Phenotypic Features and Salivary Parameters in Patients with Ectodermal Dysplasia: Report of Three Cases.

Ectodermal dysplasia (ED) is a rare hereditary disorder affecting the development of ectoderm-derived organs and tissues. The aim of this study was to describe phenotypic features and the therapeutic approach in dentistry among three patients with ED, correlating their data with the literature. Additionally, to investigate the salivary gland disorders and their impacts on oral microbiota, we performed salivary tests, including salivary flow rate, salivary buffering capacity, and concentration levels of mutans streptococci, lactobacilli, and yeasts. All patients presented oligodontia, resulting in a significant masticatory dysfunction and aesthetic impairment. The counts of mutans streptococci (n=3) and yeasts (n=2) were high; on the other hand, the count of lactobacilli (n=3) was low. Therefore, salivary and microbiological tests showed that the patients with ED, particularly the hypohidrotic type, presented a high risk of enamel caries and susceptibility to oral infections, which may be likely triggered by reduction of salivary flow and/or possible immunological disorders.

Temporomandibular disorder in children at deciduous and mixed denture / Disfunções temporomandibulares em crianças com dentição decídua e mista

The temporomandibular joint (TMJ) plays an important role in the function of stomatognathic system. The acronym TMD – Temporomandibular disorder – is a general term for a series of signs and symptoms involving the masticatory muscles, TMJ, and associated structures. TMDs have a multifactorial etiology despite that many controversies still exist on this subject. Structural factors as trauma, malocclusion, systemic hypermobility, oral parafunctions, andemotional conditions (stress, anxiety, and depression) may trigger TMDs appearance. Objective: This study aimed to evaluate the signs and clinical symptoms of TMDs in patients treated at the School of Dentistry of the Institute of Science and Technology of São José dos Campos – UNESP - SP. Material and Methods: Fiftypatients, both genders, aged between five and thirteenyears were examined through muscle palpation and auscultation. Intra and extraoral examinations were performed, observing occlusion interference, denture type, protrusion or retrusion of the mandible, open biteor crossbite, edge-to-edge bite relation, midline shifts, limitation of mouth opening, and mandible shift during mouth opening and closing. Anamnesis comprised questions on the child’s habits and symptoms noticeableby the parents or legal guardians, information on the child’s personality and mood. Results: The obtained data were analyzed through percentage and qualitative analysis. Conclusion: It can be concluded that children exhibited signs and symptoms of TMDs, but TMDs presence cannot be affirmed in the studied sample; stress or altered behavior influenced on the presence of the signs and symptoms in the TMJ area...

A Articulação Temporomandibular (ATM) tem grande importância no funcionamento do sistema estomatognático. A expressão DTM – Disfunção Temporo Mandibular – é um termo genérico para uma série de sinais e sintomas que envolvem os músculos mastigatórios, a ATM e estruturas associadas. Pode-se considerar que as DTMs apresentam etiologia multifatorial, apesar de muitas controvérsias ainda existirem sobre o assunto. Fatores estruturais como trauma, maloclusões, hipermobilidade sistêmica, para funções orais e condições emocionais como: estresse, ansiedade e depressão; podem provocar o aparecimento das DTMs. Objetivo: O objetivo desta pesquisa foi avaliar sinais e sintomas clínicos e subjetivos em pacientes que se encontravam em tratamento na Faculdade de Odontologia do Instituo de Ciências e Tecnologia de São José dos Campos – UNESP - SP. Material e Métodos: Para sua execução foram examinados (palpação da musculatura e auscultação) de t50 (cinquenta) pacientes, de ambos os sexos, com idade entre 5 (cinco) e 13 (treze)anos, acompanhados por responsável legal. Foram realizados exames clínicos intra e extraorais, observando: interferência de oclusão, tipo dentição, protrusão ou retrusão de mandíbula, mordida aberta ou cruzada, relação topo a topo, desvios de linha média, limitação de abertura de boca e desvio de mandíbula durante abertura e fechamento. Resultados: Realizou-se anamnese envolvendo questões como hábitos da criança e sintomas perceptíveis pelos responsáveis, assim como informações sobre sua personalidade e temperamento. Conclusão: Conclui-se que: existem sinais e sintomas em crianças, Não podemos afirmar a existência de DTMs na amostra estudada, O estresse ou comportamentos alterados influem na presença de sinais e sintomas na região de complexo articular...

