Cost-Effectiveness Analysis of Rehabilitation Interventions for Teeth With Extensive Coronary Destruction.

OBJECTIVE: To perform a cost-effectiveness analysis of rehabilitation interventions for management of posterior teeth (molar) with extensive coronary destruction. METHODOLOGY: An economic model by Markov simulated a hypothetical 10-year cohort with 1,000 patients requiring treatment for a molar tooth with pulp necrosis and extensive coronary destruction. This study adopted the perspective of a local manager from Specialized Center in Dentistry, based on the transfer from the Ministry of Health. Treatments were proposed: Tooth Extraction + Removable Partial Denture (TE+RPD); Root Canal Treatment + Intra-Radicular Restoration + Single Crown (RCT+RIR+SC); and Tooth Extraction + Dental Implant + Single Crown (TE+DI+SC). The costs were obtained from the SUS Integrated System of Procedures, Medicines and orthoses; prostheses and special materials table management (SIGTAP). Failure and survival rates were obtained from systematic reviews. The variable "years of survival" was an outcome of effectiveness. The probabilistic simulation considered the confidence interval of 95%, variation of parameters by 5% and annual discount rate of 5%. RESULTS: TE+RPD intervention presented lower cost and effectiveness. The incremental cost-effectiveness ratio (ICER) of RCT+IRR+SC and TE+DI+SC interventions compared to TE+RPD were $13.06 and $9.92 per year of survival. Compared to RCT+IRR+SC, the TE+DI+SC intervention had an ICER=$26.90 per year of survival. The acceptability curve indicates that the choice of intervention depends on the willingness to pay. CONCLUSION: The RCT+IRR+SC intervention presented a balance of cost-effectiveness. Rehabilitation with implants can be considered in view of the higher expectation of longevity and, especially, greater willingness to pay.

Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002-2017.

Background: Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods: This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002-2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results: Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases (p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care (p < 0.001). Conclusions: The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities' population size, the population's socioeconomic status and the availability of public dental services.

Glucose supplementation effect on the acidogenicity, viability, and extracellular matrix of Candida single- and dual-species biofilms.

AIM: Evidence of glucose supplementation effect on Candida biofilm metabolism has not been demonstrated. Therefore, the aim of the present study was to evaluate the effect of glucose concentration on Candida biofilms. METHODS: Single- and dual-species biofilms of Candida were grown on saliva-coated poly(methyl-methacrylate) disks for 72 hours. Biofilms (N = 8/group) were exposed to the following concentrations of glucose: 100 mmol/L (G100), 300 mmol/L (G300), and no glucose (G0: control). Biofilms were collected to determine the acidogenicity, viability, amount of soluble and insoluble extracellular polysaccharides (IEPS), and surface roughness. Data were analyzed using analysis of variance and Tukey's tests (α < 0.05). RESULTS: Single- and dual-species biofilms from G300 were more acidogenic at 48 and 72 hours compared to G100 and G0 (P < 0.05). The viability of the G100 and G300 groups did not differ (P > 0.05), but differed statistically from G0. The amount of IEPS in the G300 group was statistically higher than the G0 and G100 groups (P < 0.05). The G300 group also presented a higher IEPS proportion per number of viable cells compared to others. G300 presented greater surface roughness for both single- (mean roughness = 1460 µm) and dual-species (mean roughness = 1990 µm) biofilms. CONCLUSIONS: Higher glucose concentration (300 mmol/L) during biofilm development favors the growth of single- and dual-species biofilms of Candida.

The use of mouthguards and prevalence of dento-alveolar trauma among athletes: A systematic review and meta-analysis.

