Oral function in amyotrophic lateral sclerosis patients: A matched case-control study.

BACKGROUND & AIMS: Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups. METHODS: We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or Mann-Whitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups. RESULTS: Twenty-six ALS patients (bulbar onset: n = 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p = 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r = -0.45, p < 0.05)) and tongue force (r = -0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function. CONCLUSION: Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT01772888.

Associations of religiosity and spiritual well-being with appearance concerns after head and neck cancer surgery.

OBJECTIVE: To investigate whether religiosity and spiritual well-being are associated with appearance concerns among people with visible sequelae due to cancer surgery in the head and neck region. METHODS: A cross-sectional study was carried in 202 adult patients in a referral hospital for cancer treatment in Midwest Brazil. Data on sociodemographic, psychosocial and clinical aspects and cancer-related behaviours were collected through interviews, clinical examination and medical records. The outcome was the patients' appearance concerns (Derriford Appearance Scale-DAS24). The independent explanatory variables were religiosity (Duke University Religiousness Index-DUREL) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-FACIT-Sp12). Data were analysed using Pearson's chi-square and Poisson regression. RESULTS: Most of the participants were male (76.2%), and mean age was 58.6 years (SD = 11.6). The scores of appearance concerns (DAS24) ranged from 21 to 75 (median = 33.0). In the bivariate analysis, appearance concerns were associated with spiritual well-being (FACIT-Sp12), degree of disfigurement and treatment with radiotherapy/chemotherapy. Religiosity (DUREL) was not associated with the outcome. In the adjusted regression model, a lower prevalence of appearance concerns was found among patients with higher levels of spiritual well-being (PR = 0.86; CI = 0.79-0.94), males (PR = 0.87; CI = 0.79-0.95), those with lower degrees of disfigurement (PR = 0.89; CI = 0.82-0.98) and those who had no treatment with radiotherapy/chemotherapy (PR = 0.83; CI = 0.72-0.94). CONCLUSION: High spiritual well-being was independently associated with lower levels of appearance concerns in people with visible sequelae due to cancer surgery in the head and neck region. Understanding the role of this psychosocial determinant may help in the coping process.

The Effect of Photobiomodulation on Nitrite and Inflammatory Activity in Radiotherapy-Induced Oral Mucositis: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: To investigate pro- and anti-inflammatory cytokines and nitrite salivary levels in patients with head and neck cancer receiving photobiomodulation therapy (PBMT) associated with a Preventive Oral Care Program (POCP), for prevention and control of oral mucositis (OM) during radiotherapy (RT) associated or not with chemotherapy protocol. STUDY DESIGN/MATERIALS AND METHODS: In this randomized double-blinded clinical trial, 48 patients were randomly assigned to two groups: PBMT (n = 25) and Control (n = 23). In the PBMT group, patients were submitted to PBMT associated with the POCP. In the Control group, patients were submitted only to the POCP. Saliva samples were collected in the 1st (baseline), 7th, 14th, 21st, and 30th sessions of RT, and the levels of interleukin-6 (IL-6), IL-8, IL-10, IL-12p70, IL-1ß, and tumoral necrosis factor-α (TNF-α) were measured using the cytometric bead array. Nitrite levels were measured by colorimetric method. OM was assessed using the World Health Organization and the National Cancer Institute scales. RESULTS: Patients in the PBMT group presented less severe OM. PBMT tended to stabilize nitrite concentration levels during the RT regimen. The IL-1ß concentration was associated with higher OM scores. PBMT promoted an increase in IL-12p70, TNF-α, and IL-10 concentration. CONCLUSION: PBMT was effective in the prevention and control of severe OM, and its mechanism of action may be related to a better balance of inflammatory response that may favor injury control. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Comparison of smartphone-camera and conventional flatbed scanner images for analytical evaluation of chewing function.