Effect of activation mode on flexural strength in dual-polymerized resin cements / Efeito do modo de ativação na resistência a flexão de cimentos resinosos duais

Objective: To compare he influence of two activation modes on two similar dual-polymerized resin cements. Methods: Bars (2 × 2 × 12 mm) of RelyX ARC (3M ESPE, MN, USA) (ARC) and Enforce (Dentsply, Rio de Janeiro, Brazil) (ENF) were prepared, and three types of polymerization method were tested: (1) L: LED photoactivation/40 s; (2) H: halogen Light activations/40 s, and (3) C: chemical activation only (Complete absent of light). The groups were ARC-L; ARC-H, ARC-C, Enf-L, Enf-H, and Enf-C (n = 8). After 24 h, the specimens were tested using the 3-point bending method on a universal testing machine. Results: The ARC cement showed superior flexural strength results. The mode of activation revealed similar results on both cements tested, but lightactivated groups (with LED or Halogen light) showed higher flexural strength values than did the chemical-activation-only group. Conclusion: (1) RelyX ARC cement showed superior flexural strength when compared with Enforce; and (2) light activation resulted in better flexural strength values when compared to chemical activation on dual-polymerized resin cements.

Objetivo: Comparar a influência do modo de ativação de dois cimentos semelhantes, porém de fabricantes distintos. Métodos: Barras (2 x 2 x 12 mm) dos cimentos RelyX ARC (3M ESPE, MN, USA) e Enforce (Dentsply, Rio de Janeiro, Brasil) (ENF) foram confeccionadas com auxílio de uma matriz de teflon bipartida, e três modos de fotopolimerização foram testados: (1) L: fotoativação por LED / 40 segundos; (2) H - fotoativação por luz halógena / 40 segundos; e (3) Q - apenas ativação química (ausência total de luz). Os grupos formados foram: ARC-L; ARC-H; ARC-Q; Enf-L; Enf-H e Enf-Q, com 8 amostras cada. Após 24 horas, o teste de miniflexão de três pontos foi aplicado em máquina universal de testes. Resultados: O cimento ARC apresentou resultados de resistência superiores ao cimento Enf. O modo de ativação agiu de forma semelhante nos dois cimentos testados, sendo que a ativação por luz, seja L ou H, aumentou a resistência para ambos, comparada a ativação Q. Conclusão: (1) O cimento RelyX ARC (3M ESPE, MN, USA) apresentou maior resistência à flexão de três pontos quando comparado ao cimento Enforce(Dentsply, Rio de Janeiro, Brasil); e (2) a ativação por luz aumentou a resistência para cimentos resinosos duais.

Cephalometric analysis for the diagnosis of sleep apnea: a comparative study between reference values and measurements obtained for Brazilian subjects.

OBJECTIVE: To verify if the reference values of Sleep Apnea cephalometric analysis of North American individuals are similar to the ones of Brazilian individuals presenting no craniofacial anomalies. The study also aimed to identify craniofacial alterations in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) patients in relation to individuals without clinical characteristics of the disease through this cephalometric analysis. METHODS: It were used 55 lateral cephalograms consisting of 29 for the control group of adult individuals without clinical characteristics of OSAHS and 26 apneic adults. All radiographs were submitted to Sleep Apnea cephalometric analysis through Radiocef Studio 2.0. The standard values of this analysis were compared, by means of z test, to the ones obtained from the control group and these were compared to values from apneic group through Student's t test. RESULTS: There were no significant differences between values obtained from control group and standard values. On the group of OSAHS patients it was observed a decrease on the dimensions of upper airways and an increase on the soft palate length. CONCLUSIONS: The standard values of Sleep Apnea analysis can be used as reference in Brazilian individuals. Besides, through lateral cephalograms it was possible to identify craniofacial alterations in OSAHS patients.

Influence of three types of drinks on the surface of human dental enamel: in vitro study / Influência de três tipos de bebidas sobre a superfície de esmalte dentário humano: estudo in vitro

Objective: The aim of this study was to evaluate the erosive effect of three beverages which are considered to be acidic in vitro study.Methods: We used 45 third molars. The teeth were cut to obtain 90 4x4 mm enamel blocks, obtained from the buccal and lingual surfaces of each tooth. The groups were divided by type of beverage (Coca-Cola®, Coca-Cola do Brasil, Rio de Janeiro, Brazil; Coca-Cola Zero®, Coca-Cola do Brasil, Rio de Janeiro, Brazil and Gatorade uva®, Ambev, Jaguariúna, Brazil) and number of cycles (7, 15 and 30 cycles). For each cycle, the specimens were immersed in the drink for 2.5 minutes by alternating with immersion in saliva for 1 hour. Each cycle simulates one day of intake. Statistical analysis, ANOVA and Tukey 5% for profilometry showed the statistical difference between the kind of beverages and between periods.Results: Coca-Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brazil) (3.99±1.25) differed from other kinds of beverage. All the periods differed and the period of 30 days saw the greatest structural loss. For microhardness, the statistical analysis showed greater loss of surface hardness for the group Coca-Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brazil) within 30 days (126.02 ± 30.98) SHL. Conclusion: IIt was concluded that the soft drink Coca Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brazil) had the greatest erosive effects and the higher the number of cycles the greater the influence on the process of dental erosion.

