Short term effect of antimicrobial photodynamic therapy and probiotic L. salivarius WB21 on halitosis: A controlled and randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis. METHODS: Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn's post-test. The significance level was α = 0.05. RESULTS: Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively). CONCLUSION: There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies. TRIAL REGISTRATION: Clinical Trials NCT03996044.

Efficacy of antibiotic and iodoform pastes in non-instrumental endodontic treatment of anterior primary teeth-Protocol for a randomized controlled clinical.

The maintenance of the deciduous tooth until its physiological exfoliation occurs is one of the main objectives of pediatric dentistry. Endodontic treatment in deciduous teeth resulting from carious or traumatic lesions with pulpal involvement is often necessary and we often find it difficult to perform it, due to the difficult control of the child, the internal anatomy of the root canals, and root resorptions. The non-instrumental endodontic treatment technique (NIET) associated with antimicrobial drugs has advantages such as shorter chair time and less complexity than the conventional technique in which root canal instrumentation is performed. The aim of this study is to carry out a controlled and randomized clinical trial to compare the effectiveness of (NIET) in primary teeth associated with the use of two obturator pastes. One hundred and twenty necrotic deciduous teeth of children aged between 3 and 6 years will be selected; and the teeth will be divided into two groups. In Group 1 and Group 2, root canals will not be instrumented, just irrigated and filled with the respective pastes, antibiotic (CTZ) and iodoform (Guedes-Pinto). Presence of fistula and mobility will be clinically evaluated. The evaluations will be carried out in both groups on the day of treatment and in periods of 1, 3 and 6 months after treatment. For the main outcome, the tooth will be the unit of analysis and the Kaplan-Meier test will be performed to estimate the survival rates of the included teeth. For comparison between the two groups, Student's t test or Mann-Whitney test will be performed, depending on the normality of the data. In addition, Poisson regression analyzes will be carried out, in order to allow the evaluation of the influence of some variables on the results. For all analyses, the significance value will be adjusted to 5%. Trial registration: NCT04587089 in ClinicalTrials.gov. Approval date: May 15, 2023.

Functional orthopedic treatment for anterior open bite in children. A systematic review of randomized clinical trials.

PURPOSE: This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children. METHODS: A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence. RESULTS: We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63-4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85-6.55) with Frankel's functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, a beneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported. CONCLUSION: There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects. PROSPERO REGISTER: CRD42020175634, prospectively registered (05 July 2020).

The effect of systemic versus local transcutaneous laser therapy on tension-type cephalea and orofacial pain in post-COVID-19 patients: A pragmatic randomized clinical trial.

INTRODUCTION: Orofacial pain and tensional cephalea were symptoms commonly reported in COVID-19 patients, even after recovery, and were considered chronic pain in these cases. The aim of this research is to evaluate the effect of the application of photobiomodulation with red and infrared lasers applied locally and systemically. METHODS AND ANALYSIS: For this purpose, individuals who have been diagnosed with COVID-19 and have had a tension headache and/or orofacial pain for more than 3 months will be selected by convenience. The participants will be divided into two different groups: G1-photobiomodulation with red and infrared laser with local application on the pain points (808 nm and 660 nm, 100 mW, 6 J per point) and G2-photobiomodulation with red laser with transcutaneous application on the radial artery (660 nm, 100 mW, 30 minutes). All participants will be treated for a period of 4 weeks, with 8 application sessions. The effects will be measured by means of blood lactate level, Brief Pain Inventory, Visual Analog Scale (VAS), and Cephalea Impact Test. The data will be collected weekly before and after the treatment, and the following tests will be applied: Analysis of variance (ANOVA), Tukey paired t test, Kruskal-Wallis, or Wilcoxon, according to data distribution. α = 0.05 will be considered as the level of statistical significance. ETHICS AND DISSEMINATION: This study was approved by the Research Projects Committee of the Nove de Julho University (approval number 4.673.963). Results will be disseminated through peer-reviewed journals and events for the scientific and clinical community, and the general public. It is registered in the ClinicalTrials.gov database with the number NCT05430776.

Evaluation of different methods for the diagnosis of primary caries lesions: Study protocol for a randomized controlled clinical trial.

