relacionados à PAL, a participação de outros fatores na patogênese da doença e a estabilidade, a longo prazo, dos dentes com destruição periodontal inicialmente severa.

Dentists' knowledge regarding signs and symptoms of the systemic toxicity of local anesthetic solutions / Conhecimento de cirurgiões-dentistas sobre sinais e sintomas de toxicidade sistêmica associados ao uso de soluções anestésicas locais

OBJECTIVE: To evaluate the knowledge of dentists about signs and symptoms that may be indicative of systemic toxicity associated with the use of local anesthetic solutions. METHODS: One hundred and twenty-four (124) dentists from private clinics in São Luís (Maranhão, Brazil) answered a questionnaire regarding the choice of solutions, selection criteria for local anesthetics and vasoconstrictors, and side effects associated with these substances. Results were analyzed by using descriptive statistics. RESULTS: Although most respondents reported being likely to choose local anesthetics at less toxic concentrations (including 2% mepivacaine or lidocaine), they were also likely to have similar vasoconstrictor solutions (epinephrine) as the second choice. The main selection criteria of anesthetic solutions reported were the duration of procedures and patients' individual characteristics. In general, dentists demonstrated being aware of some side effects associated with vasoconstrictors; however, they showed a lack of knowledge regarding signs and symptoms related to an overdose of local anesthetics. CONCLUSION: The group of dentists involved in this study showed limited knowledge about the toxicity of local anesthetics, as well as some inconsistent background over the choice of vasoconstrictors. Thus, strategies are required towards improving the knowledge of professionals from private dental clinics regarding local anesthetics and/or vasoconstrictors. .

OBJETIVO: Avaliar as soluções anestésicas utilizadas por um grupo de cirurgiões-dentistas e o nível de conhecimento desses profissionais sobre riscos associados a essas substâncias. MÉTODOS: Cento e vinte e quatro (124) cirurgiões-dentistas da rede privada do município de São Luís (Maranhão, Brasil) responderam um questionário contendo perguntas relativas às soluções de escolha, aos critérios de escolha de anestésicos locais e vasoconstritores e à avaliação do conhecimento sobre os efeitos colaterais associados às substâncias. RESULTADOS: Os resultados obtidos foram analisados utilizando-se estatística descritiva. Observou-se que a maior parte dos cirurgiões-dentistas optaram por anestésicos locais em concentrações menos tóxicas, como a mepivacaína 2% e a lidocaína 2%, porém se verificou que a maioria dos profissionais optaram pelo mesmo vasoconstritor (epinefrina) em soluções de segunda escolha. Os principais critérios de escolha das soluções anestésicas foram a duração do procedimento e as características do paciente. Analisando os dados em conjunto, os cirurgiões-dentistas pareceram conhecer alguns efeitos colaterais associados a vasoconstritores, porém demonstraram uma deficiência no conhecimento de sinais e sintomas relacionados à sobredosagem de anestésicos locais. CONCLUSÃO: Concluiu-se que o grupo de cirurgiões-dentistas envolvido no presente estudo apresentou conhecimento limitado em relação à toxicidade de anestésicos locais, bem como contradição em relação à escolha de vasoconstritores. Estratégias para aprofundar o conhecimento sobre anestésicos locais e/ou vasoconstritores de profissionais da rede privada são necessárias. .

Salivary IgA and periodontal treatment needs in diabetic patients.

Salivary IgA can serve as a first line of defense against pathogens that colonize and invade mucosal surfaces and may be protective against periodontal disease. The aim of this study was to assess salivary immunoglobulin A levels in diabetic and non-diabetic patients with different periodontal treatment needs. The Periodontal Screening & Recording (PSR) system was used to evaluate the periodontal treatment needs of 41 diabetic and 42 non-diabetic patients. Unstimulated whole saliva was collected from each patient immediately before clinical examination and stored at -20 °C until analysis. Salivary immunoglobulin A (s-IgA) levels were determined using an enzyme-linked immunosorbent assay, and values were expressed as optical density. Diabetic and non-diabetic patients were compared using clinical and laboratory data. PSR data indicated that periodontal disease was more frequent and more severe in diabetic patients. A higher prevalence of codes 3 and 4 was observed in diabetics as compared with non-diabetics (odds ratio = 2, P < 0.05). Furthermore, non-diabetic patients had more healthy sextants (code 0) than did diabetic patients. Over half of diabetic patients (∼54%) presented with s-IgA levels that were lower than the normal range (optical density from 0.4 nm to 0.6 nm; P < 0.05). In addition, diabetic patients showed a higher variability in s-IgA levels as compared with non-diabetic patients. In conclusion, diabetic individuals had lower s-IgA levels, more-frequent and more-severe periodontal disease, and a greater need for periodontal treatment as compared with non-diabetic patients.