Objetivo: Avaliar o efeito erosivo de três bebidas ácidas sobre o esmalte dentário num estudo in vitro. Métodos: Foram utilizados 45 terceiros molares humanos. Noventa blocos de esmalte de dente humano (4X4 mm) foram obtidos a partir das faces vestibular e lingual de terceiros molares. Os blocos de esmalte foram divididos de acordo com o tipo de bebida testada (Coca-Cola®, Coca-Cola do Brasil, Rio de Janeiro, Brasil; Coca-Cola Zero®, Coca-Cola do Brasil, Rio de Janeiro, Brasil e Gatorade uva®, Ambev, Jaguariúna, Brasil) e quantidade de ciclos (7, 15 e 30 ciclos). Cada ciclo simulava um dia de ingestão, o qual compreendia a imersão dos corpos de prova (n=10/tipo de bebida e quantidade de ciclos) nas bebidas (2,5 minutos), alternados por imersão em saliva (1 hora). Para quantificação do efeito erosivo, foi avaliada a perfilometria (?m±DP) e a perda de dureza superficial. Os dados foram analisados por ANOVA 2 fatores e Tukey 5%. Resultados: A perfilometria demonstrou diferença estatística entre as bebidas e entre os períodos, sendo que a Coca-Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brasil) (3.99±1,25) diferiu das outras bebidas. Todos os períodos diferiram entre si sendo que para o período de 30 dias ocorreu a maior perda de estrutura. Para a microdureza a análise estatística demonstrou maior perda de dureza superficial para o grupo Coca-Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brasil) no período de 30 dias (126,02 ± 30,98) perda de dureza superficial. Conclusão: Concluiu-se que a Coca-Cola® (Coca-Cola do Brasil, Rio de Janeiro, Brasil) apresentou os maiores efeitos erosivos e quanto maior número de ciclos, maior a influência no processo dentário erosivo.

Cephalometric analysis for the diagnosis of sleep apnea: a comparative study between reference values and measurements obtained for Brazilian subjects

OBJECTIVE: To verify if the reference values of Sleep Apnea cephalometric analysis of North American individuals are similar to the ones of Brazilian individuals presenting no craniofacial anomalies. The study also aimed to identify craniofacial alterations in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) patients in relation to individuals without clinical characteristics of the disease through this cephalometric analysis. METHOD: It were used 55 lateral cephalograms consisting of 29 for the control group of adult individuals without clinical characteristics of OSAHS and 26 apneic adults. All radiographs were submitted to Sleep Apnea cephalometric analysis through Radiocef Studio 2.0. The standard values of this analysis were compared, by means of z test, to the ones obtained from the control group and these were compared to values from apneic group through Student's t test. RESULTS: There were no significant differences between values obtained from control group and standard values. On the group of OSAHS patients it was observed a decrease on the dimensions of upper airways and an increase on the soft palate length. CONCLUSIONS: The standard values of Sleep Apnea analysis can be used as reference in Brazilian individuals. Besides, through lateral cephalograms it was possible to identify craniofacial alterations in OSAHS patients.

OBJETIVO: verificar se os valores de referência da análise cefalométrica para apneia do sono, referentes a indivíduos norte-americanos, são semelhantes aos de indivíduos brasileiros não portadores de anomalias craniofaciais. Identificar, também por meio dessa análise cefalométrica, alterações craniofaciais em indivíduos portadores de síndrome da apneia obstrutiva do sono (SAOS) em relação a indivíduos sem características clínicas da doença. MÉTODOS: foram utilizadas 55 radiografias cefalométricas laterais advindas de arquivos, sendo 29 radiografias para o grupo controle, sendo composto de indivíduos adultos sem características clínicas de SAOS, e 26 de indivíduos adultos apneicos. Todas as radiografias foram submetidas à análise cefalométrica para apneia do sono por meio do software Radiocef Studio 2.0. Por meio do teste z, valores-padrão dessa análise foram comparados aos valores obtidos do grupo controle, e esses, por sua vez, foram comparados aos valores do grupo de apneicos por meio do teste t de Student. RESULTADOS: não houve diferenças significativas entre os valores obtidos do grupo controle e os valores-padrão. No grupo de indivíduos portadores de SAOS, observou-se diminuição nas dimensões das vias aéreas superiores e aumento do comprimento do palato mole. CONCLUSÕES: os valores-padrão da análise de apneia do sono podem ser utilizados como referência em indivíduos brasileiros. Além disso, por meio da radiografia cefalométrica lateral foi possível identificar alterações craniofaciais em indivíduos portadores de SAOS.