BACKGROUND: The two-colour mixing test is a quick method to assess chewing function (CF). The use of smartphone cameras for acquiring images may help in further simplifying the process. OBJECTIVE: This study evaluated the reliability of smartphone-camera images of chewing gums to assess CF. METHODS: Five test samples of a bicoloured chewing gum were produced by a single fully dentate adult volunteer. The specimens were flattened to 1-mm thick wafers. The two sides of the wafers were digitised with a conventional flatbed scanner (control) and were photographed 20 times using 8 different smartphones. The images were assessed optoelectronically to obtain the variance of hue (VoH) and subjectively by visual assessment (SA) using a categorical scale (SA1-SA5). Spearman's correlation and regression models were used for statistical analyses. RESULTS: The intra-group variability for SA1-SA3 was <1% for all smartphones, but significantly higher than controls for SA4 and SA5 (smartphone: SA4 = 5.57%; SA5 = 8.76%; control: SA4 = 2.5%; SA5 = 0.79%). VoH was progressively lower from SA1 to SA5 for all imaging devices (r > -.97; P < .001). VoH comparisons between control and smartphone images revealed significant differences for the individual SA categories, and however, the magnitude of differences was small and non-significant when the full range of SA levels were considered. The linear mixed model regression showed significant effects for all the smartphones (P < .001) and SA levels (P < .001) in relation to the flatbed scanner values. CONCLUSIONS: Smartphone cameras may be used to evaluate colour mixture for a bolus-kneading test, however, the precision is lower with higher degrees of colour mixing.

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants.

BACKGROUND: There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. AIM: This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). METHODS: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method. RESULTS: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis. CONCLUSION: This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

Effectiveness of a simplified method for final impression in complete denture treatment: A pragmatic clinical trial.

PURPOSE: This study aimed to compare two methods for final impression during the fabrication of complete dentures: a traditional method using custom trays (T-group) and a simplified method using the trial denture baseplate (S-group). METHODS: A pragmatic clinical trial was conducted among edentulous individuals referred for conventional denture treatment. A consecutive sample of edentulous patients was assigned to two groups by cluster randomisation according to the final impression strategy, 30 in the T-group and 38 in the S-group. In the T-group, an auto-polymerising acrylic resin custom tray was used for impression; in the S-group, the final impression was performed using the try-in dentures. For both groups, zinc oxide eugenol paste was used as the impression material. The quality of the dentures was assessed using two rating scales (Functional Assessment of the Dentures and Kapur method). Moreover, clinical time for denture fabrication, number of post-insertion appointments for adjustments, patient satisfaction and post-treatment oral health-related quality of life impacts were also assessed. RESULTS: There were no significant differences between groups regarding prosthodontic and patient-reported outcomes. The S-group demanded less clinical time (P = 0.002), with a 23.3% mean reduction in clinical time (P = 0.002) and lower number of appointments until the delivery of the dentures (S-group = 4.18 vs T-group = 5.0; P = 0.001). CONCLUSIONS: This study showed that the alternative method for final impression is less time-consuming and has similar clinical outcomes when compared to the traditional final impression method. Findings suggest that this alternative may be considered when efficiency is a critical issue in healthcare services.

Impact of patient characteristics on edentulous subjects' preferences for prosthodontic rehabilitation with implants.

OBJECTIVE: The aim of this study was to assess the influence of patient characteristics on edentulous subjects' preferences for different prosthodontic treatments with implants. MATERIALS AND METHODS: A cross-sectional study was carried out with 131 edentulous subjects referred for treatment at a university clinic. Participants received detailed information about available treatment options and were asked to rank their preferences among three alternatives for rehabilitation of the maxilla and mandible: conventional dentures (CD), 2-implant-retained overdentures (IOD), or 4-implant fixed dentures (IFD). Individual data and prosthodontic-related variables were assessed through interviews. Oral health-related quality of life impacts was measured using the Brazilian version of the Oral Health Impact Profile for edentulous subjects (OHIP-Edent). Descriptive statistics, bivariate tests, and binary and multinomial logistic regressions were used for data analysis. RESULTS: The majority of participants chose CD as their most preferred treatment for the maxilla (45.8%), while IFD was the most prevalent choice for the mandible (38.9%). Regression analysis showed that the OHIP-Edent "oral pain and dysfunction" (OPD) domain scores were positively associated with IOD preference for the maxilla (OR = 1.31; p = 0.010) and mandible (OR = 1.46; p = 0.002) and with IFD preference for the mandible (OR = 1.20; p = 0.031). Subjects with lower levels of formal education and those with lower income levels were less likely to choose IFD. CONCLUSION: Level of education, income, and perceived quality of life impacts are potentially predictive variables of edentulous patients' preference for rehabilitation with implants. These factors may constitute important aspects to be considered by clinicians when treatment planning for edentulous patients.

