Whitening efficacy of activated charcoal-based products: A single-blind randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial evaluated the whitening efficacy, tooth sensitivity (TS), and volunteers' satisfaction following the use of activated charcoal powder and toothpaste. METHODS: Fifty-six volunteers were randomly allocated into 4 groups (n = 14) according to a 14-day toothbrushing or whitening treatment with activated charcoal powder (ACPW), activated charcoal toothpaste (ACT), regular fluoridated toothpaste (RT), and 10 % carbamide peroxide (CP). Objective (ΔE00) and subjective (ΔSGU) color and whiteness index (ΔWID) changes were calculated. Patients self-reported the risk and intensity of TS using a visual analogue scale and the volunteer's satisfaction was determined by a questionnaire. Color assessments were analyzed by Kruskal-Wallis followed by Dwas-Steel-Crithlow-Fligner, and absolute TS risk and volunteer's satisfaction by Fisher exact test (p < 0.05). RESULTS: ACPW and ACT promoted similar effects in ΔE00, ΔSGU, and ΔWID to that observed for RT. No significant difference was found in terms of TS risk intensity. TS risk became high after 7 and 14 days, with higher TS prevalence in CP. Volunteers reported that ACPW exhibited the lowest ease-of-use, comfort, and whitening satisfaction among groups (p < 0.05). CONCLUSION: Activated charcoal-based products presented a minor and unsatisfactory whitening effect while CP resulted in optimal tooth whitening and the highest level of satisfaction among volunteers. Risk was higher from 7 days onwards and was more pronounced in the CP. CLINICAL RELEVANCE: Based on the whitening effect and patient satisfaction, this controlled-randomized clinical evidence supports that the use of activated charcoal-based products should be discouraged.

Dental aesthetic perception of patients submitted to activated charcoal-based bleaching agents: A randomized clinical trial.

OBJECTIVE: To evaluate the effects of activated charcoal-based products used in two presentation forms (powder or toothpaste), compared to 10 % carbamide peroxide and conventional toothpaste on aesthetic perception and psychosocial impact before and after treatment. METHODS: Fifty-six participants were divided into 4 experimental groups (n = 14). Activated charcoal-based powder (PW); Activated charcoal-based dentifrice (AC); Conventional fluoride toothpaste (CD) and 10 % carbamide peroxide (CP). All products were used for 14 days. Psychosocial impact on dental esthetics (PIDAQ), oral health impact profile (OHIP- Esthetics) and orofacial esthetics scale (OES) questionnaires were applied before and after treatment. Descriptive and exploratory data analyses were performed and analyzed using linear mixed models for repeated measures over time considering significance level of α = 0.05. RESULTS: For PIDAQ, the CP group showed significant decrease in psychological impact, aesthetic perception domains and overall score, while in the PW group, there was only a significant decrease in the psychological impact domain. Decrease in OHIP was observed for the functional limitation domain scores for treatments with CP and PW, in the psychological discomfort domain, decrease was observed for all groups, while for the OES questionnaire, significant increase in the color domain was observed for the CP group. CONCLUSION: Activated charcoal-based products showed lower scores in all questionnaires when compared with carbamide peroxide; thus, charcoal-based products promoted lower impact on quality of life and aesthetic perception. CLINICAL RELEVANCE: In this randomized clinical trial, charcoal-based OTC products had inferior quality of life and aesthetic perception results compared to conventional carbamide peroxide bleaching.

In vitro assessment of activated charcoal-based dental products.

OBJECTIVE: Assess the effects of activated charcoal-based products on whitening and changes on dental enamel surface. MATERIAL AND METHODS: Fifty-two blocks of bovine dental enamel were randomly distributed in four groups (n = 13): brushing with activated charcoal-based powder (PW); brushing with activated charcoal-based dentifrice (AC); brushing with a conventional dentifrice containing 1450 ppm of fluoride (CD); and whitening with 10% carbamide peroxide (CP). Color, microhardness, and surface alteration were analyzed at baseline and after 14 days of treatment. Three samples per group were randomly selected and examined using scanning electron microscopy (SEM) to analyze the morphology. RESULTS: PW exhibited greater color change for the ΔE00 , ΔWID, Δb* and ΔL* parameters than other groups (p < 0.05). After treatment, microhardness decreased in AC and CP groups (p < 0.05). Also, PW and AC groups showed more surface alteration than CD and CP (p < 0.001). Changes in the morphology of dental enamel were observed by SEM in PW and AC groups. CONCLUSION: Activated charcoal-based products showed a lower whitening effect than 10% carbamide peroxide. These products also influenced dental enamel microhardness, resulting in greater surface alteration. CLINICAL SIGNIFICANCE: Activated charcoal-based products promoted minimum whitening effects with significant enamel surface alteration. The 10% carbamide peroxide was more effective for whitening and caused slight enamel surface alteration.

