Antibacterial photodynamic therapy for dental caries: evaluation of the photosensitizers used and light source properties.

Photodynamic therapy studies have shown promising results for inactivation of microorganisms related to dental caries. A large number of studies have used a variety of protocols, but few studies have analyzed photosensitizers and light source properties to obtain the best PDT dose response for dental caries. This study aims to discuss the photosensitizers and light source properties employed in PDT studies of dental caries. Three questions were formulated to discuss these aspects. The first involves the photosensitizer properties and their performance against Gram positive and Gram negative bacteria. The second discusses the use of light sources in accordance with the dye maximum absorbance to obtain optimal results. The third looks at the relevance of photosensitizer concentration, the possible formation of self-aggregates, and light source effectiveness. This review demonstrated that some groups of photosensitizers may be more effective against either Gram positive or negative bacteria, that the light source must be appropriate for dye maximum absorbance, and that some photosensitizers may have their absorbance modified with their concentration. For the best results of PDT against the main cariogenic bacteria (Streptococcus mutans), a variety of aspects should be taken into account, and among the analyzed photosensitizer, erythrosin seems to be the most appropriate since it acts against this Gram positive bacteria, has a hydrophilic tendency and even at low concentrations may have photodynamic effects. Considering erythrosin, the most appropriate light source should have a maximum emission intensity at a wavelength close to 530 nm, which may be achieved with low cost LEDs.

Educação permanente em saúde para técnicos de saúde bucal e auxiliares de saúde bucal: relato de experiência / Permanent health education for oral health technicians and oral health auxiliaries: report of experience

RESUMO O trabalho relata a experiência da I Oficina sobre Educação Permanente em Saúde (EPS) para Técnicos em Saúde Bucal (TSBs) e Auxiliares em Saúde Bucal (ASBs) de Maringá (PR), organizado pela Universidade Estadual de Maringá e pela Prefeitura Municipal Utilizando uma situação problema, foram realizadas discussões a partir de um caso fictício. Do total de 76 participantes, 37% conheciam a EPS, 29% a realizavam e 94% gostariam de saber mais sobre o assunto. Verificou-se que as informações relacionadas à EPS são restritas, que há grande interesse dos TSBs e ASBs sobre o tema e é de fundamental importância a inclusão destes profissionais nas discussões do processo de trabalho para a qualificação da atenção.

ABSTRACT The paper reports the experience of the First Workshop on Continuing Education in Health (EPS) for Oral Health Technicians (TOH) and Oral Health Auxiliaries (AOH) of Maringá (Paraná, Brazil), organized by Universidade Estadual de Maringá and City Hall. Using a problem situation, discussions took place from a fictitious case, From a total of 76 participants, 37% knew EPS, 29% performed it and 94% would like to know more. It was found that knowledge about EPS is restricted, there is great interest of TOH and AOH on the subject and is of fundamental importance to include these professionals in discussions of the work process for the qualification of attention.

Experiência de clínica ampliada em odontologia na Universidade Estadual de Maringá / An experience with expanded clinical care in dentistry at the State University in Maringá

A clínica ampliada (CA) representa uma estratégia da Política Nacional de Humanização (PNH) para reflexão sobre o cuidado com o usuário do Sistema Único de Saúde (SUS). Impulsionados pelo Programa Pró-Saúde e pela PNH, docentes do curso de Odontologia da UEM promoveram uma reestruturação do atendimento clínico ofertado, resultando na implantação da CA. Este trabalho relata a experiência vivenciada na implantação dessa clínica, que visa a promover a interação e o vínculo do aluno com a comunidade e a equipe multiprofissional de saúde, de modo a obter o cuidado integral e humanizado. A CA está estruturada para acolher o usuário em um ambiente multiprofissional, direcionando-o dentro de um fluxograma até a sua alta, promovendo a autonomia na manutenção de sua saúde bucal. A CA tem dado subsídios para melhorar a visão do cuidado integral do usuário da clínica odontológica da UEM, fortalecendo a formação acadêmica e o cuidado prestado à comunidade. Nota-se que a construção coletiva agrega muito valor às ações, mas é um processo lento e depende da maturidade dos envolvidos.

