Hydroalcoholic Extract of Eugenia uniflora as Denture Disinfectant: Antimicrobial Activity and Effect on the Physical Properties of Polymethylmethacrylate

Abstract To the moment, there is no ideal substance for home-based denture disinfection. This study assessed in vitro the antimicrobial effect of the hydroalcoholic extract of Eugenia uniflora and the effect on the physical properties of denture polymethylmethacrylate (PMMA). Candida albicans, Staphylococcus aureus, and Klebsiella oxytoca were isolated from samples of saliva collected from denture wearers. The extracts were produced in three concentrations, according to the Brazilian Pharmacopeia. One hundred eighty-eight disc-shaped specimens of thermopolymerizable PMMA were prepared and randomly allocated to five treatment groups: sterile saline solution (0.85%; control); chlorhexidine digluconate (0.2%); and hydroalcoholic extract of E. uniflora (0.2%, 0.8%, and 1.16%). The specimens were disinfected for 8 hours/day for 30 days. Adherence of microorganisms to the surface, PMMA surface roughness, and color stability were assessed. Inferential statistics were performed with one- and two-way ANOVA/Tukey test, and Kruskal Wallis, Mann-Whitney U, and paired t-tests, at α=0.05. The extract of E. uniflora at 0.2% and 1.16% reduced the microbial load of K. oxytoca, while chlorhexidine digluconate significantly reduced microbial load of all microrganisms. Microbial adherence at day 10 was reduced by all experimental substances (p<0.001). Surface roughness was not affected by the disinfecting substances (p>0.05). Nevertheless, all experimental groups produced unacceptable color change at the end of the disinfection protocol (p<0.001). The non-adherent potential against microorganisms isolated from the oral cavity confirm the potential of use of the hydroalcoholic extract of E. uniflora as a denture disinfectant. Yet, unacceptable color changes may occur, regardless of extract concentration.

How do dental faculty members relate to Evidence-Based Dentistry?

Building the rationale to critically appraise scientific evidence on the best approach for each patient requires incorporating the Evidence-Based Dentistry (EBD) model, preferably into undergraduate dental courses. This approach would favor the diffusion of EBD culture amongst dental professionals. Therefore, this study aimed to characterize the relationship of dental faculty members with the EBD model. The study was conducted in 2018 with all 23 dental faculty members (100% response rate) of a community university. They responded the Evidence-Based Practice Questionnaire (EBPQ) and a set of supporting questions involving sociodemographics, search for information, proficiency of foreign languages, and perceived need for knowledge on issues related to EBD. The data were analyzed by descriptive statistics. A total of 73.9% of faculty members claimed having been prepared to search for scientific evidence and 69.5% are aware of connected computer systems for research. Scientific journals, the internet, courses, and colleague opinions were the main sources of information. Reading and comprehension of foreign languages was limited to 30%. The practice and attitudes towards EBD by dental faculty members were positive, with the lowest mean value of 4.85. Knowledge and skills related to EBD had lower mean values, which coincided with a relatively high perceived need for knowledge on EBD. Dental faculty members present a positive attitude towards the EBD model, have been trained to search for scientific information and acknowledge the existence of institutional structure for applying and teaching EBD. On the other hand, knowledge and skills associated with EBD may require improvement (AU).

A construção do raciocínio para avaliar criticamente a evidência científica sobre a melhor abordagem para cada paciente requer a incorporação do modelo de Odontologia Baseada em Evidências (OBE), preferencialmente ainda no ensino de graduação. Essa abordagem favorece a difusão da cultura da OBE entre os profissionais de Odontologia. Assim, este estudo teve como objetivo caracterizar a relação de docentes de um curso de Odontologia com o modelo OBE. O estudo foi conduzido em 2018 com todos os 23 professores de uma universidade comunitária. Eles responderam o EvidenceBased Practice Questionnaire (EBPQ) e algumas perguntas complementares envolvendo fatores sociodemográficos, busca por informação, proficiência em idioma estrangeiro e necessidade percebida de conhecimento sobre aspectos relacionados à OBE. Os dados foram analisados descritivamente. Aproximadamente 74% dos professores afirmaram ter sido preparados para pesquisar por evidência científica e 69,5% reconheceram a existência de computador conectado para essa finalidade. Periódicos, internet, cursos e opinião de colegas foram as principais fontes de informação. Leitura e compreensão de idiomas estrangeiros foram limitadas a 30%. A prática e as atitudes voltadas à OBE pelos professores foram positivas, com um valor mínimo de 4,85. O conhecimento e as habilidades relacionadas à OBE tiveram valores mais baixos, que coincidiram com alta necessidade percebida de informação sobre OBE. Os professores apresentaram uma atitude positiva com relação ao modelo da OBE, foram treinados para buscar informação científica e reconhecem a estrutura institucional para fazê-lo e ensiná-lo. Por outro lado, o conhecimento e as habilidades relacionadas à OBE requerem melhorias (AU).