Mechanical loading prediction through accelerometry data during walking and running.

Currently, there is no way to assess mechanical loading variables such as peak ground reaction forces (pGRF) and peak loading rate (pLR) in clinical settings. The purpose of this study was to develop accelerometry-based equations to predict both pGRF and pLR during walking and running. One hundred and thirty one subjects (79 females; 76.9 ± 19.6 kg) walked and ran at different speeds (2-14 km·h-1) on a force plate-instrumented treadmill while wearing accelerometers at their ankle, lower back and hip. Regression equations were developed to predict pGRF and pLR from accelerometry data. Leave-one-out cross-validation was used to calculate prediction accuracy and Bland-Altman plots. Our pGRF prediction equation was compared with a reference equation previously published. Body mass and peak acceleration were included for pGRF prediction and body mass and peak acceleration rate for pLR prediction. All pGRF equation coefficients of determination were above 0.96, and a good agreement between actual and predicted pGRF was observed, with a mean absolute percent error (MAPE) below 7.3%. Accuracy indices from our equations were better than previously developed equations. All pLR prediction equations presented a lower accuracy compared to those developed to predict pGRF. Walking and running pGRF can be predicted with high accuracy by accelerometry-based equations, representing an easy way to determine mechanical loading in free-living conditions. The pLR prediction equations yielded a somewhat lower prediction accuracy compared with the pGRF equations.

Peak ground reaction forces can be accurately predicted through raw accelerometry data.These predictions are valid for a broad range of body masses and for ankle, lower back and hip accelerometer placements.Peak loading rate prediction presented lower accuracy compared with peak ground reaction force prediction.These findings result in a simple method to predict mechanical loading in clinical practice, which is relevant in some areas of sports medicine such as bone health and injury prevention.

Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach.

INTRODUCTION: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. METHODS: A cross-sectional study was conducted involving 89 patients. RESULTS: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. CONCLUSION: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

Comparison of upper limb kinematics in two activities of daily living with different handling requirements.

INTRODUCTION: Recently, kinematic analysis of the drinking task (DRINK) has been recommended to assess the quality of upper limb (UL) movement after stroke, but the accomplishment of this task may become difficult for poststroke patients with hand impairment. Therefore, it is necessary to study ADLs that involve a simpler interaction with a daily life target, such as the turning on a light task (LIGHT). As the knowledge of movement performed by healthy adults becomes essential to assess the quality of movement of poststroke patients, the main goal of this article was to compare the kinematic strategies used by healthy adults in LIGHT with those that are used in DRINK. METHODS: 63 adults, aged 30 to 69 years old, drank water and turned on a light, using both ULs separately, while seated. The movements of both tasks were captured by a 3D motion capture system. End-point and joint kinematics of reaching and returning phases were analysed. A multifactorial analysis of variance with repeated measures was applied to the kinematic metrics, using age, sex, body mass index and dominance as main factors. RESULTS: Mean and peak velocities, index of curvature, shoulder flexion and elbow extension were lower in LIGHT, which suggests that the real hand trajectory was smaller in this task. In LIGHT, reaching was less smooth and returning was smoother than DRINK. The instant of peak velocity was similar in both tasks. There was a minimal anterior trunk displacement in LIGHT, and a greater anterior trunk displacement in DRINK. Age and sex were the main factors which exerted effect on some of the kinematics, especially in LIGHT. CONCLUSION: The different target formats and hand contact in DRINK and LIGHT seem to be responsible for differences in velocity profile, efficiency, smoothness, joint angles and trunk displacement. Results suggest that the real hand trajectory was smaller in LIGHT and that interaction with the switch seems to be less demanding than with the glass. Accordingly, LIGHT could be a good option for the assessment of poststroke patients without grasping ability. Age and sex seem to be the main factors to be considered in future studies for a better match between healthy and poststroke adults.

Effect of mouth rinses on tooth enamel surface.