BACKGROUND: According to the World Health Organization (WHO), dental caries is considered one of the greatest pediatric health problems in the world, due to its high prevalence and incidence. Therefore, the early diagnosis of caries lesions is a fundamental procedure for planning treatment aimed at prevention, minimal intervention and promotion of oral health. The present study aims to evaluate, through a randomized and controlled clinical study, which is the best strategy for diagnosing primary caries lesions located in the interproximal region. MATERIALS AND METHODS: Eighty patients, aged between 4 and 10 years will be randomized and allocated into 2 groups for analysis and comparison of methods for diagnosing caries lesions. The following diagnostic methods will be analyzed and compared: visual clinical examination using ICDAS (International Caries Detection and Assessment System), the iTero Element 5D System (intraoral scanner with near infrared imaging (NIRI) technology) and bitewing radiography (BWX). All evaluations will be carried out by 02 examiners. Examiners will be trained and calibrated to use the visual and radiographic criteria and also to use the iTero 5D intraoral scanner, following the manufacturer's instructions. TRIAL REGISTRATION: NCT04900246 in ClinicalTrial.gov. First released in 05/11/2021 and last updated in 10/06/2021.

Effect of the combination of photobiomodulation therapy and the intralesional administration of corticoid in the preoperative and postoperative periods of keloid surgery: A randomized, controlled, double-blind trial protocol study.

Keloid scars are characterized by the excessive proliferation of fibroblasts and an imbalance between the production and degradation of collagen, leading to its buildup in the dermis. There is no "gold standard" treatment for this condition, and the recurrence is frequent after surgical procedures removal. In vitro studies have demonstrated that photobiomodulation (PBM) using the blue wavelength reduces the proliferation speed and the number of fibroblasts as well as the expression of TGF-ß. There are no protocols studied and established for the treatment of keloids with blue LED. Therefore, the purpose of this study is to determine the effects of the combination of PBM with blue light and the intralesional administration of the corticoid triamcinolone hexacetonide on the quality of the remaining scar by Vancouver Scar Scale in the postoperative period of keloid surgery. A randomized, controlled, double-blind, clinical trial will be conducted involving two groups: 1) Sham (n = 29): intralesional administration of corticoid (IAC) and sham PBM in the preoperative and postoperative periods of keloid removal surgery; and 2) active PBM combined with IAC (n = 29) in the preoperative and postoperative periods of keloid removal surgery. Transcutaneous PBM will be performed on the keloid region in the preoperative period and on the remaining scar in the postoperative period using blue LED (470 nm, 400 mW, 4J per point on 10 linear points). The patients will answer two questionnaires: one for the assessment of quality of life (Qualifibro-UNIFESP) and one for the assessment of satisfaction with the scar (PSAQ). The team of five plastic surgeons will answer the Vancouver Scar Scale (VSS). All questionnaires will be administered one, three, six, and twelve months postoperatively. The keloids will be molded in silicone prior to the onset of treatment and prior to excision to assess pre-treatment and post-treatment size. The same will be performed for the remaining scar at one, three, six, and twelve months postoperatively. The removed keloid will be submitted to histopathological analysis for the determination of the quantity of fibroblasts, the organization and distribution of collagen (picrosirius staining), and the genic expression of TGF-ß (qPCR). All data will be submitted to statistical analysis. Trial registration: This study is registered in ClinicalTrials.gov (ID: NCT04824612).

Effect of photobiomodulation combined with physical therapy on functional performance in children with myelomeningocele: A protocol randomized clinical blind study.