Denture disinfection using Salvia officinalis L: microbial load and selected properties of PMMA

Denture use may aggravate the occurrence of oral infections, considering it enhances microbial adherence. Aim: This study assessed the reduction of microbial loads of Candida albicans, Staphylococcus aureus, and Klebsiella oxytoca by disinfecting the polymethylmethacrylate (PMMA) of complete dentures with hydroalcoholic extract of Salvia officinalis. Additionally, the effect of such extract on the properties of PMMA was examined. Methods: Microorganisms were isolated from saliva samples collected from complete denture wearers. The hydroalcoholic extract of S. officinalis was produced according to the Brazilian Pharmacopoeia 5. The PMMA specimens (n=188) were immersed in microbial inoculum and incubated at 37°C for 16 hours per day. Then, they were subjected to a disinfection protocol for 30 days. The specimens were divided into five treatment groups: sterile saline solution (0.85%; control), 0.2% chlorhexidine digluconate, and hydroalcoholic extract of S. officinalis (0.2%, 0.8%, and 1.16%). Microorganism adherence to the PMMA surface was also assessed, as well as surface roughness (Ra in µm) and color stability of the PMMA (mean ΔE). Changes in microbial load and surface roughness after the disinfection protocol were verified with paired t-test. Substances at day 10, adherence, and color stability were compared by the Kruskall-Wallis and Mann-Whitney tests, and one-way ANOVA was used to compare substances at the beginning and end of the experiment (α=0.05). Results: The 1.16% S. officinalis extract significantly reduced the microbial load of all the microorganisms after 30 days of disinfection (p<0.05). The microbial load of K. oxytoca was also reduced at lower concentrations of the S. officinalis extract (0.2% and 0.8%) (p<0.02). Antimicrobial and anti-adherent effects against microorganisms isolated from the oral cavity were observed. There was no significant change in surface roughness (p>0.05) and color stability was significantly higher in the control group (p<0.0001). Conclusions: The hydroalcoholic extract of S. officinalis may be used as a disinfectant solution for dentures

Elementos contribuintes para a aplicação da Odontologia baseada em evidências: parte II

Visando aplicar o modelo da Odontologia baseada em evidências (OBE) no dia a dia, o profissional precisa conhecer alguns conceitos de epidemiologia clínica e bioestatística. Objetivos: este estudo traz os elementos envolvidos na geração quantitativa da evidência com base na análise de estudos primários, na avaliação do risco de viés desses estudos e na determinação da qualidade da evidência gerada. Revisão de literatura: ensaios clínicos controlados randomizados (ECCRs) representam o melhor modelo de estudo para determinar a eficácia terapêutica de tecnologias em saúde, gerando dados que permitem calcular a diferença média entre grupos terapêuticos, o risco relativo ou o odds ratio (razão de chance). Essas medidas de tamanho de efeito, juntamente com seus intervalos de confiança, são gera -das em revisões sistemáticas pela metanálise e permitem determinar a alternativa terapêutica mais indicada para a situação clínica a ser resolvida. A metanálise também gera informações quanto à heterogeneidade dos dados obtidos. Revisões sistemáticas devem também sintetizar a qualidade da informação provida pelos estudos primários e da evidência gerada. Isso é feito com instrumentos como o da ColaboraçãoCochrane, para avaliação do risco de viés, e o GRADE, que permite avaliar a qualidade da evidência gerada centrada no desfecho. Considerações finais: estes estudos visaram instrumentalizar estudantes e profissionais de odontologia para o vislumbre da prática clínica sob o mode -lo daOBE, apresentando elementos da construção e análise de revisões sistemáticas e ECCRs. Este estudo focou nos elementos relativos à análise dos dados e na qualificação da evidência gerada.

Efficacy and safety of over-the-counter whitening strips as compared to home-whitening with 10 % carbamide peroxide gel--systematic review of RCTs and metanalysis.

OBJECTIVES: The study aims to compare the efficacy and safety of over-the-counter whitestrips with the American Dental Association (ADA)-recommended home-whitening using the 10 % carbamide peroxide gel. MATERIALS AND METHODS: Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of the whitestrips with the 10 % carbamide peroxide (10 % CP) gel applied on tray for tooth whitening in adults were searched at PubMed and Cochrane Central Register of Controlled Trials databases and selected up to October 2014. Efficacy of the whitening techniques was assessed through ∆E, ∆L, and ∆b parameters, while side effects were analyzed as dichotomous variables. Data was extracted independently by two reviewers. Metanalysis was performed using random- and fixed-effect models (RevMan 5.3). RESULTS: Eight studies were included in the metanalysis. The metanalysis revealed no significant difference between the intervention groups for tooth-whitening efficacy measured as ΔE (mean difference [MD]-0.53; 95 % CI [-1.72;0.66]; Z = 0.88; p = 0.38) and ΔL (MD-0.22; 95 % CI [-0.81;0.36]; z = 0.75; p = 0.45); reduction of yellowing was higher with the whitestrips (MD-0.47; 95 % CI [-0.89; -0.06]; Z = 2.25; p = 0.02). Tooth sensitivity (risk ratio [RR] 1.17; 95 % CI [0.81-1.69]; Z = 0.81; p = 0.42) and gingival sensitivity (RR 0.76; 95 % CI [0.53-1.10]; Z = 1.44; p = 0.15) were similar, regardless of the whitening method used. The observed gingival irritation was higher when the 10 % CP gel was applied on tray (RR 0.43; 95 % CI [0.20-0.93]; Z = 2.14; p = 0.03). The quality of evidence generated was rated very low for all outcomes. CONCLUSIONS: There is no sound evidence to support the use of the whitening strips in detriment of the ADA-recommended technique based on the 10 % carbamide peroxide gel applied on tray. CLINICAL RELEVANCE: To the moment, there is no sound evidence in dental literature to suggest that the ADA-recommended whitening technique based on 10 % carbamide peroxide gel could be substituted by the whitening strips. The existing studies, with their limitations, revealed similar tooth whitening and tooth and gingival sensitivity for both whitening techniques.