This study aims to evaluate the effect of mouth rinses on the color, microhardness, and surface roughness of tooth enamel. Sixty dental blocks were collected from human third molars and divided in five groups (n = 12): the control group (CG) without immersion in mouth rinse, Listerine Zero, Colgate Plax Fresh Mint, Listerine Whitening, and Colgate Luminous White. The groups were subjected to initial color analysis; the microhardness and roughness of the enamel surfaces were evaluated. Next, the samples were subjected to immersion in mouth rinses or brushing with conventional fluoride toothpaste (CG) according to the manufacturer's instructions; after a 12-week treatment, the color, microhardness, and roughness were once again assessed and compared with the initial analysis. Data were tabulated and analyzed through a two-way analysis of variance (ANOVA) (color and roughness) followed by Tukey's test. Microhardness was analyzed through the Kruskal-Wallis test followed by Dunn's test; the level of significance was 5%. All groups immersed in mouth rinses had a higher level of microhardness loss than CG; additionally, all groups showed changes in the enamel surface. Enamel surface loss was observed using a roughness test, and the mouth rinses promoted a higher level of color changes than CG. Given the results, it can be concluded that the mouth rinses led to significant changes in tooth enamel.

Analysis of the Preventative Influence of an Oral Hygiene Protocol on Ventilator-Associated Pneumonia / Análise da Influência Preventiva de um Protocolo de Higiene oral na Pneumonia Associada à Ventilação Mecânica

Ventilator-associated pneumonia (VAP) is the most commonly reported nosocomial infection among intensive care unit (ICU) patients. This study aimed to evaluate the influence of an oral hygiene protocol on VAP incidence among mechanically-ventilated (MV) ICU patients. The dentate patients admitted without VAP to the hospital's adult ICU requiring mechanical ventilation for ≥48 hours during a 4-month period in two consecutive years (2015 ­ Control group and 2016 ­ Experimental group) were included in this investigation. The oral hygiene protocol was implemented daily, once a day, in the morning hours, using a disposable brush with suction and ultrasoft bristles and 3 g of 0.12% chlorhexidine gel. Hospital-related respiratory infection data, including VAP diagnoses and microbiological analyses, were collected from the monthly health epidemiological notification bulletins issued by the hospital. T tests were applied to compare variables before versus after implementation of the oral hygiene protocol with a significance criterion of P < .05. 43.94% reduction in VAP rate after the protocol implementation was observed. Implementation of the protocol was associated with a significant reduction of Enterobacter spp infections and no cases of VAP related to the main etiological agents of the disease (i.e., S. aureus and C. albicans) were identified. It can be concluded that an oral hygiene protocol performed with a suction brush and 0.12% chlorhexidine gel can serve as an effective prophylaxis against VAP in patients under mechanical ventilation. (AU)

A pneumonia associada à ventilação (PAV) é a infecção nosocomial mais comumente relatada em pacientes de Unidade de Terapia Intensiva (UTI). Este estudo teve como objetivo avaliar a influência de um protocolo de higiene bucal na incidência de PAV entre pacientes sob ventilação mecânica (VM). Os pacientes dentados internados na UTI adulta do hospital sem PAV e que necessitaram de ventilação mecânica por ≥ 48 horas durante um período de 4 meses em dois anos consecutivos (2015 - grupo Controle e 2016 - grupo Experimental) foram incluídos nesta investigação. O protocolo de higiene bucal foi implementado diariamente, uma vez ao dia, nas primeiras horas da manhã, utilizando-se escova descartável com cerdas de sucção e ultramacia e 3 g de gel de clorexidina a 0,12%. Dados de infecção respiratória relacionada ao hospital, incluindo diagnósticos de PAV e análises microbiológicas, foram coletados dos boletins mensais de notificação epidemiológica de saúde emitidos pelo hospital. Testes t foram aplicados para comparar as variáveis antes e após a implementação do protocolo de higiene bucal com um critério de significância de P <0,05. Observamos uma redução de 43,94% na taxa de PAV após a implementação do protocolo A implementação do protocolo foi associada à uma redução significativa das infecções por Enterobacter spp e não foram identificados casos de PAV relacionados aos principais agentes etiológicos da doença (isto é, S. aureus e C. albicans). Pode-se concluir que u protocolo de higiene bucal realizado com escova de sucção e gel de clorexidina a 0,12% pode servir como uma profilaxia efetiva contra a PAV em pacientes sob ventilação mecânica. (AU)

Hematomas traumáticos intracranianos múltiplos na síndrome de Alagille / Multiple intracranial traumatic hematomas in Alagille syndrome

Os autores relatam um caso de Síndrome de Alagille, que consiste numa displasia arteriohepática com colestase crônica, associada à trauma crânio-encefálico com hematomas intracranianos múltiplos. Feita uma revisao da literatura do assunto dos últimos 4 anos, nao foi encontrado nenhum relato da associaçao acima citada.