Efficacy and safety of two ramipril and hydrochlorothiazide fixed-dose combination formulations in adults with stage 1 or stage 2 arterial hypertension evaluated by using ABPM.

BACKGROUND: Fixed-dose combinations of antihypertensive agents demonstrate advantages in terms of efficacy, tolerability, and treatment adherence. OBJECTIVE: This study was designed to compare the efficacy and safety of 2 ramipril and hydrochlorothiazide (HCTZ) fixed-dose combinations in patients with hypertension stage 1 or 2. Patients' blood pressure (BP) profiles were evaluated by using 24-hour ambulatory BP monitoring (ABPM). METHODS: This was a multicenter, prospective, randomized, open-label, parallel-group, noninferiority trial of adult patients (age ≥18 years) with hypertension stage 1 or 2 and systolic blood pressure (SBP) within 140 to 179 mm Hg or diastolic blood pressure (DBP) 90 to 109 mm Hg. After a 2-week washout period, eligible patients were randomized to receive 1 of 2 ramipril/HCTZ fixed-dose combination formulations (5/25 mg/d) for 8 weeks. The primary end point was the difference in 24-hour ABPM SBP/DBP mean reductions between groups after 8 weeks of treatment. The secondary end points were the changes in daytime and nighttime ABPM and in office BP. Safety profile and tolerability assessments included monitoring of adverse events. RESULTS: A total of 102 patients with hypertension (54 in group A [test formulation] and 48 in group B [reference formulation]), aged 27 to 85 years, completed the 8-week treatment period. The decreases in SBP and DBP according to 24-hour ABPM from baseline to week 8 were significant and similar in both groups. SBP decreased from 149.1 to 133.0 mm Hg (-16.1 mm Hg) in group A and from 146.2 to 130.6 mm Hg in group B (-15.6 mm Hg) (P = 0.8537); DBP was reduced by 8.8 mm Hg in group A and by 8.5 mm Hg in group B (P = 0.8748). Because the lower 95% CI limit for the difference between groups A and B of 3.96 mm Hg in SBP and 3.54 mm Hg in DBP was lower than that preestablished by the trial protocol (4 mm Hg), noninferiority of the test formulation was demonstrated compared with the reference formulation. For the secondary end points, there was no significant difference between groups in SBP and DBP during daytime or nighttime at the end of week 8. Office BP was significantly reduced in both treatment groups, with no significant differences between groups. The incidence of adverse events was 23.7% in group A and 21.7% in group B. CONCLUSIONS: Both treatment options were well tolerated and equally reduced BP. The results support the conclusion that group A (new fixed-dose combination of ramipril/HCTZ) was noninferior to group B (reference medication in Brazil). ISRCTN Register: ISRCTN05051235.

Cuspal deflection of directly or indirectly restored teeth / Deflexão cuspídea de dentes restaurados direta ou indiretamente

Objective: The aim of this study was to evaluate the cuspal deflection of teeth restored directly and indirectly. Material and Methods: Forty sound maxillary premolar teeth were restored with composite and different base materials. Wide mesial-occlusal-distal cavity preparations were performed, with isthmus width of one third of the distance between the cuspal tips, 3 mm occlusal and a 5 mm interproximal preparation height. The teeth were divided into 4 groups (n = 10), according to the restoration type: G1) GIC-DCR (1 mm glass ionomer cement base and direct restoration using nanoparticulate composite); G2) FL-DCR (1 mm base of flowable composite resin and direct restoration using nanoparticulate composite); G3) GIC-ICR (1 mm glass ionomer cement base and indirect restoration using nanoparticulate composite GIC base); G4) FL-ICR (1 mm base of flowable composite resin and indirect restoration using nanoparticulate composite). The specimens were submitted to compressive load of 50 N on the buccal and lingual cusps, in a universal testing machine. The lingual cusp microstrain (με) measurements were executed by strain gauges. Results: The Kruskal-Wallis (5%) test was used and showed there were no significant differences among the microstrain values for the four study groups (G1 = 1250; G2 = 1075; G3 = 1279; G4 = 937). Conclusion: It could be concluded that the restorative techniques and the bases employed did not show any influences in cuspal deflection