Expanded clinical care is a strategy under the National Policy for Humanized Care for reflection on care for users of the Unified National Health System. Under the impetus of the Pró-Saúde program and the National Policy for Humanized Care, faculty from the School of Dentistry at the State University in Maringá (UEM) conducted a restructuring of clinical care, resulting in the implementation of expanded care. This study reports on the experience with the implementation of such expanded clinical care, aimed at promoting interaction between students, community, and the multi-professional health team, so as to obtain comprehensive and humanized care. Expanded care is structured to receive users in a multi-professional setting, directing them within a flowchart all the way to their discharge and fostering autonomy in the maintenance of their oral health. Expanded care has provided backing for improving the vision of comprehensive care for users of the UEM dental clinic, strengthening academic training and community care. The collective construction adds considerable value to the activities, but it is a slow process that requires maturity on the part of participants.

Perfil de cirurgiões-dentistas formados por um currículo integrado em uma instituição de ensino pública brasileira / Profile of dentists trained with an integrated curriculum at a Brazilian public teaching institution

O objetivo deste trabalho foi caracterizar o perfil dos egressos do Curso de Odontologia da Universidade Estadual de Maringá e a contribuição do projeto pedagógico para atuação profissional. Um questionário on-line composto por 20 questões foi enviado via e-mail para os egressos formados entre 2003 e 2010. Para armazenamento e extração das informações utilizou-se o software MYSQL e SQLYOG respectivamente, e foram exportadas para o formato XLS (Microsoft Excel) para a análise descritiva. Do total de 273 egressos deste período, foram contatados 208 (76%) e destes, 148 responderam ao questionário (71%). A maioria dos egressos foi do sexo feminino (63%), faixa etária de 26 a 30 anos, oriundos do Paraná (84%) e atuava neste estado (80%). Aproximadamente 50% apresentaram uma renda anual de 12-36 mil R$/ano, a maioria faz ou fez algum curso de pós-graduação (95%), atuava em consultório particular (61%) e apenas 9% sentiam-se realizados financeiramente. Quanto a proposta pedagógica, mais de 90% a consideraram boa ou ótima, 59% relataram que o currículo ocorre parcialmente de forma integrada e que as disciplinas atendiam parcial (48%) ou totalmente aos objetivos propostos (49%). Concluiu-se que o curso tem formado profissionais predominantemente do sexo feminino, jovem e com atuação concentrada no Paraná. O projeto pedagógico do curso tem contribuído para uma formação generalista, as disciplinas atendem aos objetivos do curso, porém na visão dos egressos, o desenvolvimento curricular ocorre de forma parcialmente integrada indicando a necessidade de novas reformulações visando a melhoria do curso (AU).

The aim of this study was to characterize the profile of the State University of Maringa Dentistry Course alumni and relate the contribution of the institution's pedagogic project to their professional life. An on-line questionnaire composed of 20 questions was sent via email to alumni who graduated between 2003 and 2010. MYSQL and SQLYOG software were used for storage and retrieval of the information, respectively, and data were exported to XLS (Microsoft Excel) format for a descriptive analysis. Of a total of 273 alumni from this period, 208 (76%) were contacted, 148 of which responded to the questionnaire (71%). The majority of the alumni were women (63%), with an age range from 26 to 30 years, who came from Paraná (84%) and worked in that state (80%). Approximately 50% reported an annual income of 12 thousand to 36 thousand real (R$/annum). The majority were currently taking or had taken some graduate courses (95%) and were working in private practice (61%). Only 9% felt that they had achieved financial satisfaction. As regards the pedagogic proposal, over 90% considered it good or excellent, 59% reported that the curriculum is partially integrated and that the subjects of the curriculum met their proposed objectives either partially (48%) or completely (49%). It was concluded that the course has predominantly trained young, women professionals with activities concentrated in the state of Paraná; the pedagogic project of the course has contributed to fostering a generalist education and that the disciplines have met the objectives of the course; however, from the point of view of the alumni, curricular development is only partially integrated, indicating the need for new formulations with a view to improving the course (AU).

Prevalência do uso de protetores bucais em praticantes de artes marciais de um município do Paraná / The prevalent use of mouthguards by martial arts’ practitioners in a city in the state of Paraná

O objetivo deste trabalho foi verificar a prevalência do uso de protetores bucais por praticantes de artes marciais e a porcentagem de indivíduos que já sofreram traumatismos em academias de um município do estado do Paraná. Indivíduos de ambos os sexos, maiores de 18 anos e praticantes não profissionais de muay thai, jiu-jitsu e judô foram convidados a participar doprojeto respondendo a um questionário. Os resultados indicaram uma prevalência de 34,6% do uso do protetor bucal e uma variação na prevalência de traumatismo dentário de 6,6% a 26,6%, dependendo da modalidade de esporte. É papel do cirurgião-dentista informar e conscientizar a população sobre o uso de protetores bucais na prática de esportes que ofereçam maior risco à saúde bucal.