Changes in masticatory performance of edentulous patients treated with single-implant mandibular overdentures and conventional complete dentures.

OBJECTIVES: The aim of this study was to test the effect of a single-implant mandibular overdenture (SIMO), compared with conventional complete denture (CD), on masticatory performance measured by the mixing ability of a two-coloured chewing gum. METHODS: A sample of edentulous subjects was randomly assigned to the SIMO (n = 15) and CD (n = 19) groups. Patients in both groups received a set of new complete dentures, and the SIMO group received a single implant in the symphyseal region of the mandible (Straumann® Standard Plus SLActive®) and an eliptical matrix and ball attachment for denture retention. Masticatory tests were performed using a two-colour chewing gum (Vivident Fruitswing, Perfetti van Melle, Turkey) for 20 and 50 chewing cycles. Colour-mixing ability was assessed by electronic colourimetric analysis (ViewGum©, Dhal Software, Greece), expressed by the variance of hue. Tests were performed at baseline and at the 6- and 12-month follow-ups. Multilevel linear regression was used to model the changes in masticatory performance. RESULTS: Groups were similar at baseline for 20 and 50 cycles (P > 0.05). A significant linear effect was observed on time points for 20 and 50 cycles (P < 0.001). No difference was observed between treatment groups factor (P > 0.05). However, the way masticatory performance varied according to time points differed in the CD and SIMO groups for 20 cycles (P = 0.048). CONCLUSION: Masticatory performance improved significantly after 12 months, irrespective to the insertion of a single implant to retain a mandibular overdenture. Moreover, results suggest that SIMO treatment may perform better than CD in the shorter follow-up period.

Intraoral radiographs texture analysis for dental implant planning.

BACKGROUND AND OBJECTIVES: Computer vision extracts features or attributes from images improving diagnosis accuracy and aiding in clinical decisions. This study aims to investigate the feasibility of using texture analysis of periapical radiograph images as a tool for dental implant treatment planning. METHODS: Periapical radiograph images of 127 jawbone sites were obtained before and after implant placement. From the superimposition of the pre- and post-implant images, four regions of interest (ROI) were delineated on the pre-implant images for each implant site: mesial, distal and apical peri-implant areas and a central area. Each ROI was analysed using Matlab® software and seven image attributes were extracted: mean grey level (MGL), standard deviation of grey levels (SDGL), coefficient of variation (CV), entropy (En), contrast, correlation (Cor) and angular second moment (ASM). Images were grouped by bone types-Lekholm and Zarb classification (1,2,3,4). Peak insertion torque (PIT) and resonance frequency analysis (RFA) were recorded during implant placement. Differences among groups were tested for each image attribute. Agreement between measurements of the peri-implant ROIs and overall ROI (peri-implant + central area) was tested, as well as the association between primary stability measures (PIT and RFA) and texture attributes. RESULTS: Differences among bone type groups were found for MGL (p = 0.035), SDGL (p = 0.024), CV (p < 0.001) and En (p < 0.001). The apical ROI showed a significant difference from the other regions for all attributes, except Cor. Concordance correlation coefficients were all almost perfect (ρ > 0.93), except for ASM (ρ = 0.62). Texture attributes were significantly associated with the implant stability measures. CONCLUSION: Texture analysis of periapical radiographs may be a reliable non-invasive quantitative method for the assessment of jawbone and prediction of implant stability, with potential clinical applications.

Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients.

