RESUMO
Hormonal changes and physiological alterations in pregnancy increase the susceptibility of the woman to oral diseases such as plaque-induced gingivitis. In individual oral prophylaxis, effective tooth brushing can reduce gingival inflammation. Therefore, it is necessary to update the scientific evidence to identify which type of toothbrush, manual or sonic-powered, is most effective in reducing the incidence of gingivitis in pregnant women. The aim of this clinical trial is to compare the biofilm control effectiveness of two manual and two sonic toothbrushes in pregnant women. This study is designed as a four-arm, parallel, randomized controlled trial with an allocation ratio of 1:1:1:1. The pregnant woman will be included at 15-18 weeks of amenorrhea and followed for 3 months. The primary outcome will be the change in the incidence of gingival bleeding from a baseline and various follow-up periods of the study. Secondary outcomes measures will be to compare clinical effects of the toothbrushes tested on (i) gingival inflammation, (ii) dental plaque, (iii) gingival attachment and (iv) periodontal pocket; and to assess toothbrush acceptability. Thus, identifying the best device for effective tooth brushing in pregnancy could be helpful in reducing and improving the incidence of gingival inflammation.
RESUMO
BACKGROUND AND OBJECTIVES: Skeletal muscle dysfunction is a major problem among the co-morbidities associated with chronic obstructive pulmonary disease (COPD). However, muscle weakness and increased fatigability are not the only limitations of skeletal muscle function. Motor-respiratory coordination (MRC) may occur even during movements at lowest workloads. MRC modifies the temporal pattern of motor actions, thus probably impairing motor performance and movement precision. Little attention has been paid to the question of whether motor functions may be compromised in COPD patients independent of workload and required muscle strength and endurance. The present pilot study was designed to investigate the effects of a simulated obstruction (SO) in healthy subjects on their breathing pattern and the timing of a rhythmical forearm movement. METHODS: Twenty-one subjects performed flexion- extension movements with their right forearm at a self-chosen rate within a range between 0.2 and 0.4 Hz. After a control experiment with normal breathing, a plug with a narrow hole was inserted between face mask and pneumotachograph to simulate obstruction. Subjects were required to repeat the rhythmical forearm movement at the same rate as in the control experiment. RESULTS: The condition of SO significantly prolonged breath duration but reduced tidal volume and ventilation. In addition, period duration of the forearm movement increased significantly under this condition while the movement-to-breathing frequency ratio remained almost constant. Increased breathing resistance was considered to cause prolonged breath duration accompanied by an increase in movement period duration. The constant near-integer ratio between movement and breathing rates indicates that the change in movement period duration resulted from MRC. CONCLUSIONS: The findings of this pilot study demonstrate that increased breathing resistance may compromise motor performance even at lower workloads. This means that in COPD patients, not only muscle strength and endurance are reduced but, moreover, fine motor skills may be impaired. This aspect has particular importance for many everyday activities as reduced fine motor performance substantially contributes to a progressive inability of the patients to manage their daily life.