BACKGROUND/AIMS: The evidence that mouthguards prevent dental trauma is inconsistent. The aim of this study was to determine, through a systematic review and meta-analysis (MA), the impact of mouthguards (MG) on the prevalence of dento-alveolar trauma (DT) among athletes of contact sports. MATERIAL AND METHODS: Searches were performed at Medline, Scopus, Web of Science, Lilacs, Cochrane Library, and SIGLE without restriction of language or publication date. After the application of eligibility criteria, studies were evaluated regarding their methodology quality and risk of bias. Two meta-analyses (MA) were performed considering: studies free of problems or with minor problems (MA1) and only free of problems studies (MA2). DT prevalence (events) and total number of athletes from each group (use of MG and non-use of MG) were used for odds ratio calculation (α = 5%). The evidence was quality tested using the GRADE approach. RESULTS: A total of 256 articles were identified. After applying the eligibility criteria, 14 studies were selected for qualitative synthesis, and 11 were used in quantitative synthesis. Meta-analyses showed that 73% (MA1) and 83% (MA2) of mouthguard users have a lower prevalence of DT. In MA1 (eight studies), DT prevalence among MG users was 7.75% (n = 183), while non-users had 48.31% (n = 974) (OR = 0.18, 95% CI = 0.07-0.45, P < 0.001). In MA2 (three studies), DT prevalence among MG users was 7.5% (n = 160), while DT prevalence among non-users was 59.48% (n = 750) (OR = 0.10, 95% CI = 0.05-0.08, P < 0.001), with moderate evidence quality level. CONCLUSION: Mouthguards contribute to a lower prevalence of dento-alveolar trauma among athletes of contact sports.

Candida albicans Increases Dentine Demineralization Provoked by Streptococcus mutans Biofilm.

Streptococcus mutans are considered the most cariogenic bacteria, but it has been suggested that Candida albicans could increase their cariogenicity. However, the effect of this dual-species microorganisms' combination on dentine caries has not been experimentally evaluated. Biofilms of C. albicans, S. mutans and C. albicans + S. mutans (n = 12/biofilm) were grown in ultra-filtered tryptone yeast extract broth culture medium for 96 h on root dentine slabs of known surface hardness and exposed 8 times per day for 3 min to 10% sucrose. The medium was changed 2 times per day (after the 8 cariogenic challenges and after the overnight period of famine), and aliquots were analyzed to determinate the pH (indicator of biofilm acidogenicity). After 96 h, the biofilms were collected to determine the wet weight, colony-forming units, and the amounts of extracellular polysaccharides (soluble and insoluble). Dentine demineralization was assessed by surface hardness loss (% SHL). The architecture of the biofilms was analyzed by confocal laser scanning microscopy (CLSM) and transmission electron microscopy (TEM). Data were analyzed by ANOVA followed by Tukey's test (α = 0.05). The dual-species C. albicans + S. mutans biofilm provoked higher % SHL on dentine (p < 0.05) than the S. mutans and C. albicans biofilm. This was supported by the results of biofilm acidogenicity and the amounts of soluble (6.4 ± 2.14 vs. 4.0 ± 0.94 and 1.9 ± 0.97, respectively) and insoluble extracellular polysaccharides (24.9 ± 9.22 vs. 18.9 ± 5.92 and 0.7 ± 0.48, respectively) (p < 0.05). The C. albicans biofilm alone presented low cariogenicity. The images by CLSM and TEM, respectively, suggest that the C. albicans + S. mutans biofilm is more voluminous than the S. mutans biofilm, and S. mutans cells interact with C. albicans throughout polysaccharides from the biofilm matrix. These findings show that C. albicans enhances the cariogenic potential of the S. mutans biofilm, increasing dentine demineralization.

In vitro antibacterial activity of silver diamine fluoride in different concentrations.