Objetivo: O objetivo deste trabalho foi avaliar, por meio de medidores de tensão, a deflexão cuspídea sofrida por dentes restaurados, direta e indiretamente, com resinas compostas e diferentes materiais de base. Material e Métodos: Para o preparo dos corpos-de-prova (CP) foram utilizados 28 dentes pré-molares humanos íntegros, extraídos por razões ortodônticas que tiveram suas raízes embutidas em poliuretano de densidade semelhante a do osso e suas raízes recobertas por um espaçador visando simular o espaço referente ao ligamento periodontal. Na etapa seguinte os dentes receberam preparos cavitários do tipo mésio-ocluso-distais amplos e então restaurados direta e indiretamente com resina composta e dois diferentes materiais de base/forramento, resina flow e cimento de ionômero de vidro. Para a realização das medidas de deflexão das cúspides foram utilizados extensômetros lineares elétricos colados à face lingual de cada dente e submetidos a uma carga de 50 N aplicada por uma ponta romba de diâmetro de 3,0 mm, que promoveu compressão simultânea nas vertentes triturantes das cúspides vestibular e lingual, numa máquina universal de ensaios. Resultados: Foi realizado o teste de Kruskall-Wallis (5%) de significância e não foram encontradas diferenças estatísticamente significantes entre os grupos (G1 – 1250; G2 = 1075; G3 = 1279; G4 = 937). Conclusão: Pode-se concluir que o tipo de restauração bem como o tipo de base empregados nesse estudo não alteram a deflexão cuspídea dos dentes com restaurações amplas.

Study of the psychological preparation on the dental care of children with special needs / Estudo da eficácia do preparo psicológico no atendimento de crianças portadoras de necessidades especiais

The psychology in Dentistry is a great challenge for the clinicians during the care of their patients. The conditioning of a patient to achieve a behavior meeting the professional’s needs for developing a procedure within the quality standards is necessary. When this conditioning focuses on the child patients the challenge is even greater because the child will use all ways to make difficult the action of the clinician due to fear or discomfort. The ability of the dentist to condition the patient will be directly proportional to the training and theoretical knowledge acquired. Considering the Patients with Special Needs (PSN), this training should be differentiated because there is the physical, cognitive, and the previous dental/medical history in addition to the psychological and emotional difficulties. The aim of this study was to evaluate the profile of the patient to be conditioned satisfactorily and which conditioning techniques would be more efficient to ambulatory dental care of PSN. Thirty patients, both genders, aged from 20 months to 11 years-old who were enrolled at the ambulatory treatment of NEAPE were observed. It was concluded that when there is the cognitive development of the individual, they are able to be conditioned for the ambulatory care; the use of auxiliary methods is important in the conditioning for the ambulatory care of the individuals; the syndromic patients had the best results for the conditioning aiming to the ambulatory care; there was a significant improvement in the behavior of individuals between the first and last appointments.

A psicologia em odontologia é um grande desafio para os profissionais no atendimento clínico de seus pacientes. Condicionar um paciente para que este tenha um comportamento condizente com as necessidades do profissional para o desenvolvimento de um procedimento dentro dos padrões de qualidade torna-se necessário. Quando este condicionamento tem como foco o paciente infantil este desafio é extremamente exarcebado, pois a criança usará de todos os meios para que dificulte a ação do profissional, ou por medo ou desconforto. O destreza do profissional em condicionar o paciente será diretamente proporcional ao treinamento e conhecimento teórico por ele adquirido. Com os Pacientes Portadores de Necessidades Especiais (PNE) este treinamento deverá ser diferenciado pois além das dificuldades psicológicas e emocionais temos as limitações físicas, cognitivas e com sua história médica/odontológica pregressa. A proposta deste trabalho foi avaliar que perfil de paciente pode ser condicionado de modo satisfatório e quais técnicas de condicionamento são mais eficazes para o tratamento odontológico em ambulatório de PNE. Foram observados 30 pacientes, de ambos os sexos, com idade entre 20 meses a 11 anos, que freqüentavam o ambulatório do NEAPE. Concluímos que: quando existe um desenvolvimento cognitivo do individuo, os indivíduos são passiveis de serem condicionados para o atendimento ambulatorial; o uso de métodos auxiliares é importante no condicionamento para o atendimento ambulatorial dos indivíduos; os pacientes sindrômicos foram os de melhor resultados no condicionamento para atendimento ambulatorial; existiu melhoria significante no comportamento dos indivíduos entre a primeira e ultima sessão de atendimento.