The purpose of this study was to evaluate the prevalence of the use of mouthguards by martial arts’ practitioners, as well as to verify the percentage of who have already had traumas in fitness centers of a city in thestate of Paraná. Male and female subjects who were over 18 years old and non-professionals practitioners of muay thai, jiu-jitsu and judo were invited to participate by answering a questionnaire. The results showed that the use of mouthguards has a prevalence of 34,6% and a variation of 6,6% to 26,6% for the occurrence oftraumas. It’s the surgeon dentist’s obligation aware the population about the importance of use mouthguardswhile practicing sports. There are different types of mouthguards and the precise indication depends on each situation.

Periodontal parameters and BANA test in patients with chronic renal failure undergoing hemodialysis.

OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7 ± 7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77 ± 0.32 and 2.65 ± 0.53; GR: 0.58 ± 0.56 and 0.51 ± 0.36; PLI: 1.64 ± 0.56 and 1.24 ± 0.67; GI: 0.64 ± 0.42 and 0.93 ± 0.50; CI: 1.17 ± 0.54 and 0.87 ± 0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001) in the control group. Comparison of the other clinicial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05) in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05). None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9% for the CRF group and 35.7% for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

Periodontal parameters and BANA test in patents with chronic renal failure undergoing hemodialysis

OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77±0.32 and 2.65±0.53; GR: 0.58±0.56 and 0.51±0.36; PLI: 1.64±0.56 and 1.24±0.67; GI: 0.64±0.42 and 0.93±0.50; CI: 1.17±0.54 and 0.87±0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001) in the control group. Comparison of the other clincial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05) in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05). None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9 percent for the CRF group and 35.7 percent for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

Implementação do Pró-Saúde no Curso de Odontologia da Universidade Estadual de Maringá / Implementing the "Pró-Saúde" program in the Dentistry Course at State University of Maringá

Este trabalho objetivou relatar a implementação do Pró-saúde no curso de Odontologia da Universidade Estadual de Maringá (UEM) e as atividades realizadas até o ano 2010. Trata-se de um estudo documental retrospectivo de consulta a relatórios técnicos e financeiros das duas cartas acordos do projeto. Uma equipe de seis docentes do Departamento de Odontologia da UEM se encarregou de avaliar todo o material e relacionar as principais ações desenvolvidas. Neste processo, foram fundamentais as constituições de comitês gestor e de acompanhamento e a contratação de assessorias administrativa e pedagógica de recursos humanos. Dentre as ações, destacam-se a atuação nas atividades extramurais, a re-inserção de acadêmicos nos serviços municipais de saúde de Maringá, o estabelecimento de parceria com a Secretaria de Saúde de Marialva, a criação da Clínica Ampliada em Odontologia, os fóruns para relato de experiência e avaliação, os levantamentos epidemiológicos e o projeto de heterocontrole das águas de abastecimento público de Maringá. Conclui-se que a implantação do Pró-Saúde serviu como marco inicial do processo de mudança com a constituição de uma massa crítica de docentes engajados na formação dos profissionais de saúde e trabalhando de forma colegiada. Persistem como desafios a integração multiprofissional e a mudança do paradigma curativista para o de promoção de saúde (AU).

The aim of this study was to report on the implementation of the "Pró-Saúde" Program at the State University of Maringá (UEM), and the activities performed up to 2010. This is a retrospective documentary study that examined technical and financial reports on two letters of agreement for the program. Six teachers were in charge of evaluating all the material and listing the main actions developed. The fundamental actions in this process were the establishment of management and monitoring committees and the hiring of administrative and teaching advisers in the area of human resources. Other key actions included: performance in extramural activities, reintegration of academics in the Maringá municipal health services, establishment of a partnership with the Marialva Department of Health, creation of the "Clínica Ampliada em Odontologia" (Extended Dental Clinic), forums for reporting on the experience obtained and for evaluation, epidemiological surveys and external control of fluoride levels in the Maringá public water supply. It was concluded that the implementation of the "Pró-Saúde" program was a landmark for establishing a critical mass of teachers engaged in the training of health professionals. Remaining challenges are to achieve multidisciplinary integration and make a shift from a curative to a health promotion paradigm (AU).