INTRODUCTION: Myelomeningocele is a severe type of spina bifida, resulting from improper closure of the neural tube. This condition drastically affects the structures of the spinal cord resulting in deficiencies. The combination of these deficiencies results in an overall decrease in mobility and functional participation amongst this population. Physiotherapy plays an essential role in rehabilitating people with MMC. The current literature shows that resources such as photobiomodulation (PBM) may support the rehabilitation of neurological conditions. The aim of the proposed study is to evaluate the effects of photobiomodulation (PBM) combined with physical therapy on functional performance in children with low lumbosacral myelomeningocele. MATERIALS AND METHODS: This is a protocol randomized clinical blind study, that will include 30 individuals of both sexes, aged between 5 to 8 years, diagnosed with low and sacral lumbar myelomeningocele and capable of performing the sit-to-stand task. The participants will be randomly assigned into two treatment groups: PBM + physiotherapeutic exercises and sham PBM + physiotherapeutic exercises. Irradiation will be carried out with light emitting diode (LED) at a wavelength of 850 nm, energy of 25 J per point, 50 seconds per point and a power of 200 mW. The same device will be used in the placebo group but will not emit light. Muscle activity will be assessed using a portable electromyograph (BTS Engineering) and the sit-to-stand task will be performed as a measure of functioning. Electrodes will be positioned on the lateral gastrocnemius, tibialis anterior and rectus femoris muscles. The Pediatric Evaluation of Disability Inventory will be used to assess functional independence. Quality of life will be assessed using the Child Health Questionnaire-Parent Form 50. Changes in participation will be assessed using the Participation and Environment Measure for Children and Youth. The data will be analyzed with the aid of GraphPad PRISM. DISCUSSION: The results of this study can contribute to a better understanding of the effectiveness of PBM on functioning and quality of life in children with myelomeningocele. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04425330.

Treatment of halitosis with photodynamic therapy in older adults with complete dentures: A randomized, controlled, clinical trial.

BACKGROUND: Halitosis of oral origin is mainly caused by the release of H2S (hydrogen sulfide) by bacteria lodged on the tongue. Antimicrobial photodynamic therapy (aPDT) has been evaluated for the treatment of halitosis, but there are no previous reports of the use of this treatment modality in older people with dentures. The aim of the present study was to compare the effect of aPDT and tongue scraping (standard treatment) in older people with complete dentures diagnosed with halitosis (H2S gas concentration>112 ppb). METHODS: The participants were divided into two groups: G1- treatment with a tongue scraper (n = 20); G2- treatment with aPDT (n = 20). Halimeter testing was performed before and after treatments using gas chromatography and was repeated after seven days. RESULTS: After treatment, the group treated with aPDT had a lower mean concentration of H2S gas (18.5 ppb) than the tongue scraping group (185.3 ppb). After one week, the mean concentration of H2S increased to 218.2 ppb in the tongue scraping group and 39 ppb in the PDT group. CONCLUSIONS: Both treatments were able to reduce the concentration of H2S but only treatment with aPDT was able to decrease halitosis to socially unnoticeable levels. Moreover, this normal breath condition remained for seven days only in the aPDT group.

Tratamiento del bruxismo del sueño en niños / Tratamento do bruxismo do sono em crianças / Treatment of sleep bruxism in children

Los enfoques actuales para el tratamiento del Bruxismo del Sueño en niños se focalizan en el manejo de los síntomas y la prevención de complicaciones, siendo muy amplio el espectro de alternativas, para utilizar en forma individual o combinada. Se recomienda identificar y controlar los factores causales asociados al bruxismo. Las posibilidades de tratamiento varían desde la educación del paciente y la familia, el uso da apara-tos intraorales, y las técnicas psicológicas hasta la medicación. Teniendo en cuenta lo complejo del tema se hace necesario un abordaje multidisciplinario para el trata-miento del Bruxismo del Sueño en niños

As abordagens atuais para o tratamento do bruxismo do sono em crianças se concentram no manejo dos sintomas e na prevenção de complicações, sendo o espectro de alternativas muito amplo, a ser utilizado individualmente ou emcombinação. Recomenda-se identificar e controlar os fatores causais associados ao bruxismo. As possibilidades do tratamento variam da instrução do paciente e da família, do aparelhos ortopédicos, e de técnicas psicológicas à medicamentação. Tendo em conta a complexidade do tema, é necessária uma abordagem multidisciplinar para o tratamento do bruxismo do sono em crianças

Current approaches for Sleep Bruxism treatment in children focus on symptom management and prevention of related complications. A broad spectrum of alternatives is identified that can be used individually or in combination. It is recommended to identify and control the causal factors associated with sleep bruxism. Treatment possibilities range from patient and family education, orthopedic appliances, psychological techniques up to medication. Taking into account the complexity of this topic, a multidisciplinary approach is needed for Sleep Bruxism management in children

Remineralization of early enamel caries lesions induced by bioactive particles: An in vitro speckle analysis.