BACKGROUND AND OBJECTIVE: Oral mucositis (OM) is considered a painful and debilitating side effect in patients receiving head and neck cancer treatment. Low-level laser therapy (LLLT) proved to be effective to prevent and treat chemoradiotherapy-induced OM. The aim of this study was to evaluate the effect of LLLT in the severity of OM in patients with head and neck cancer and on the release of salivary inflammatory mediators. Clinical (score of OM severity) and biochemical parameters (concentration of inflammatory mediators, growth factors, and enzymes in saliva) were used. MATERIALS AND METHODS: Thirty patients were randomized into two groups: control and laser. LLLT was performed three times a week in the laser group, while control group received sham irradiation. OM severity was assessed according to the World Health Organization (WHO) and National Cancer Institute (NCI) scales. Pro-inflammatory and anti-inflammatory cytokines (TNF-α, IL-6, IL-1ß, IL-10, TGF-ß), growth factors (EGF, FGF, VEGF), and metalloproteinases (MMP2/TIMP2, MMP9/TIMP2) concentrations were assessed using ELISA test. Saliva samples were collected on admission, and at the 7th, 21st, and 35th sessions of radiotherapy. RESULTS: The laser group showed a reduction in the severity of OM, which coursed with significantly diminished salivary concentration of EGF and VEGF in the 7th radiotherapy session and of IL-6 and FGF in the 35th. There was a trend for reduced levels of IL-1ß, TNF-α, IL-10, TGF-ß, MMP2/TIMP2, MMP9/TIMP2 in the laser group compared to the control, however, no statistically significant differences were found. CONCLUSIONS: These findings demonstrated that LLLT was effective in reducing the severity of chemoradiotherapy-induced OM and was associated with the reduction of inflammation and repair.

The effect of marginal bone level changes on the stability of dental implants in a short-term evaluation.

OBJECTIVES: To evaluate whether changes in marginal bone level (MBL) around implants, in sites with different bone types, affect the over time implant stability measured by resonance frequency analysis (RFA). MATERIAL AND METHODS: Seventy-eight implants were inserted into jawbones of 32 patients using a two-stage surgical protocol, and implant bone sites were grouped according to the Lekholm and Zarb bone classification. The implant stability quotient (ISQ) was measured by RFA at four time points: implant placement, uncovering, rehabilitation, and at 1-year follow-up after loading. The MBL was measured on periapical radiographs at uncovering and at 1-year follow-up. Percent change in bone level was calculated based on the difference between the implant length and height from the crestal bone level to the implant apex. Descriptive statistics, Pearson's correlation, and repeated-measures ANOVA were used for data analysis. RESULTS: Significant improvement of ISQ was found between implant insertion and uncovering surgery (P < 0.001), while no significant changes were detected throughout the remaining follow-up period. The greatest improvement of ISQ was observed for bone type 4, compared with the other groups (P < 0.001). Percent change in bone level had no effect on longitudinal measures of ISQ (P = 0.337). The ISQ difference between uncovering and 1 year after loading was not correlated with percent change in bone level (r = 0.16; P = 0.157). CONCLUSION: There was increased implant stability after implant placement, but it was not affected by changes in marginal bone level during the first year of loading.

Patient satisfaction and oral health-related quality of life after treatment with traditional and simplified protocols for complete denture construction.

OBJECTIVES: The objective of this randomised controlled clinical trial study was to compare the effectiveness of a traditional and a simplified protocol for construction of conventional CD. BACKGROUND: The replacement of conventional dentures can result in potential functional and aesthetic benefits to the patient. Previous studies suggest that simplified procedures for complete dentures (CD) construction achieve results similar to the traditional methods. MATERIALS AND METHODS: Fifty patients were randomly divided into two equal groups, traditional protocol (T group) and simplified protocol (S group). Treatment outcomes were assessed before the insertion of the new dentures and 30 days and 6 months after the last adjustment. It included measurements of quality of life related to oral conditions measured by the Brazilian version of OHIP-Edentulous scale and patients' satisfaction with the upper and lower dentures using a visual analogue scale (VAS), which combines the patient's perception in relation to overall satisfaction with the comfort, stability, ability to chew, ability to talk and aesthetics. RESULTS: The results showed significant reduction in negative impacts of oral conditions on quality of life and improved satisfaction with the upper and lower dentures (p < 0.001) at the 30-day and 6-month follow-up. Quality of life improvement occurred in all dimensions of the OHIP-Edentulous (p < 0.001). Despite the significant reduction in quality of life impacts and significant increase in patients' satisfaction with the dentures, there were no differences between the traditional and simplified protocols (p > 0.05). CONCLUSIONS: It was concluded that the simplified protocol results in patent's perception of treatment outcomes similar to the traditional protocol.

