Anticaries effect of toothpaste with nano-sized sodium hexametaphosphate.

OBJECTIVE: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ. METHODS: This crossover double-blind study consisted of four phases (7 days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100 ppm F (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student-Newman-Keuls' test (p < 0.001). RESULTS: 1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001). CONCLUSION: 1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste. CLINICAL RELEVANCE: This toothpaste could be a viable alternative to patients at high risk of caries.

Remineralizing effect of a fluoridated gel containing sodium hexametaphosphate: An in vitro study.

OBJECTIVES: To evaluate in vitro the effect of neutral pH topical gels with reduced fluoride concentration (F), supplemented or not with sodium hexametaphosphate (HMP) on the remineralization of dental enamel, using a pH-cycling model. Materials and methods Bovine enamel blocks with caries-like lesions were randomly treated with five gels (n = 24/group): without F/HMP (Placebo); 4500 ppm F (4500F), 4500F plus 9% HMP (4500F + HMP); 9000 ppm F (9000F); and 12,300 ppm F (Acid gel). After pH-cycling, the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), and concentrations of loosely- (CaF2) and firmly-bound (FA) fluoride formed and retained in/on enamel were determined. The results were analyzed by ANOVA followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 4500F + HMP gel promoted the highest %SHR among all groups; the lowest ΔKHN was achieved by 4500F + HMP and Acid gel, without significant differences between these. The Acid gel group presented the highest CaF2 and FA formed and retained on/in enamel (p < 0.001). CONCLUSION: Based on the present results, the addition of 9% sodium hexametaphosphate to a gel with reduced fluoride concentration (4500F) was able to significantly enhance the remineralization of artificial carious lesions in vitro when compared to 4500F, reaching protective levels similar to an acidic formulation with ∼3-fold higher fluoride concentration.

Fluoride toothpastes containing micrometric or nano-sized sodium trimetaphosphate reduce enamel erosion in vitro.

OBJECTIVE: To evaluate the effect of fluoride toothpastes supplemented with micrometric or nano-sized sodium trimetaphosphate (TMP or TMPnano, respectively) on enamel erosion in vitro, as well as the influence of salivary acquired pellicle and saliva. MATERIAL AND METHODS: Bovine enamel blocks (n = 120) were randomly assigned into the following experimental toothpastes: no F/TMP/TMPnano (Placebo); 1100 ppm F (1100 ppm F); 1100 ppm F plus 3% TMP or 3% TMPnano (1100 TMP or 1100 TMPnano, respectively) and 5000 ppm F (5000 ppm F). Erosive challenge was performed by immersion of the blocks in citric acid for 5 min, followed by 2 h immersion in human or artificial saliva, 4×/day, during 5 days. After each erosive challenge, blocks were exposed to slurries of the toothpastes. Enamel erosion (µm), surface hardness (SHf) and cross-sectional hardness (ΔKHN) were analyzed as response variables and the data were submitted to two-way ANOVA, followed by the Student-Newman-Keuls test (p < .05). RESULTS: 1100 TMPnano significantly reduced enamel loss when compared to 1100 TMP (p = .002), reaching values similar to those promoted by 5000 ppm F (p = .96). 1100 ppm F presented significantly lower enamel loss than Placebo (p < .001), and higher than 1100 TMP (p < .001). Significantly higher SHf and lower ΔKHN was observed for 1100 TMPnano and 5000 ppm F when compared with the other groups (p < .001). The type of saliva did not influence enamel erosion, SHf and ΔKHN for the groups treated with TMP-containing toothpastes. CONCLUSION: The addition of 3% TMPnano to 1100 ppm F toothpastes significantly increases the protective effect against enamel erosion in vitro when compared with its counterparts with micrometric TMP or without TMP. This effect was not influenced by the presence of acquired enamel pellicle and saliva.

Efeito da adição de nanopartículas de hexametafosfato de sódio em dentifrícios fluoretados sobre o processo de remineralização, desmineralização e biofilme dentário: estudos in situ / Effect of the addition of nanoparticles of sodium hexametaphosphate in fluoridated toothpaste on the process of remineralization, demineralization and dental biofilm: in situ studies