This study aimed at evaluating the remineralization effect promoted by different bioactive fillers on simulated early caries lesions in enamel (ECLE). Forty sound bovine incisors were used to prepare buccal enamel specimens (6 × 6 × 2 mm). The specimens were divided into two areas (3 × 3 mm²): control (CTR) and experimental (EXP). All the enamel specimens were then submitted to a specific protocol for a period of 48 h to induce simulated caries lesions. Subsequently, the specimens were treated for 7 days (2 min, twice a day) with a slurry pastes containing different bioactive particles (P/L ratio: 1 g/mL). All the specimens were analyzed by laser speckle before and after treatments. The results showed after the first analysis that the ECLE had very low average intensity (back-scattered light). Conversely, after application of the bioactive pastes, higher average intensity was always detected; this was comparable to CTR sound specimens. In conclusion, innovative pastes/gels developed for enamel remineralization should contain bioactive particles that when applied daily on early caries lesions may "boost" the remineralization process to reestablish a sound enamel.

Effect of photodynamic therapy in the reduction of halitosis in patients with multiple sclerosis: clinical trial.

Smell and odours play a vital role in social interaction. Halitosis is a social problem that affects one third of the population, causing a negative impact on the quality of life. There is little knowledge on the prevalence and management of halitosis in multiple sclerosis (MS) patients. The present study aims to evaluate the presence of halitosis in patients with MS when compared to a control group, and also evaluate treatment of the problem with antimicrobial photodynamic therapy (aPDT). This is a case-control clinical study in which 60 patients were evaluated: 30 MS patients in treatment at the Specialties Clinic School of Medicine, and 30 healthy patients, matched in age and gender for the control group. Data was collected on the duration of the disease as well as the degree of disability and medication use in the MS group. For all patients, halitosis was assessed with Oral Chroma™. Individuals with halitosis underwent treatment with tongue scraping and aPDT. The photosensitizer was methylene blue (0.005%) and a THERAPY XT-EC® laser (660 nm, 9 J, 100 mW for 90 s per point, 320 J cm-2, 3537 mW cm-2) was used. Six points 1 cm apart from each other were irradiated in the tongue dorsum. There was a positive correlation between the disability and disease duration. No parameter was correlated with halitosis. Patients with MS have higher levels of SH2 compounds when compared to the control group (p = 0.003, Mann-Whitney), but after aPDT both groups significantly reduced the levels to under the halitosis threshold. The aPDT scraping treatment was effective in the immediate reduction of halitosis in both groups.

Effect of photodynamic therapy for the treatment of halitosis in adolescents - a controlled, microbiological, clinical trial.

Halitosis can exert a negative influence on the social relations of adolescents and affect one's self-image. The aim of this study was to evaluate the clinical and microbiological effect of antimicrobial photodynamic therapy (aPDT) on halitosis in adolescents. Forty-six individuals aged 12 to 19 years were randomly allocated: Group 1 - treatment with photodynamic therapy; Group 2 - treatment with a tongue scraper and Group 3 - treatment with a tongue scraper and photodynamic therapy. The count of bacterial colony-forming units per milliliter was used for the microbiological analysis. Statistical analysis involved the Kruskal-Wallis test followed by the Student-Newman-Keuls test. ANOVA was used for the determination of colony-forming units after treatment. The level of significance for all statistical tests was 5% (p < 0.05). After treatment, a statistically significant reduction in total volatile sulfur compounds was found in all groups (p < 0.001), with the largest reduction (median: 0) found in Group 3 (tongue scraper and photodynamic therapy). Moreover, a statistically significant difference was found between treatment with aPDT and a tongue scraper alone (p < 0.001). The present findings demonstrate an option for the treatment of halitosis in adolescents, with an immediate effect and without the mechanical aggression to the toungue. Clinical Trials: NCT02007993.

Photomodulation of the osteoclastogenic potential of oral squamous carcinoma cells.