Bone quality assessment in routine dental implant treatment among Brazilian and Swedish specialists.

OBJECTIVES: To investigate the interpretation and assessment of bone quality among Brazilian and Swedish specialist performing implant treatment. MATERIAL AND METHODS: A questionnaire was developed containing open and closed questions on attitudes, knowledge, and understanding of diagnostic methods for bone quality assessment. The questionnaire was sent by mail to dental implant specialists in Brazil while the Swedish version was Web-based and sent to specialists in periodontology and maxillofacial surgery. The response rate in the Brazilian group was 15.4% and in the Swedish group 36.5%. RESULTS: Most respondents in both groups considered bone quality to be an important parameter for implant treatment outcome. Among Swedish specialists, bone quality, however, was considered to be of low relevance. The most popular method for assessing bone quality among Swedish specialists was the hand-felt perception of drilling resistance followed by radiography. The Brazilian specialists more often used peak insertion torque. Most respondents classified bone quality, and both groups used the classification proposed by Lekholm & Zarb (Tissue-Integratedprosthesis: Osseointegration in Clinical Dentistry, 1985, Quintessence, Chicago) most frequently. CONCLUSION: Specialists in both countries considered bone quality to be an important parameter for implant treatment outcome, but there was no consensus neither on what bone quality means nor on how to assess bone quality.

Análise comparativa da condição de dentes pilares de próteses parciais removíveis intercaladas e de extremidades livres / Comparative analysis of abutment teeth condition of tooth-supported and extension-base removable partial dentures

O objetivo deste estudo foi avaliar a condição dental e periodontal dos dentes pilares diretos de próteses parciais removíveis de extremidade livre (classes I e II de Kennedy), em comparação com os dentes pilares diretos de próteses intercaladas (classes III e IV de Kennedy). Foram avaliadas condições clínicas como o índice de placa bacteriana, presença de inflamação gengival, profundidade de sondagem, presença de cárie e cálculo e grau de mobilidade dental. Para a avaliação clínica foram selecionados, aleatoriamente, 37 pacientes (6 do sexo masculino e 31 do sexo feminino), totalizando 44 próteses, sendo 21 de extremidade livre e 23 intercaladas. Os pacientes não receberam qualquer tipo de tratamento prévio e foram avaliados por um único examinador. Os resultados indicaram que houve diferença significativa no índice de placa e na inflamação gengival entre os dois grupos de próteses, sendo maior no grupo de extremidade livre. De acordo com os resultados, concluiu-se que as próteses parciais removíveis de extremidades livres apresentaram maior efeito adverso sobre os dentes pilares diretos, em comparação com as próteses intercaladas.

The aim of this study was to assess and compare dental and periodontal condition of direct abutment teeth of extension base RPDs (Kennedy classes I and II) and tooth supported RPDs (Kennedy classes III and IV). Clinical conditions such as plaque index, gingival inflammation, pocket depth, presence of carious lesions and calculus, and tooth mobility were assessed, Thirty seven patients were assigned at ramdom for clinical assessment, 6 males and 31 females, totalizing 44 prostheses (21 extension base prostheses and 23 tooth supported prostheses). The patients did not receive any kind of previous treatment and were evaluated by only one examiner. Results showed that plaque index and gingival inflammation were significantly higher in the extension-base group. According to these results, the extension-base RPDs showed greater negative effects on direct abutment teeth than tooth-supported RPDs.

Clínica integrada de ensino odontológico: perfil dos usuários e necessidades odontológicas / Undergraduate comprehensive dental care clinic: users? profiles and dental needs