Salivary IgA and periodontal treatment needs in diabetic patients

Salivary IgA can serve as a first line of defense against pathogens that colonize and invade mucosal surfaces and may be protective against periodontal disease. The aim of this study was to assess salivary immunoglobulin A levels in diabetic and non-diabetic patients with different periodontal treatment needs. The Periodontal Screening & Recording (PSR) system was used to evaluate the periodontal treatment needs of 41 diabetic and 42 non-diabetic patients. Unstimulated whole saliva was collected from each patient immediately before clinical examination and stored at -20 °C until analysis. Salivary immunoglobulin A (s-IgA) levels were determined using an enzyme-linked immunosorbent assay, and values were expressed as optical density. Diabetic and non-diabetic patients were compared using clinical and laboratory data. PSR data indicated that periodontal disease was more frequent and more severe in diabetic patients. A higher prevalence of codes 3 and 4 was observed in diabetics as compared with non-diabetics (odds ratio = 2, P < 0.05). Furthermore, non-diabetic patients had more healthy sextants (code 0) than did diabetic patients. Over half of diabetic patients (∼54 percent) presented with s-IgA levels that were lower than the normal range (optical density from 0.4 nm to 0.6 nm; P < 0.05). In addition, diabetic patients showed a higher variability in s-IgA levels as compared with non-diabetic patients. In conclusion, diabetic individuals had lower s-IgA levels, more-frequent and more-severe periodontal disease, and a greater need for periodontal treatment as compared with non-diabetic patients.

Effects of 7-epiclusianone on Streptococcus mutans and caries development in rats.

The aim of this study was to evaluate the effects of 7-epiclusianone (7-epi) on specific virulence attributes of Streptococcus mutans in vitro and on development of dental caries in vivo. 7-Epi was obtained and purified from fruits of Rheedia brasiliensis. We investigated its influence on surface-adsorbed glucosyltransferase (Gtf) B activity, acid production, and viability of S. MUTANS in biofilms, as well as on caries development using a rodent model. 7-Epi (100 µg/mL) significantly reduced the activity of surface-adsorbed GtfB (up to 48.0 ± 1.8 of inhibition at 100 µg/mL) and glycolytic pH-drop by S. mutans in biofilms (125 and 250 µg/mL) (vs. vehicle control, p < 0.05). In contrast, the test compound did not significantly affect the bacterial viability when compared to vehicle control (15 % ethanol, p > 0.05). Wistar rats treated topically with 7-epi (twice daily, 60-s exposure) showed significantly smaller number of and less severe smooth- and sulcal-surface carious lesions (p < 0.05), without reducing the S. mutans viable population from the animals' dental biofilms. In conclusion, the natural compound 7-epiclusianone may be a potentially novel pharmacological agent to prevent and control dental caries disease.

Inhibitory effects of 7-epiclusianone on glucan synthesis, acidogenicity and biofilm formation by Streptococcus mutans.

The aim of this study was to examine the effects of 7-epiclusianone, a new prenylated benzophenone isolated from the plant Rheedia gardneriana, on some of the virulence properties of Streptococcus mutans associated with biofilm development and acidogenicity. The synthesis of glucans by glucosyltransferases B (GTF B) and C (GTF C) was markedly reduced by 7-epiclusianone showing more than 80% inhibition of enzymatic activity at a concentration of 100 microg mL(-1). Double-reciprocal analysis (Lineweaver-Burk plots) revealed that the inhibition of GTF B activity was noncompetitive (mixed) while GTF C was inhibited uncompetitively. The glycolytic pH drop by S. mutans cells was also disrupted by 7-epiclusianone without affecting the bacterial viability, an effect that can be attributed, in part, to inhibition of F-ATPase activity (61.1+/-3.0% inhibition at 100 microg mL(-1)). Furthermore, topical applications (1-min exposure, twice daily) of 7-epiclusianone (at 250 microg mL(-1)) disrupted biofilm formation and physiology. The biomass (dry-weight), extracellular insoluble polysaccharide concentration and acidogenicity of the biofilms were significantly reduced by the test agent (P<0.05). The data show that 7-epiclusianone disrupts the extracellular and intracellular sugar metabolism of S. mutans, and holds promise as a novel, naturally occurring compound to prevent biofilm-related oral diseases.