O objetivo geral deste estudo foi avaliar o efeito de um dentifrício fluoretado convencional (1100 ppm F), contendo nanopartículas de hexametafosfato de sódio (HMPnano) sobre a remineralização de lesões artificiais de cárie e desmineralização do esmalte in situ e biofilme. O estudo de remineralização, foi duplo-cego cruzado, realizado em quatro fases de três dias cada. Voluntários (n=12) usaram dispositivos palatinos contendo quatro blocos de esmalte bovino com lesões artificiais de cárie. A seguir foram distribuídos aleatoriamente nos seguintes grupos de tratamento: sem F/HMP/HMPnano (Placebo); 1100 ppm F (1100F); 1100F associado a 0,5% HMP microparticulado e nanoparticulado (1100F/HMP; 1100F/HMPnano). Os voluntários foram instruídos a escovar seus dentes naturais com os dispositivos palatinos na boca durante 1 min (3x/dia), de modo que os blocos foram tratados com slurry de dentifrícios. Após cada fase, determinou-se a porcentagem de recuperação de dureza de superfície (%SHR), recuperação integrada de dureza de subsuperfície (ΔIHR), recuperação mineral integrada (ΔIMR) e concentração de fluoreto (F) no esmalte. Os resultados foram submetidos a análise de variância de medidas repetidas seguido pelo teste Student-Newman-Keuls (p < 0,001). A superfície do esmalte tornou-se 68% mais remineralizada quando tratada com 1100F/HMPnano em comparação com 1100F (p < 0,001). O tratamento com 1100F/HMP e 1100F/HMPnano promoveu um aumento em ~ 23% e ~ 87% da ΔIHR quando comparado ao 1100F (p < 0,001). Além disso, ΔIMR foi de ~ 75% e ~ 33% maior para 1100F/HMPnano quando comparado a 1100F e 1100F/HMP, respectivamente (p < 0,001). O estudo de desmineralização foi duplo-cego cruzado, e consistiu em quatro fases (7 dias cada). Voluntários (n=12) usaram aparelhos palatinos contendo quatro blocos de esmaltes bovinos. O desafio cariogênico foi realizado pela solução de sacarose a 30% (6x/dia). Os tratamentos com os dentífricios (3x/dia) foram os seguintes: sem F/ HMP/HMPnano (Placebo); 1100 ppm F (1100F); 1100F associado a 0,5% HMP microparticulado e nanoparticulado (1100F/HMP; 1100F/HMPnano). Após sete dias determinou-se a porcentagem de perda de dureza de superfície (%SH), perda integrada de dureza subsuperfície (ΔKHN), cálcio (Ca), fósforo (P) e fluoreto (F) no esmalte. Além disso, no biofilme formado sobre os blocos analisou-se as concentrações de polissacarídeos extracelulares (EPS), F, Ca, P. Os resultados foram submetidos a análise de variância de medidas repetidas seguido pelo teste Student-Newman-Keuls (p < 0,001). Resultados: 1100F/HMPnano promoveu menor %SH e ΔKHN quando comparado aos demais grupos (p < 0,001). A adição de HMPnano a 1100F não aumentou a absorção de F e P no esmalte, mas aumentou significativamente as concentrações de Ca (p < 0,001). O grupo 1100F/HMPnano apresentou valores mais baixos de concentração de EPS quando comparado com 1100F (~ 70%) (p < 0,001). Todos os grupos foram supersaturados em relação a hidroxiapatita (HA). Somente, o grupo 1100F/HMPnano foi supersaturado em relação ao fluoreto de cálcio (CaF2) (p < 0,05). As atividades iônicas de íon fluoreto de cálcio (CaF+) e fluoreto de hidrogênio neutro (HF0) para o grupo 1100F/HMPnano foram significativamente maiores quando comparadas aos demais grupos (p < 0,001). Conclui-se que a adição de HMPnano a um dentifrício convencional promoveu um efeito remineralizador significantemente maior em lesões artificiais de cárie e demonstrou um maior efeito protetor contra a desmineralização e variáveis do biofilme in situ(AU)