A disciplina de Clínica Integrada nos cursos de graduação foi criada com o objetivo de desenvolver a capacidade do graduando em diagnosticar, planejar e executar procedimentos multidisciplinares de forma a integrar conhecimentos adquiridos ao longo do curso de odontologia, possibilitando a formação de um clínico geral. Neste contexto, o objetivo deste trabalho foi identificar o perfil dos pacientes e os tipos de procedimentos odontológicos realizados na CI da Faculdade de Odontologia da UFG. Realizou-se um estudo retrospectivo em prontuários (n=652) de pacientes atendidos na CI no período de 2004 a 2009. A maioria dos pacientes era do gênero feminino (67,8%), sendo que a faixa etária preponderante foi de 30 a 50 anos (51,9%). A maioria estava empregada e a ocupação mais prevalente foi de profissionais autônomos, na categoria de trabalhadores diversos, residentes na capital do estado (71,5%). A queixa principal mais reportada foi a dor de dente (32,8%). As necessidades típicas destes pacientes são relacionadas à cárie e edentulismo, com conseqüente predominância de procedimentos característicos da prática generalista (restauradores, periodontais e protéticos). Entretanto, a combinação de especialidades odontológicas em muitos casos não é a recomendada, o que sugere maior aprimoramento no processo de triagem de pacientes.

The Comprehensive Dental Care Clinic (CDCC) aims at providing appropriate care for all patients? individual general dental needs and developing the competence of dental students to diagnose, plan and perform general dental procedures.The aim of the present study was to identify the profile of patients and types of dental procedures performed on the CDCC of the School of Dentistry of the Federal University of goias, Brazil. It was a retrospective study of dental records (n = 652) of patients treated at the CDCC in the period between 2004 and 2009. Most patients were female (67.8%) and the predominant age range was 30 to 50 years (51.9%). Most were employed and the most prevalent occupation was self-employed professionals in various categories of workers, and residents in Goiania, the capital of the State of Goias (71.5%). The main reported chief complaint was toothache (32.8%). Typical dental needs were associated to caries and edentulousness, and consequent predominance of general dental procedures (restorative, periodontal and prosthodontic). Conversely, combination of dental treatment needs of the individual patient was not the recommended in many cases, suggesting improvement in the screening procedures of patients.

Analysis of cell proliferation and pattern of invasion in oral squamous cell carcinoma.

Cell proliferation markers play an important role in the biological behavior of neoplasms. This study investigated the immunohistochemical expression of PCNA, Ki-67 and Cyclin B1 proteins based on the pattern of cell invasion in oral squamous cell carcinoma (OSCC). A total of 39 OSCC specimens and 13 samples of normal oral mucosa (control) were immunohistochemically analyzed. Protein expression was evaluated according to World Health Organization - Histological Malignancy Grading (WHO-HMG) and a specific grading system for invasion, graded from 1 to 4, varying from a consistently well-defined "pushing" border to diffuse infiltration and cellular dissociation, and was then correlated with clinical features. We found higher expression of Ki-67 and Cyclin B1 in OSCC when compared with the control group. High Ki-67 expression levels were more commonly seen in the floor of the mouth than in the tongue (P = 0.009). Cyclin B1 showed a positive correlation with histological grade, according to WHO-HMG criteria (P = 0.01). Our results suggest that Cyclin B1 is a reliable proliferation marker for indicating degree of tumor proliferation. Correlations between PCNA, Ki-67, Cyclin B1 and invasive tumor front with overall survival were not observed. Further studies are needed in order to elucidate whether cell proliferation activity at the tumor invasion front is related to prognosis.

Perfil de acidentes com material biológico em uma instituição de ensino odontológico / Profile of accidents with organic material in an institution of dental education

A equipe odontológica está sujeita a condições que favorecemexposições ocupacionais a material biológico tais como aatuação na cavidade bucal - ambiente de pequenas dimensões,difícil acesso e colonizado por diversos microrganismos - e ouso de instrumentos perfurocortantes e equipamentos rotatóriosgeradores de respingos e aerossóis. Neste contexto, o objetivodeste trabalho foi identificar o perfil epidemiológico dos acidentesenvolvendo material biológico notificados na instituição.Foi delineado um estudo descritivo transversal considerandoas fichas (n=71) de registro de acidentes com material biológicoocorridos na instituição no período de março de 2002 a julhode 2008. Dentre os acidentes notificados, 91,6% ocorreram emestudantes, 4,2% em técnicos administrativos, 2,8% em professorese 1,4% em estagiários, sendo 64,8% dos acidentados dosexo feminino. Considerando que 31 notificações permaneceramcom dados incompletos, os demais acidentes (n=40) apresentaramo seguinte perfil: Exposição percutânea (34/85,0%) erespingos em mucosas (6/15,0%); A Área corporal mais atingidaforam as mãos (32/80,0%), e mucosas (6/15,0%); o materialbiológico envolvido foi o sangue e saliva (17/42,5%) e saliva(5/12,5%); houve prevalência do reencape (9/22,5%) e manuseio(7/17,5%) de agulha anestésica e da execução de procedimentoscirúrgicos (6/15,0%); A fonte era conhecida em 75,0% (n=30)dos acidentes. O uso de todos os equipamentos de proteção individualfoi apontado por 75,0% (n=30) dos respondentes e acobertura vacinal contra hepatite B por 95,0% (n=38), sendo que92,1% possuíam esquema vacinal completo e 50,0% conheciame eram respondedores ao Anti HBs. Conclui-se que o risco biológicoé iminente para a equipe odontológica e que é necessárioestabelecer um programa de educação permanente focado emestratégias de educação e prevenção de acidentes com materialbiológico e na sensibilização deste público quanto à importânciada notificação de acidentes, além de aperfeiçoar o sistema deregistro da CCIO.