Fluorose dental em estudantes da rede estadual de ensino de Maringá ? PR / Dental fluorosis in students from state schools of Maringá -PR

O objetivo deste estudo foi avaliar a prevalência de fluorose dental em estudantes da rede estadual de ensino do município de Maringá/PR. A amostra foi constituída por 313 crianças aos 12 anos de idade, de ambos os sexos, recrutadas dentre as 30 escolas estaduais do município. Após receber consentimento dos responsáveis pelas crianças, as faces vestibulares dos incisivos centrais superiores foram examinadas medianteremoção mecânica do biofilme dental e secagem dos dentes com auxílio de gaze. Para classificar os diferentes graus de fluorose, utilizou?se o índice de Dean. Solicitou-se aos responsáveis que preenchessem um questionário com dados relativos a criança.O exame foi realizado nas escolas, sob iluminação natural indireta, por uma única examinadora. Os resultados demonstraram que do total de crianças examinadas, 42 (13,4%) apresentavam fluorose, sendo que 35 (11,2%) apresentavam fluorose muito leve e 7 (2,2%) apresentavam fluorose leve. A prevalência e a severidade da fluorosedental nos estudantes da rede estadual de ensino de Maringá/PR foram baixas, não justificando medidas urgentes de saúde pública. Ainda assim, há necessidade constante de se conscientizar a população e os profissionais de saúde a evitarem o excesso da ingestão de fluoretos e, com isso, os efeitos adversos como a fluorose dental.

Alkali-soluble fluoride deposition on enamel after professional application of topical fluoride in vitro

Considerando que a eficácia dos produtos para aplicação tópica profissional de flúor (géis, espumas e vernizes) está relacionada com a reatividade do flúor (F) com o esmalte e sendo esta dependente da disponibilidade do F em cada produto, este estudo foi conduzido. A concentração de F nos seguintes produtos foi estudada: I - Flúor Fosfato Acidulado (FFA) gel (1,23% F), II - FFA espuma (1,23% F) e III- Verniz fluoretado (2,26% F). Foram confeccionados 40 blocos de esmalte bovino, tratados de acordo com os grupos descritos, sendo um deles utilizado como controle. O F fracamente ligado (''CaF2'') ao esmalte foi determinado após a extração com 1.0 M KOH e analisado em eletrodo específico. A concentração de F encontrada no gel foi de 12.642, na espuma 12.755 e no verniz 23.183 mg F/g. Todos os produtos formaram uma quantidade significantemente maior de ''CaF2'' na superfície do esmalte, comparado ao grupo controle (p < 0,05), mas entre eles, esta diferença não foi significante (p > 0,05). Assim, a formação de ''CaF2'' na superfície do esmalte não foi proporcional ao conteúdo de F nos produtos, sugerindo que o pH e o veículo utilizado são mais importantes.

Fluoride and aluminum in teas and tea-based beverages.

OBJECTIVE: To evaluate fluoride and aluminum concentration in herbal, black, ready-to-drink, and imported teas available in Brazil considering the risks fluoride and aluminum pose to oral and general health, respectively. METHODS: One-hundred and seventy-seven samples of herbal and black tea, 11 types of imported tea and 21 samples of ready-to-drink tea were divided into four groups: I-herbal tea; II-Brazilian black tea (Camellia sinensis); III-imported tea (Camellia sinensis); IV-ready-to-drink tea-based beverages. Fluoride and aluminum were analyzed using ion-selective electrode and atomic absorption, respectively. RESULTS: Fluoride and aluminum levels in herbal teas were very low, but high amounts were found in black and ready-to-drink teas. Aluminum found in all samples analyzed can be considered safe to general health. However, considering 0.07 mg F/kg/day as the upper limit of fluoride intake with regard to undesirable dental fluorosis, some teas exceed the daily intake limit for children. CONCLUSIONS: Brazilian and imported teas made from Camellia sinensis as well as some tea-based beverages are sources of significant amounts of fluoride, and their intake may increase the risk of developing dental fluorosis.