The treatment for oral cancer usually involves surgical excision followed by chemotherapy and/or radiotherapy. The combination of these therapies generally promotes a serious inflammation of the mucosa of the digestive tract, denominated mucositis, which compromises continuity of treatment. Photobiomodulation (PBM) therapy has been used successfully to reduce the oral mucositis, however there is still some controversy regarding the effects of this therapy on unintentionally irradiated tumor cells that may remain after cancer treatment. The aim of this study was to analyze the effect of PBM therapy (using parameters for mucositis) on the modulation of osteoclastogenic potential of a cell line derived from human lingual squamous cell carcinoma (SCC9). Previously irradiated SCC9 cells were co-cultured with human osteoclast precursors. Co-cultures performed with non-irradiated SCC9 cells served as control. After 7, 14 and 21 days the co-cultures were evaluated for the tartrate-resistant acid phosphatase (TRAP) activity, an osteoclastogenic marker. Additionally, the monocultures of SCC9 cells (non-irradiated and irradiated) were analyzed for cell viability/proliferation and for the expression of IL-11 and PTHrP. The irradiation of SCC9 cells with PBM with an energy density of 4 J/cm2 decreased the pro-osteoclastogenic potential of those cells. This may represent a potential useful side effect of PBM therapy. PBM (using recommended parameters for mucositis treatment) decreases the osteoclastogenic potential of oral squamous carcinoma cells.

Effects of Massage Therapy and Occlusal Splint Usage on Quality of Life and Pain in Individuals with Sleep Bruxism: A Randomized Controlled Trial.

PURPOSE: The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism. METHOD: A randomized, controlled, blinded, clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism. Quality of life and pain assessments were performed. RESULTS: Significant differences (p < 0.05) were found on the physical functioning, general health state, vitality, role emotional and mental health subscales. A large effect size was found for all treatment protocols with regard to pain. The largest effect was found in the combined treatment group. CONCLUSIONS: The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism. Moreover, both treatments (occlusal splint usage and massage therapy on the masticatory muscles) led to a reduction in pain.

Avaliação da citotoxicidade da pasta a base de caseína-fosfato de cálcio amorfo (CPP-ACP) / Cytotoxicity assessment of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste

Introduction: Casein phosphopeptides (CPP) have been shown to be good carriers of calcium, phosphate, and hydroxide ions to promote enamel remineralization with applications in oral care products, professional dental products, and food products. Objectives: Evaluate the cytotoxicity of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste in rat fibroblasts. Materials and methods: Cytotoxicity was measured by the Trypan blue dye exclusion assay and the MTT assay. Results: Long term (1, 3, 5, and 7 days) and short term tests (0, 4, 8, and 12 hours) were performed with the Trypan blue dye exclusion assay. Data were analyzed with ANOVA and Kruskall Wallis tests. After one day, the cell viability of the CPP-ACP study group was between 80 and 100%. In the short term experiments, a reduction of cell viability in the study group was observed compared with the control group; yet viable cells were present over the evaluation period. With the MTT assay, a viability of 76.43% was observed in the study group, a significant difference from the control group (P = 0.003). Conclusion: CPP-ACP paste demonstrates low cytotoxicity in rat fibroblast culture.

Introdução: A caseína fosfopeptídea (CPP) tem demonstrado ser uma provedora de cálcio, fosfato e hidróxido, capaz de promover a remineralização do esmalte dentário, sendo utilizada em produtos de higiene oral, materiais dentários e alimentos. Objetivos: Avaliar a citotoxicidade da pasta a base de caseína (CPP-ACP) em fibroblastos de ratos. Materiais e métodos: A citotoxicidade foi avaliada pelos testes de exclusão azul de Tripan e MTT. Resultados: Testes de longo prazo (1, 3, 5 e 7 dias) e de curto prazo (0, 4, 8 e 12 horas) foram realizados com o teste azul de Tripan. Os dados foram analisados com os testes de ANOVA e Kruskall Wallis. Após um dia, a viabilidade celular do grupo de estudo CPP-ACP estava entre 80 e 100%. Nos experimentos de curto prazo, uma redução de viabilidade celular no grupo de estudo foi observada em relação ao grupo controle, mas as células viáveis foram observados durante todo o período de avaliação. Com o método MTT, foi observada no grupo de estudo a viabilidade de 76,43% f, com diferença significativa do grupo controle (P = 0,003). Conclusão: A pasta CPP-ACP demonstra baixa citotoxicidade em cultura de fibroblastos de ratos.