The dental team is subject to conditions that foster occupationalexposure to biological material such as the performance inthe oral cavity - environment of small, difficult access and colonizedby various microorganisms - and the use of professionaltools and equipment rotary-generating sneezing and aerosols.In this context, the objective was to identify the epidemiologicalprofile of accidents involving biological material institution reported.A descriptive study was outlined considering the sheetscross (n= 71) for registration of accidents with biological materialoccurring in the institution during the period from March 2002to July 2008. Among the accidents, 91.6% occurred in students,4.2% in technical, administrative, 2.8% and 1.4% in teachers intrainees, with 64.8% of the injured were female. Consideringthat 31 notices remained with incomplete data, other accidents(n=40) showed the following: percutaneous exposure (34/85.0%)and sneezing in mucous (6 /15.0%); The body area most affectedwere the hands (32/80.0%), and as mucous (6/15.0%); thebiological material involved: there was the prevalence of bloodand saliva (17/42.5.0%), followed by saliva (5 /12.5%) and blood(3/7.5%), 4. Location of accident: there was a prevalence of reencape(9/22.5%) and handling (7/17.5%) of anesthetic needle andimplementation of surgical procedures (6/15.0%); 5. Situation ofthe patient source: source known in 75.0% (n=30) of accidents.The use of all equipment for individual protection was reportedby 75.0% (n=30) of respondents and immunization coverageagainst hepatitis B by 95.0% (n=38), and 92.1% had full immunizationschedule and 50.0% knew and were responsive to antiHBs. It was concluded that the biological risk is imminent forthe dental team and it is necessary to establish a program of continuingeducation focused on strategies for education and preventionof accidents with biological material and in this publicawareness about the importance of the notification of accidents,and improve the system of registration of CCIO.

Profiling alumni of a Brazilian public dental school.

BACKGROUND: Follow-up studies of former students are an efficient way to organize the entire process of professional training and curriculum evaluation. The aim of this study was to identify professional profile subgroups based on job-related variables in a sample of former students of a Brazilian public dental school. METHODS: A web-based password-protected questionnaire was sent to 633 registered dentists who graduated from the Federal University of Goias between 1988 and 2007. Job-related information was retrieved from 14 closed questions, on subjects such as gender, occupational routine, training, profits, income status, and self-perception of professional career, generating an automatic database for analysis. The two-step cluster method was used for dividing dentists into groups on the basis of minimal within-group and maximal between-group variation, using job-related variables to represent attributes upon which the clustering was based. RESULTS: There were 322 respondents (50.9%), predominantly female (64.9%) and the mean age was 34 years (SD = 6.0). The automatic selection of an optimal number of clusters included 289 cases (89.8%) in 3 natural clusters. Clusters 1, 2 and 3 included 52.2%, 30.8% and 17.0% of the sample respectively. Interpretation of within-group rank of variable importance for cluster segmentation resulted in the following characterization of clusters: Cluster 1 - specialist dentists with higher profits and positive views of the profession; Cluster 2 - general dental practitioners in small cities; Cluster 3 - underpaid and less motivated dentists with negative views of the profession. Male dentists were predominant in cluster 1 and females in cluster 3. One-way Anova showed that age and time since graduation were significantly lower in Cluster 2 (P < 0.001). Alternative solutions with 4 and 5 clusters revealed specific discrimination of Cluster 1 by gender and dental education professionals. CONCLUSIONS: Cluster analysis was a valuable method for identifying natural grouping with relatively homogeneous cases, providing potentially meaningful information for professional orientation in dentistry in a variety of professional situations and environments.