Fluoride and aluminum in teas and tea-based beverages

OBJECTIVE: To evaluate fluoride and aluminum concentration in herbal, black, ready-to-drink, and imported teas available in Brazil considering the risks fluoride and aluminum pose to oral and general health, respectively. METHODS: One-hundred and seventy-seven samples of herbal and black tea, 11 types of imported tea and 21 samples of ready-to-drink tea were divided into four groups: I-herbal tea; II-Brazilian black tea (Camellia sinensis); III-imported tea (Camellia sinensis); IV-ready-to-drink tea-based beverages. Fluoride and aluminum were analyzed using ion-selective electrode and atomic absorption, respectively. RESULTS: Fluoride and aluminum levels in herbal teas were very low, but high amounts were found in black and ready-to-drink teas. Aluminum found in all samples analyzed can be considered safe to general health. However, considering 0.07 mg F/kg/day as the upper limit of fluoride intake with regard to undesirable dental fluorosis, some teas exceed the daily intake limit for children. CONCLUSIONS: Brazilian and imported teas made from Camellia sinensis as well as some tea-based beverages are sources of significant amounts of fluoride, and their intake may increase the risk of developing dental fluorosis.

Alkali-soluble fluoride deposition on enamel after professional application of topical fluoride in vitro.

Since the efficacy of topical fluoride products is related to the fluoride (F) availability and its reactivity with enamel, this study was conducted. The F concentration of the following materials was verified: I- acidulated phosphate fluoride (APF) gel (1.23% F), II- APF foam (1.23% F) and III- Varnish (2.26% F). Forty blocks of bovine enamel were divided into 4 groups and treated according to the materials described, being one of them used as control. Loosely bound fluoride (''CaF2'') was determined on enamel after extraction with 1.0M KOH and analyzed by ion-selective electrode. Total F concentration found in gel was 12,642, in foam 12,755 and in varnish 23,183 mg F/g. All products formed statistically higher amounts of ''CaF2'' on enamel compared to the control group (p < 0.05), but the difference between them was not significant (p > 0.05). Thus, ''CaF2'' formation was not proportional to the total F content in the products, suggesting that the pH and the vehicle used are more important.

Effect of a novel type of propolis and its chemical fractions on glucosyltransferases and on growth and adherence of mutans streptococci.

Flavonoids have been considered the main biologically active components in propolis. However, a new variety of flavonoid-free propolis was recently found and chemically classified as type 6. Because it showed activity against oral microorganisms, this study evaluated the effects of the crude ethanolic extract of this propolis and its chemical fractions on the activity of purified glucosyltransferases (GTFs) and on the growth and adherence of mutans streptococci. The inhibitory effect of propolis extracts on GTF activities was determined either in solution or adsorbed onto saliva-coated hydroxyapatite. Streptococcus mutans Ingbritt 1600, Streptococcus sobrinus 6715, and two clinical isolates of each species were used for antibacterial assays. Susceptibilities to the test extracts were analyzed using the agar diffusion method and by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC); the effect on bacterial adherence to a glass surface was also assessed. The activity of GTFs in solution was effectively inhibited by the ethanolic extract of propolis type 6 (EEP) (>80% inhibition at 0.5 mg/ml), hexane, and chloroform fractions (60-90% inhibition at 100 microg/ml); their inhibitory effects on surface enzymes were less pronounced. The EEP, hexane, and chloroform fractions also showed significant antibacterial activity. The data showed that propolis type 6 remarkably reduced GTF activity and inhibited mutans streptococci growth and adherence; these biological activities are associated with its nonpolar components.

Relationship between stressful situations, salivary flow rate and oral volatile sulfur-containing compounds.

The relationship between stress, salivary flow rate and oral volatile sulfur-containing compounds (VSCs) is not clearly established. Two stressful situations were studied: psychological stress caused by a biochemistry examination (Study I) and psychophysiological stress caused by premenstrual syndrome (PMS) (Study II). Seventy-one undergraduate dental students took part in Study I and VSCs were measured 1 wk before the examination, on the day of examination and 1 wk after. In Study II, 50 women were selected (23 with and 27 without PMS) and the measurements were made during non-menstrual, premenstrual and menstrual stages. Unstimulated salivary flow was determined in the subjects of both studies. On the day of the biochemistry examination, VSCs significantly increased and salivary flow decreased compared with baseline values. Women with PMS showed higher VSC concentrations during the premenstrual stage than those without PMS (P < 0.05), but the salivary flow was not statistically different. A change in VSCs was observed during different stages of the menstrual cycle for the groups of women, but the salivary flow did not change. The results suggest that a stressful situation can be a predisposing factor for the increase of VSCs in the mouth air, but the mechanism cannot be simply explained by reduction of the salivary flow.