Avaliação do desconforto postural em manicures / Evaluation of postural discomfort in manicures

Introdução: As desordens musculoesqueléticas encontram-se no topo das doenças ocupacionais e a manicure pertence a um grupo profissional exposto ao risco de adquirir algum tipo desses distúrbios. Objetivo: Descrever a frequência das queixas osteomusculares e os principais fatores associados em manicures. Método: Realizou-se um estudo de corte transversal e de caráter descritivo em cem manicures, utilizou-se o mapa de desconforto postural como instrumento de avaliação. Foram calculadas as frequências e porcentagens da idade, do tempo de profissão e das regiões com mais desconforto das voluntárias. Para as associações entre as regiões anatômicas e idade e tempo de profissão, usou-se o teste Qui-quadrado. Resultados: Houve associação de desconforto na mão esquerda com relação à idade das mulheres. Observou-se que 33% das manicures encontravam-se na faixa etária entre 21 a 30 anos e 56% tinham entre 1 a 10 anos de profissão. Conclusão: Não houve muito desconforto nas regiões anatômicas estatisticamente significantes.

Introduction: Musculoskeletal disorders are on top of occupational diseases and manicure belongs to a professional group exposed to a risk of acquiring any type of these disorders. Objective: To describe the frequency of musculoskeletal complaints and associated factors in manicures. Method: It was conducted a cross-sectional and descriptive study with one hundred manicures, we used the map of postural discomfort as an evaluation tool. We calculated frequencies and percentages of age, length of service, and regions with more discomfort of the volunteers. For associations between anatomical regions, age and length of employment was used chi-square. Results: There was an association of discomfort of the left hand with age of women. It was observed that 33% of manicures were aged between 21 and 30 years old, and 56% were from 1 to 10 years in this occupation. Conclusion: There was not much discomfort in anatomical regions statistically significant.

Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.

OBJECTIVE: The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms. MATERIALS AND METHODS: Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months. RESULTS AND DISCUSSION: The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients. CONCLUSIONS: We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.

Barniz de fluoruro y clorhexidina en el control de la caries dental: presentación de un protocolo / Fluoride and chlorhexidine varnish in dental caries control: presentation of a protocol

Presentar un protocolo profilactico combinado para el uso del barniz de flúor y clorhexidina en el control de las caries dental, diseñado sobre la base de las condiciones de riesgo a la enfermedad y el estado de salud bucal de los individuos, de fácil aplicación en la práctica clínica. En este trabajo se propone un protocolo profiláctico para el uso de barniz de flúor y clorhexidina con una frecuencia que depende de la fase de tratamiento, edad, estado de erupción y condiciones de higiene bucal del paciente. La combinación de clorhexidina y fluoruros tópicos, pueden tener un efecto cariostático aumentado, comparado con el efecto que pueda lograr se con el tratamiento separado e independiente de cada uno de estos agentes. No obstante, es necesario realizar ensayos clínicos que comprueben la efectividad de este protocolo.

Estudo das alterações bucais que auxiliam no diagnóstico da bulimia nervosa do tipo purgativo: revisão de literatura / Oral changes in nervous purgative bulimia: literature review

A bulimia nervosa do tipo purgativo é um transtorno alimentar que atinge cerca de 2% a 4% das mulheres adolescentes e adultas e se caracteriza por repetidos ataques de hiperfagia seguidos de métodos compensatórios inadequados para evitar o ganho de peso, tais como uso de laxantes, diuréticos e auto-indução de vômitos. A auto-indução de vômitos corresponde a 85% dos casos de bulimia nervosa do tipo purgativo e é o método que mais causa alterações na cavidade oral. Por ser esta prática sempre mantida em sigilo pelo paciente, a doença só chega ao conhecimento dos familiares quando já se encontra em estágio avançado. O cirurgião-dentista deve estar atento a essas alterações, pois ao realizar o exame clínico pode diagnosticar a doença precocemente e encaminhar o paciente a tratamento médico adequado. Os sinais clínicos mais evidentes são a perimólise, cáries, "ilhas" de amálgama, doença periodontal, edema de glândulas salivares, particularmente a parótida, dermatite perioral, xerostomia, halitose, mucosite, queilite, glossite, úlceras na mucosa oral, fratura dos ângulos incisais, perda de dimensão vertical, bruxismo e hipersensibilidade dentinária. Após revisão da literatura pertinente ao assunto se concluiu que cabe ao cirurgião-dentista estar atento e saber reconhecer essas alterações bucais causadas pela bulimia nervosa do tipo purgativo, para que esta possa ser diagnosticada precocemente, permitindo que o paciente seja orientado para um tratamento médico-odontológico adequado, impedindo, assim, a progressão da doença.