Gênero e escolha por especialidades odontológicas: estudo com egressos de uma universidade pública / Gender and choice for dental specialties: study of a public university students

A tendência à especialização e o incremento feminino na graduação é uma realidade, porém, existem na literatura científica poucos trabalhos que relacionam a escolha pela especialização e o gênero, e até o presente momento não se verifcou referências à região Centro-Oeste. O objetivo deste estudo foi analisar a escolha por especialidades odontológicas dos egressos da Universidade Federal de Goiás, segundo o gênero, em um período de 20 anos. A população de estudo foi os 1188 egressos do período de 1988 a 2007. Os dados secundários foram coletados no Departamento de Assuntos Acadêmicos da Universidade Federal de Goiás e no Conselho Federal de Odontologia. Foram realizadas análise descritiva e teste qui-quadrado. Verifcou-se que 436 (36,7%) dos profissionais tinham pelo menos uma especialidade e 46 (3,9%) tinham duas especialidades registradas no Conselho Federal de Odontologia. A proporção de especialistas foi maior entre homens (41,0%) que entre as mulheres (33,9%) (p=0.013). As especialidades preferidas entre os profissionais foram ortodontia (18,3%), prótese (17,8%), endodontia (15,4%), periodontia (13,9%) e odontopediatria (12,7%). Destas a única que teve diferença signifcativa entre os gêneros foi a odontopediatria. Dentre as outras especialidades houve diferença entre os gêneros na cirurgia buco-maxilo-facial e na implantodontia. O gênero infuenciou na escolha de algumas especialidades e apesar de haver mais mulheres especialistas, proporcionalmente os homens optaram mais por fazerem uma especialidade.

Trends toward specialization and feminilization in Dentistry are a reality in Brazil, but few studies explore the association between specialization and gender and there is no information about this phenomenon in the Brazilian Midwest. The aim of this study was to analyze the Federal University of Goias graduates choice of dental specialties according to gender, in a period of 20 years. The study sample was 1188 graduates of the period from 1988 to 2007. Secondary data were collected at the Department of Academic Afairs of the Federal University of Goias and the Federal Board of Dentistry. Descriptive analysis and chi-square test were used for data analysis. There was 436 (36.7%) with at least one speciality and 46 (3.9%) with two specialities registered in the Federal Council Dentistry. The proportion of specialists was greater for men (41.0%) that women (33.9%) (p=0.013). The most prevalent specialties were orthodontics (18.3%), prosthodontics (17.8%), endodontics (15.4%), periodontics (13.9%) and restorative dentistry (12.7%). There were signifcant diference for pediatric dentistry (greater for women), and maxillofacial surgery and implantology (greater for men). It was concluded that gender was associated with the choice for some specialities.

Factors influencing students' performance in a Brazilian dental school.

Comprehensive assessment of students' academic performance plays an important role in educational planning. The aim of this study was to investigate variables that influence student's performance in a retrospective sample including all undergraduate students who entered in a Brazilian dental school, in a 20-year period between 1984 and 2003 (n=1182). Demographic and educational variables were used to predict performance in the overall curriculum and course groups. Cluster analysis (K-means algorithm) categorized students into groups of higher, moderate or lower performance. Clusters of overall performance showed external validity, demonstrated by Chi-square test and ANOVA. Lower performance groups had the smallest number of students in overall performance and course groups clusters, ranging from 11.8% (clinical courses) to 19.2% (basic courses). Students' performance was more satisfactory in dental and clinical courses, rather than basic and non-clinical courses (p<0.001). Better student's performance was predicted by lower time elapsed between completion of high school and dental school admission, female gender, better rank in admission test, class attendance rate and student workload hours in teaching, research and extension (R(2)=0.491). Findings give evidence about predictors of undergraduate students' performance and reinforce the need for curricular reformulation focused on with improvement of integration among courses.