Avaliação da dureza de resina composta à base de silorano fotoativada com diferentes fotopolimerizadores e após o uso de colutórios bucais / Evaluation of hardness of the silorane-based composite resin cured with different photoactivators and after use of mouthwashes

Este estudo avaliou a microdureza da resina composta à base de silorano (RCS) fotoativada com luz halógena (LH) e LED, seguido da exposição aos colutórios bucais Periogard, Listerine e Colgate Plax Sem Álcool. Foram confeccionados 40 espécimes da RCS Filtek P90 e divididos em 2 grupos (n = 20): Grupo LED - fotoativação com LED por 40 s (1200 mW/cm2); Grupo LH - fotoativação com LH por 40 s (600 mW/cm2). Os espécimes foram distribuídos em 4 subgrupos (n-5) de acordo com o bochecho: Subgrupo C - imersos em saliva artificial por 7 dias; Subgrupo LI - agitados no colutório Listerine 1 vez ao dia por 1 minuto durante 7 dias, em seguida, armazenados em saliva artificial; Subgrupo CP - agitados no colutório Colgate Plax Sem Álcool, seguindo o mesmo protocolo acima; Subgrupo PE - agitados no colutório Periogard, seguindo o mesmo protocolo acima. Os espécimes foram submetidos ao ensaio de microdureza no Microdurômetro digital Vickers com três endentações e carga de 50 g/ 15 s e os dados, submetidos aos testes ANOVA dois fatores (Fonte de luz e Colutório bucal) e Tukey (5%). Houve diferença significante para os fatores Fonte de luz e Colutório bucal (p = 0,00). Os valores da microdureza para o fator Fonte de luz: Grupo LED - 72,61 a; Grupo LH - 67,21 b; para o fator Colutório bucal: Subgrupo C - 79,29 a; Subgrupo PL - 75,5 a; Subgrupo PE - 66,12 b; Subgrupo LI - 58,75c. Para o fator Fonte de luz, LED apresentou dureza superior a LH. Para o fator Colutório bucal, o armazenamento em saliva artificial apresentou dureza superior em relação ao uso dos colutórios Periogard e Listerine.

This study evaluated the microhardness of silorane-based composite resin cured with halogen light and LED, followed by the use of mouthwashes: Periogard, Listerine, and Colgate Plax Without Alcohol. Forty specimens were fabricated with silorane-based composite resin Filtek P90 and divided into two groups (n = 20): Group LED - LED light curing for 40 s (1200 mW/cm2), Group HL - Halogen light curing for 40 s (600 mW/cm2). The specimens were divided into four subgroups (n-5) in accordance with the use of the mouthwash: Subgroup C - immersed in artificial saliva for 7 days; Subgroup LI - Listerine mouthwash once daily for 1 minute during 7 days, then stored in artificial saliva; Subgroup CP - Colgate Plax Without Alcohol mouthwash, following the same protocol above; Subgroup PE - Periogard mouthwash, following the same protocol above. The specimens were subjected to microhardness test on digital Microhardness Vickers with three indentations and load of 50 g/ 15 s. The data were submitted to ANOVA two factors (Light and Mouthwash) and Tukey (5%). There were significant differences for the factors Light and Mouthwash (p = 0.00). The values of microhardness for Light Factor: LED Group - to 72.61 a and Group HL - 67.21 b; for Mouthwash Factor: Subgroup C - 79.29 a; subgroup PL - to 75.5 a; subgroup EP - 66.12 b; Subgroup LI - 58.75 c. For Light Factor, LED showed hardness higher than halogen light. For Mouthwash Factor, storage in artificial saliva showed higher hardness compared to the use of Listerine and Periogard mouthwashes.

Clinical and microbiological evaluation of the use of toothpaste containing 1% chlorhexidine and the influence of motivation on oral hygiene in patients with motor deficiency.

Patients with motor deficiency have variable difficulties with mechanical plaque control, and as a consequence, the incidence of dental caries and periodontal disease can be higher in these patients. The objective of this study was to evaluate the clinical and microbiological efficacy of a toothpaste containing 1% chlorhexidine, which was used by patients with motor deficiency for 14 days. The reduction in plaque and gingival index and the impact on salivary microorganisms was evaluated. We conclude that the motivation of caregivers to carry out oral hygiene for patients with mental and motor deficiency is of great importance and is effective in reducing the formation of plaque as long as it is continuously reinforced. The use of chlorhexidine-containing toothpaste significantly reduced the plaque index and microorganism count between days 0 and 14. A reduction was also observed in the group that used a dentifrice without the chlorhexidine, but this difference was not significant.