The aim of this study was to evaluate the effect of a conventional fluoride toothpaste (1100 ppm F) containing nano-sizeds of sodium hexametaphosphate (HMPnano) on the remineralization of artificial caries lesions and enamel demineralization and biofilm in situ. The remineralization study was double-blinded crossed, performed in 4 phases of 3 days each. Volunteers (n = 12) used palatal devices containing four blocks of bovine enamel with artificial lesions of caries. They were then randomly assigned to the following treatment groups: without F/ HMP/HMPnano (Placebo); 1100 ppm F (1100F); 1100F associated with 0.5% HMP microparticulate and nano-sized (1100F/HMP; 1100F/ HMPnano). The volunteers were instructed to brush their natural teeth with the palatine devices in the mouth for 1 min (3x/day), so that the blocks were treated with slurry of toothpastes. After each phase, the percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), integrated mineral recovery (ΔIMR) and fluoride (F) concentration in the enamel were determined. The results were subjected to analysis of variance of repeated measures followed by Student-Newman-Keuls test (p < 0.001). The enamel surface became 68% more remineralized when treated with 1100F/ HMPnano compared to 1100F (p < 0.001). Treatment with 1100F/HMP and 1100F/ HMPnano promoted an increase in ~ 23% and ~ 87% of ΔIHR when compared to 1100F (p < 0.001). In addition, ΔIMR was ~ 75% and ~ 33% higher for 1100F/HMPnano when compared to 1100F and 1100F/HMP, respectively (p < 0.001). The study of demineralization was double-blinded crossed, and consisted of four phases (7 days each). Volunteers (n = 12) used palatal appliances containing four blocks of bovine enamel. The cariogenic challenge was accomplished by the solution of sucrose 30% (6x/day). Treatments with the toothpaste (3x/day) were as follows: without F/HMP/HMPnano (Placebo); 1100 ppm F (1100F); 1100F associated with 0.5% HMP microparticulate and nano-sized (1100F/HMP; 1100F/HMPnano). After 7 days the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), calcium (Ca), phosphorus (P) and fluoride (F) in the enamel were determined. The results were submitted to analysis of variance of repeated measurements followed by the Student-Newman-Keuls test (p < 0.001). The results were analyzed using the Student-Newman-Keuls test (p < 0.001). Results: 1100F/HMPnano promoted lower %SH and ΔKHN when compared to the other groups (p < 0.001). Addition of HMPnano to 1100F did not increase the absorption of enamel F, but significantly increased enamel Ca concentrations (p < 0.001). The 1100F/HMPnano group had lower values of EPS concentration when compared to 1100F (~ 70%) (p < 0.001). All groups were supersaturated with respect to hydroxyapatite (HA). Only, the 1100F/HMPnano group was supersaturated relative to calcium fluoride (CaF2) (p < 0.05). The ionic activities of calcium fluoride ion (CaF+) and neutral hydrogen fluoride (HF0) for the 1100F/HMPnano group were significantly higher when compared to the other groups (p < 0.001). It was concluded that the addition of HMPnano to a conventional toothpaste promoted a significantly greater remineralizing effect on artificial caries lesions and demonstrated a greater protective effect against demineralization and biofilm in situ(AU)

Organização didático pedagógica - estratégias para o desenvolvimento de competências / Educational teaching organization - strategies to skills development

As Diretrizes Curriculares Nacionais (DCN) para o curso de graduação em Odontologia foram instituídas no ano de 2002 reorientando o ensino na direção da formação autônoma, pautada em princípios éticos e humanísticos, crítico-reflexiva, atuação em diferentes níveis de atenção e adequando-o às demandas sociais. Para alcançar estes objetivos a organização e metodologias tradicionais não têm se mostrado suficientes e novas estratégias pedagógicas têm sido propostas. Neste contexto, o objetivo do trabalho foi analisar o Projeto Pedagógico do Curso (PPC) de Odontologia das Instituições de Ensino Superior (IES) públicas e privadas do Brasil, com o propósito de caracterizar e analisar a estrutura curricular dos cursos. Foram pesquisadas 203 IES cadastradas no sistema de tramitação eletrônica de processos regulatórios das IES (e-MEC). Apenas 36 disponibilizavam integralmente os PPC na internet. 89% distribuem os conteúdos por disciplinas e 11% por módulos. Dos cursos que estão organizados por disciplinas, 53% agrupam-nas por áreas, eixos ou ciclos, mas sem demonstrar como acontece a integração dos conteúdos. Conclui-se que as instituições, mesmo após a realização das reformas curriculares, ainda necessitam realizar mudanças significativas para alcançar os objetivos das DCN (AU).

The National Curriculum Guidelines (DCN) for the Dentistry course were introduced in 2002 in order to reorient teaching toward autonomous education, guided by ethical, humanistic, critical and reflexive principles, acting upon different levels of care and adapting it the social demands. The traditional methodologies and organization have not proven to be sufficient in order to reaching such objectives, and new educational strategies have emerged. In such context, this study was aimed at analyzing the Educational Project of the Course (EPC) of the Institutions of Higher Education (IHE) from Brazilian public and private Dentistry courses, characterizing and analyzing their Syllabus. From 203 IHE registered in the electronic processing system that regulates Brazilian IHE (e-MEC), only 36 completely provided EPC on the Internet, 89% distributed the contents for subjects and 11% for modules. Among the courses that are organized by subjects, 53% used to group them by areas, axes, or cycles, but without showing how the integration of contents occur. It can be inferred that the Institutions, even after the implementation of Syllabus changes, still need to make notorious shifts in order to achieve the DCN goals (AU).