Fluoruro diamino de plata. Lo que necesitamos saber / Diamine silver fluoride. What we need to know

Introducción: El fluoruro diamino de plata deriva de la unión del nitrato de plata y fluoruro. Reduce el avance de la caries y la degeneración de colágeno en la dentina. Impide la desmineralización y fomenta la remineralización del esmalte y la dentina. Por su sencilla aplicación es un material de gran interés en aquellos niños con ansiedad o poco colaboradores. El objetivo de esta revisión es comparar las recomendaciones de uso, frecuencia y porcentaje de aplicación del fluoruro diamino de plata en dentición temporal. Métodos: Se realizó una búsqueda en las bases de datos Pubmed/Medline y Science Direct usando términos Mesh. Se han incluido estudios realizados en pacientes entre 0 y 5 años, publicados entre 2016-2020. Resultados: Se obtuvieron 12 artículos para examinar y contrastar los protocolos de porcentaje y continuidad de aplicación del fluoruro diamino de plata. Dicho material ha sido analizado en referencia a diversas variables como su frecuencia de aplicación, concentración y seguimiento, entre otros. Se describen los resultados de fluoruro diamino de plata en el microbioma presente en la placa de individuos y se cotejan los rasgos de microbioma asistentes en la placa entre la caries detenida y activa después de tratamiento. Gracias a las ventajas de este material se consigue un mejor manejo de conducta del paciente, disminuyendo su ansiedad. Conclusiones: Según los resultados analizados la aplicación más efectiva del fluoruro diamino de plata es al 38% cada 6 meses. (AU)

Introduction: Silver diamine fluoride is derived from the union of silver nitrate and fluoride. Reduce the progression of cavities and collagen degeneration in the dentin. Prevents demineralization and promotes remineralization of enamel and dentin. Due to its simple application, it is a material of great interest to those children with anxiety or little collaborators. The objective of this review is to compare the recommendations for use, frequency and percentage of application of silver diamine fl uoride in primary dentition. Methods: The Pubmed / Medline and Science Direct databases were searched using Mesh terms. Studies carried out in patients between 0 and 5 years old, published between 2016-2020, have been included. Results: Twelve articles were obtained to examine and contrast the protocols of percentage and continuity of application of silver diamine fluoride. This material has been analyzed in reference to various variables such as its frequency of application, concentration and monitoring, among others. The results of silver diamine fluoride in the microbiome present in the plate of individuals are described and the assisting microbiome traits in the plate are compared between the arrested and active caries after treatment. Thanks to the advantages of this material, a better management of the patient’s behavior is achieved, reducing their anxiety. Conclusions: According to the results analyzed, the most effective application of silver diamine fl uoride is at 38% every 6 months. (AU)

Casuística de 10 pacientes con queratitis por Acanthamoeba / A report of 10 patients with Acanthamoeba keratitis

CASOS CLÍNICOS: Presentamos 10 casos de queratitis por Acanthamoeba tratados en nuestro hospital entre 2008 y 2017. Todos eran portadores de lentes de contacto. Como tratamiento todos recibieron una biguanida junto a una diamidina. En 3 casos la infección no superaba el estroma superficial, respondiendo al tratamiento tópico. En 7 alcanzaba el estroma profundo, precisando 6 de ellos una queratoplastia penetrante, 3 «en caliente» por riesgo de perforación o extensión ocular. La agudeza visual mejoró en todos los casos. CONCLUSIÓN: La profundidad de la infección al diagnóstico aparece como el principal factor de riesgo para necesitar una queratoplastia penetrante

CLINICAL CASES: Cases are presented of 10 patients with Acanthamoeba keratitis treated between 2008 and 2017. All were contact lens wearers. All of them received treatment with a biguanide combined with a diamidine. In 3 cases the infestation did not exceed the superficial stroma, responding to topical treatment. In 7, the infection reached the deep stroma, with 6 of these cases requiring penetrating keratoplasty (PKP), 3 of them therapeutic PKP because of perforation risk or ocular spreading. The visual acuity improved in all the cases. CONCLUSION: The infestation depth at the time of diagnosis appears to be the main risk factor for requiring a PKP

Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm

Objectives: This in vitro study investigated the effects of silver diamine fluoride (SDF) on dentine carious lesion with cariogenic biofilm. Study Design: Thirty human dentine blocks were inoculated with Streptococcus mutans and Lactobacillus acidophilus dual-species biofilm to create carious lesion. They were equally divided into test and control group to receive topical application of SDF and water. After incubation anaerobically using micro-well plate at 37oC for 7 days, the biofilms were evaluated for kinetics, morphology and viability by colony forming units (CFU), scanning electron microscopy (SEM), and confocal microscopy (CLSM), respectively. The carious lesion underwent crystal characteristics analysis, evaluation of the changes in chemical structure and density of collagen fibrils using x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and immune-labeling. Results: The log CFU of S. mutans and L. acidophilus in the test group was significantly lower than control group. SEM and CLSM showed confluent biofilm in control group, but not in test group. XRD showed the loss of crystallinity of dentine due to the dissolution of hydroxyapatite crystal structure in test group was less than control group. FTIR showed that log [Amide I: HPO42-] for test vs. control group was 0.31±0.10 vs. 0.57±0.13 (p<0.05). The goldlabeling density in test vs. control group was 8.54±2.44/µm2 vs. 12.91±4.24/µm2 (p=0.04). Conclusions: SDF had antimicrobial activity against the cariogenic biofilms and reduced demineralization of dentine (AU)

Alergia de contacto a 3-dimetilaminopopilamina y cocamidopropil betaína / Contact allergy to 3-dimethylaminopropylamine and cocamidopropyl betaine

Se ha descubierto que todos los individuos con alergia a la cocamidopropil betaína (CAPB) se encuentran sensibilizados a la 3-dimetilaminopropilamina (DMAPA) y a la amidoamina, moléculas que son intermediarias en la síntesis de CAPB, y que persisten como impurezas en el material comercializado, en cantidades variables dependiendo de la calidad de la CAPB en el producto final. Se presentan 3 casos de dermatitis de contacto alérgica a DMAPA. En los tres las pruebas epicutáneas para DMAPA fueron positivas, mientras que no hubo reacción a la CAPB. La relevancia actual de estas pruebas fue confirmada por la reexposición de los pacientes a los productos propios sospechados, que contenían CAPB. La alergia de contacto a la CAPB es ahora poco frecuente, en parte por el creciente uso de nuevos agentes tensoactivos no irritantes introducidos en el mercado en la última década. Sin embargo, siguen dándose a conocer casos de pacientes alérgicos a la CAPB comercial que sólo reaccionan a la DMAPA ­y no a la CAPB­ cuando son parcheados. La propia DMAPA u otras moléculas como la amidoamina serían los alérgenos verdaderos y, por tanto, algunos casos de alergia a la CAPB se estarían pasando por alto debido a que la DMAPA no siempre está incluida en la serie de cosméticos. La CAPB podría no ser ya necesaria en las pruebas del parche, puesto que la DMAPA parece ser la principal fracción alergénica en este agente tensoactivo, y también porque los fabricantes de alérgenos epicutáneos elaboran unos extractos de CAPB tan puros que no son ya una buena herramienta de cribado de la alergia de contacto a la CAPB comercial

It has been discovered that all individuals who are allergic to cocamidopropyl betaine (CAPB) are sensitized to 3-dimethylaminopropylamine (DMAPA) and to amidoamine, molecules which are intermediaries in CAPB synthesis, and which persist as impurities in the material that is sold; the amounts vary, depending on the quality of the CAPB in the end product. We present three cases of allergic contact dermatitis to DMAPA. In all three cases, the skin tests for DMAPA were positive, while there was no reaction to CAPB. The current relevance of these tests was confirmed by the patients' re-exposure to the suspect products themselves, which contained CAPB. Contact allergy to CAPB is now infrequent, partly because of the increasing use of new non-irritating surfactants that have been introduced on the market in the last decade. However, cases of patients allergic to commercial CAPB who only react to DMAPA ­and not to CAPB­ when they are patch tested are still being reported. DMAPA itself, and other molecules like amidoamine, would be the true allergens, and some cases of CAPB allergy are therefore being overlooked because DMAPA is not always included in the cosmetics series. CAPB may no longer be necessary in patch tests, as DMAPA seems to be the principal allergenic fraction in this surfactant, and also because manufacturers of skin allergens currently prepare CAPB extracts that are so pure that they are no longer a good screening tool for contact allergy to commercial CAPB