An 18-week, prospective, randomized, double-blind, multicenter study of amlodipine/ramipril combination versus amlodipine monotherapy in the treatment of hypertension: the assessment of combination therapy of amlodipine/ramipril (ATAR) study.

BACKGROUND: A combination of antihypertensive agents of different drug classes in a fixed-dose combination (FDC) may offer advantages in terms of efficacy, tolerability, and treatment compliance. Combination of a calcium channel blocker with an angiotensin-converting enzyme inhibitor may act synergistically to reduce blood pressure (BP). OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of an amlodipine/ramipril FDC with those of amlodipine monotherapy. METHODS: This 18-week, prospective, randomized, double-blind study was conducted at 8 centers across Brazil. Patients with stage 1 or 2 essential hypertension were enrolled. After a 2-week placebo run-in phase, patients received amlodipine/ramipril 2.5/2.5 mg or amlodipine 2.5 mg, after which the doses were titrated, based on BP, to 5/5 then 10/10 mg (amlodipine/ramipril) and 5 then 10 mg (amlodipine). The primary end point was BP measured in the intent-to-treat (ITT) population. Hematology and serum biochemistry were assessed at baseline and study end. Tolerability was assessed using patient interview, laboratory analysis, and physical examination, including measurement of ankle circumference to assess peripheral edema. RESULTS: A total of 222 patients completed the study (age range, 40-79 years; FDC group, 117 patients [mean dose, 7.60/7.60 mg]; monotherapy, 105 patients [mean dose, 7.97 mg]). The mean (SD) changes in systolic BP (SBP) and diastolic BP (DBP), as measured using 24-hour ambulatory blood pressure monitoring (ABPM) and in the physician's office, were significantly greater with combination therapy than monotherapy, with the exception of office DBP (ABPM, -20.76 [1.25] vs -15.80 [1.18] mm Hg and -11.71 [0.78] vs -8.61 [0.74] mm Hg, respectively [both, P = 0.004]; office, -27.51 [1.40] vs -22.84 [1.33] mm Hg [P = 0.012] and -16.41 [0.79] vs -14.64 [0.75] mm Hg [P = NS], respectively). In the ITT analysis, the mean changes in ambulatory, but not office-based, BP were statistically significant (ABPM: SBP, -20.21 [1.14] vs -15.31 [1.12] mm Hg and DBP, -11.61 [0.72] vs -8.42 [0.70] mm Hg, respectively [both, P = 0.002]; office: SBP, -26.60 [1.34] vs -22.97 [1.30] mm Hg and DBP, -16.48 [0.78] vs -14.48 [0.75] mm Hg [both, P = NS]). Twenty-nine patients (22.1%) treated with combination therapy and 41 patients (30.6%) treated with monotherapy experienced > or =1 adverse event considered possibly related to study drug. The combination-therapy group had lower prevalence of edema (7.6% vs 18.7%; P = 0.011) and a similar prevalence of dry cough (3.8% vs 0.8%; P = NS). No clinically significant changes in laboratory values were found in either group. CONCLUSIONS: In this population of patients with essential hypertension, the amlodipine/ramipril FDC was associated with significantly reduced ambulatory and office-measured BP compared with amlodipine monotherapy, with the exception of office DBP. Both treatments were well tolerated.

Resistência adesiva de reparos em restaurações de resina composta / Adhesive resistance of repairs in composed resin restorations

Objetivo: Avaliar a resistência à tração entre resinas compostasde uso direto e seus reparos, utilizando-se três diferentes marcascomerciais: G I Palfique Estelite Ó (Tokuyama), G II Filtek Z350 (3MESPE) e G III Te Econon (Ivoclar Vivadent) e a utilização na interfacebase/reparo do adesivo AdperTM Single Bond 2 (3M-ESPE).Método: Foram confeccionadas 30 bases cônicas de cada marcacomercial de resina composta nas seguintes dimensões: 5mm X5mm X 3mm. Todas as bases de cada grupo foram submetidas a20000 ciclos de termociclagem (5ºC a 55ºC ± 2ºC, por 30s). Asbases de cada grupo foram divididas aleatoriamente em três subgrupos,nos quais realizou-se a combinação entre as marcascomerciais selecionadas para realização dos reparos. Armazenouseas amostras por 7 dias à 37°C em água destilada, sendo entãosubmetidas ao ensaio de tração em uma máquina de ensaiosuniversal EMIC – MEM 2000, com velocidade de 1,0mm/ min e célulade carga de 500Kgf, a qual carregou a amostra até que ocorressea fratura. Os dados obtidos (MPa) foram submetidos à Análise deVariância (ANOVA), e ao teste de Tukey (5%).Resultados: Para GI observou-se: Palfique Estelite Ó (11,22±4,00MPa), Te Econom (12,03±3,47 MPa) e Filtek Z350 (10,66±2,89 MPa),para GII foi: Palfique Estelite Ó (8,88±2,04 MPa), Te Econom(7,77±1,64 MPa) e Filtek Z350 (10,50±6,14 MPa) e para GIII osresultados foram: Palfique Estelite Ó (8,41±2,50 MPa), Te Econom(12,33±3,18 MPa) e Z350 (11,73±3,54 MPa).Conclusão: A resistência adesiva na interface de diferentesmarcas comerciais de resina composta submetidas a um reparo,mostrou semelhanças estatísticas independente da marcacomercial.