The antibacterial activity of Silver Diamine Fluoride - SDF -(Cariestop), at commercial concentrations of 12% and 30%, was evaluated against clinical and pattern strains (ATCC 25175) of S. mutans. Clinical isolates were obtained from the saliva of six children attending the Pediatric Dentistry Clinic UFPB, being grouped as follows: GI- low risk and caries activity, GII- high risk and caries activity. Once sown, the strains were isolated from Mitis-Salivarius Agar and divided into seven groups - M1 (pattern strain) to M7. The antibacterial activity was determined by maximum inhibitory dilution (MID) by the agar diffusion method, using serial dilutions (1:1 to 1:32) and the pure formulations of SDF and chlorhexidine 0.12% (positive control). After incubation, the inhibition zones were measured. The bactericidal and bacteriostatic actions of pure substances and in their respective MIDs were evaluated by test of germicidal power using glass specimens, after inoculation by the strains and incubation for 24 hours in BHI broth. Each specimen was exposed to chlorhexidine and to SDF for 30s, 3min, 30min and 1h, then incubated for 24 h in BHI broth. The samples were subcultured in Mitis-Salivarius Agar to evaluate the bactericidal or bacteriostatic activity of the substances. The data were analyzed in a comparative-descriptive method. The Cariestop 30% was effective until the last dilution (1:32) on all strains. For Cariestop 12%, the MIDs corresponded to last dilution (1:32) in almost all samples, except for M3 (1:8). Chlorhexidine showed DIM in the last concentrations (1:32) on five samples, and in the concentration 1:8 for M3 and M7. As evidence of the germicidal power the substances had bactericidal activity at all times analyzed. It was concluded that the cariostatic showed antibacterial activity when compared to chlorhexidine and these two substances presented bactericidal action against the strains at all contact times.

Indicadores socioeconômicos e desigualdades em saúde bucal no Brasil / Socioeconomic indicators and inequalities in oral health in Brazil

Objetivo: relacionar indicadores socioeconômicos com a oferta de cobertura na Atenção Básica e de recursos humanos em saúde bucal no Brasil. Metodologia: realizou-se um estudo ecológico com a utilização dos seguintes dados secundários, coletados por unidade federativa (n=27): Produto Interno Bruto per capita (PIB), analfabetismo acima de 15 anos (ANALF), Número de Cirurgiões-Dentistas (NCD) e População Coberta na Atenção Básica (PCAB); a partir das bases eletrônicas do Instituto Brasileiro de Geografia e Estatística; Conselho Federal de Odontologia; e Departamento de Informática do Sistema Único de Saúde. Utilizaram-se Testes de Correlação de Pearson e Exato de Fisher para análise. Resultados: evidenciou-se associação significante (p<0,01) entre: PIB/ANALF; PIB/NCD; PIB/PCAB; ANALF/NCD, ANALF/PCAB. Detectou-se correlação entre os dados: PIB/ANALF; PIB/PCAB; e ANALF/PCAB (p<0,01); ANALF/NCD (p<0,05), sendo correlações negativas: PIB/ANALF; PIB/PCAB; ANALF/NCD. Os estados, em que o valor do PIB foi baixo, caracterizaram-se por baixo NCD e altos ANALF e PCAB. Onde o ANALF foi baixo, a PCAB foi reduzida. Conclusão: os indicadores analisados podem contribuir na elaboração de modelos de decisão em saúde, na explicação dos processos organizativos e da desigualdade na oferta de serviços e recursos humanos em saúde bucal no Brasil.

Objective: to relate socioeconomic indicators with the offer coverage in primary health care and human resource in oral health in Brazil. Methods: an ecological survey was performed using the following secondary data, collected by state (n= 27): Gross Domestic Product per capita (PIB); illiteracy over 15 years (Analf), Number of Dentists (NCD) and Population Covered in Primary Health Care (PCAB); from the electronic database of the Brazilian Institute of Geography and Statistics, Federal Council of Dentistry, and Department of the Unified Health System. It has used Pearson?s correlation tests and Fisher Exact test for analysis. Results: associations were significant (p<0.01) between: GDP/Analf; GDP/NCD; GDP/PCAB; Analf/NCD; Analf/PCAB. It has detected a correlation between the data: GDP/PCAB, and Analf/PCAB (p<0.01); Analf/NCD (p<0.05), and negative correlations: GDP/Analf; GDP/PCAB; Analf/NCD. The states where the value of GDP was low, characterized by low and high NCD Analf and PCAB. Where Analf was low, the PCAB was reduced. Conclusion: the analyzaded indicators could contribute to the development of decision models in health, to the explanation of organizational processes and of inequality in the provision of services and human resources for oral health in Brazil.

Atividade antifúngica de três óleos essenciais sobre cepas de candida / Antifungal activity of three essential oils on candida strains

Objetivou-se avaliar a atividade antifúngica dos óleos essenciais de Melaleuca alternifólia (melaleuca), Cymbopogon winterianus (citronela), e Rosmarinus officinalis (alecrim) sobre Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) e C. tropicalis (ATCC13803). Determinou-se a atividade antifúngica pela Concentração Inibitória Mínima (CIM) e Concentração Fungicida Mínima (CFM), obtidas através das técnicas de microdiluição e de esgotamento, respectivamente. Em microplacas de 96 poços foram inseridos 100?L de caldo Sabouraud-Dextrose duplamente concentrado, 100?L da diluição dos óleos essenciais e 10?L do inoculo fúngico (1,5x106 microrganismos/mL). Realizou-se diluição seriada dos produtos partindo-se da concentração inicial de 8% até 0,0625%. A CIM correspondeu a menor diluição na qual se verificou ausência de crescimento fúngico visível. Realizou-se a semeadura, em Ágar Sabouraud-Dextrose, de 10?L das diluições correspondentes a CIM e duas imediatamente anteriores. Os testes foram realizados em triplicata e a Nistatina (100.000UI/mL) serviu de controle. Procedeu-se análise estatística pelos testes Kruskal-Wallis e Dunn. Para R. officinalis, observou-se melhor desempenho frente C. albicans (ATCC289065) e C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/ mL. M. alternifólia e C. winterianus apresentaram melhor desempenho frente C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/mL. O óleo essencial de R. officinalis apresentou atividade antifúngica estatisticamente diferente (p<0,05), com menores valores de CIM e CFM. Não se observou diferença estatística (p>0,05) para a ação de M. alternifólia e C. winterianus. Concluiu-se que os produtos avaliados exerceram atividade antifúngica sobre Candida, destacando-se o óleo essencial de R. officinalis, com menores CIM e CFM.

The aim was to evaluate the antifungal activity of essential oils from Melaleuca alternifólia (tea tree), Cymbopogon winterianus (citronella), and Rosmarinus officinalis (rosemary) on Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) and C. tropicalis (ATCC13803). The antifungal activity was determined by Minimum Inhibitory Concentration (MIC) and Minimal Fungicidal Concentration (MFC), obtained through the microdilution and exhaustion techniques, respectively. In 96-well microplates were inserted 100?L of Sabouraud-Dextrose broth doubly concentrated, 100?L of the dilution of essential oils and 10?L of fungal inoculums (1.5x106 microorganisms/mL). The products were diluted from initial concentration of 8% until 0.0625%. The MIC corresponded to the lowest dilution at which there was no visible fungal growth. Aliquots of 10?L of dilutions corresponding to the MIC and two immediately preceding were sown on Sabouraud-Dextrose agar. The tests were performed in triplicate and nystatin (100,000UI/mL) served as control. Statistical analysis was conducted by Kruskal-Wallis and Dunn tests. For R. officinalis, better performance was observed on C. albicans (ATCC289065) and on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. M. alternifólia and C. winterianus presented better performance on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. The essential oil from R. officinalis presented antifungal activity statistically different (p<0.05), with lower MIC and MFC. No statistical difference (p>0.05) was observed for the antifungal activity of M. alternifólia and C. winterianus. It was concluded that the evaluated products exerted antifungal activity against Candida, highlighting the essential oil from R. officinalis, with lower MIC and MFC.