Prevalência de fratura dentária em pacientes portadores de necessidades especiais / Prevalence of dental fracture among children attending special care

Objetivo: Verificar a prevalência de fraturas dentárias em pacientesjovens, com necessidades especiais do Núcleo de Estudos eAtendimento à Pacientes Especiais (NEAPE).Método: Foram analisadas 57 crianças, acompanhadas por seusresponsáveis, que procuraram atendimento no NEAPE, daFaculdade de Odontologia - UNESP, do município de São José dosCampos/SP. Realizou-se um minucioso exame clínico e anamnese,onde foram coletados os dados referentes ao sexo, idade, tipo defratura (esmalte, esmalte/dentina e esmalte/dentina/polpa), númerode dentes envolvidos e causa da fratura.Resultados: Das 57 crianças inquiridas, 22 (38,59 por cento) possuíamdentes fraturados, sendo 27,2 por cento do sexo masculino e 72,8 por cento dosexo feminino. Os dentes mais afetados foram os incisivos centraissuperiores representando 63.83 por cento dos dentes fraturados. Emrelação ao tipo de fratura verificou-se que (61,7 por cento) (95 por cento IC 46,3 a75,4) envolviam o esmalte e dentina, seguidas pelas fraturas apenasde esmalte (21,3 por cento) (95 por cento IC 10,7 a 35,66) e aquelas comenvolvimento do esmalte, dentina e polpa (17 por cento) (95 por cento IC 7,64 a30,81). As causas mais freqüentes de fraturas dentárias empacientes sindrômicos relatadas neste estudo foram; queda(36,4 por cento), crise convulsiva (18,2 por cento) e bruxismo (18,2 por cento). A cárierepresentou 4,5 por cento das causas de fratura dentária, sendo que em22,7 por cento dos casos não foi identificada a causa da fratura.Conclusão: Pôde-se concluir que 38,59 por cento das crianças comnecessidades especiais apresentavam fraturas dentárias, sendoestas mais freqüentes nos incisivos centrais superiores. A síndromede Down e paralisia cerebral foram as síndromes mais encontradas,e as quedas, convulsões, bruxismo e a cárie dental foram asprincipais causas relacionadas à fratura dentária.

Estudo multicêntrico da eficácia, tolerabilidade e efeito sobre a calemia da combinação fixa de clortalidona e amilorida no tratamento da hipertensão arterial primária / Multicenter trial on efficacy, tolerability and effect upon kalemia of the fixed combination of chlorthalidone and amiloride in the treatment of primary hypertension n

Em estudo multicêntrico e randomizado, avaliamos a eficácia anti-hipertensiva, tolerabilidade e efeito sobre a calemia da combinação fixa de clortalidona e amilorida comparada à clortalidona isolada no tratamento de pacientes com hipertensão arterial primária estágios 1 e 2. Após três semanas de descontinuidade da medicação anti-hipertensiva prévia, 201 pacientes de ambos os sexos foram randomizados para tratamento com a combinação fixa na dose de 25/5 mg (102 pacientes) ou com a clortalidona isolada na dose de 25 mg (99 pacientes), durante 12 semanas consecutivas. Resultados: observamos que a combinação fixa apresentou alta eficácia anti-hipertensiva (ΔPA = 21,7/12,6 mmHg, percentual de respondedores igual a 80,4 e 67,4

[The "LOTHAR" study: evaluation of efficacy and tolerability of the fixed combination of amlodipine and losartan in the treatment of essential hypertension]. / Estudo "LOTHAR": avaliação de eficácia e tolerabilidade da combinação fixa de anlodipino e losartana no tratamento da hipertensão arterial primária.

OBJECTIVE: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone. METHODS: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension. RESULTS: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < or = 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term. CONCLUSION: Based on these results, we can say that the combination of amlodipine and losartan--the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.