Microbial composition and diversity in intraradicular biofilm formed in situ: New concepts based on next-generation sequencing.

This study aimed to characterize the taxonomic composition of intraradicular multispecies biofilms (IMB) formed in situ in a model to reproduce clinical conditions. Twelve palatal roots of maxillary molars had its canals prepared. Two roots were randomly selected to sterility control. Ten intraoral prosthetic appliances with lateral slots were fabricated. The roots were positioned in the slots with the canal access open to the oral cavity. Eight volunteers wore the appliance for 21 days, and two wore it at two different time points. One root from each appliance was removed and stored at -20°C until DNA extraction and sequencing (n = 10). Biofilm was analyzed using next-generation sequencing and bioinformatics. The V4 hyper-variable region of the 16SrRNA gene was amplified and sequenced. For data analyses, the mothur pipeline was used for 16SrRNA processing, and subsequent analyses of the sequence dataset were performed in R using the Microbiome Analyst R package. The taxonomy-based analysis of bacterial communities identified 562 operational taxonomic units (OTUs), which belonged to 93 genera, 44 families, and 8 phyla. Bacterial colonization was different for each biofilm, and samples did not have the same group of bacteria. Alpha and beta diversity analysis revealed some general patterns of sample clustering. A core microbiome of prevalent OTUs and genera was identified. IMBs were heterogeneous when analyzed individually, but some diversity patterns were found after sample clustering. The experimental model seemed to reproduce the actual biofilm composition in endodontic infections, which suggests that it may be used to evaluate disinfection protocols.

Microbial composition and diversity in intraradicular biofilm formed in situ: New concepts based on next-generation sequencing.

This study aimed to characterize the taxonomic composition of intraradicular multispecies biofilms (IMBs) formed in situ in a model to reproduce clinical conditions. Twelve palatal roots of maxillary molars had its canals prepared. Two roots were randomly selected to sterility control. Ten intraoral prosthetic appliances with lateral slots were fabricated. The roots were positioned in the slots with the canal access open to the oral cavity. Eight volunteers wore the appliance for 21 days, and two wore it at two different time points. One root from each appliance was removed and stored at -20°C until DNA extraction and sequencing (n = 10). Biofilm was analyzed using next-generation sequencing and bioinformatics. The V4 hyper-variable region of the 16SrRNA gene was amplified and sequenced. For data analyses, the mothur pipeline was used for 16SrRNA processing, and subsequent analyses of the sequence dataset were performed in R using the MicrobiomeAnalyst R package. The taxonomy-based analysis of bacterial communities identified 562 operational taxonomic units (OTUs), which belonged to 93 genera, 44 families, and 8 phyla. Bacterial colonization was different for each biofilm, and samples did not have the same group of bacteria. Alpha and beta diversity analysis revealed some general patterns of sample clustering. A core microbiome of prevalent OTUs and genera was identified. IMBs were heterogeneous when analyzed individually, but some diversity patterns were found after sample clustering. The experimental model seemed to reproduce the actual biofilm composition in endodontic infections, which suggests that it may be used to evaluate disinfection protocols.

Evaluation of dental trauma associated with cycling accidents in a city in the south of Brazil: an observational study / Avaliação de traumatismos dentários associados a acidentes com bicicletas em uma cidade do sul do Brasil: um estudo observacional

Aim: to evaluate the cyclists' profile and the frequency of dental trauma associated with cycling in a southern city in Brazil. Materials and Methods: a questionnaire was applied to 234 cyclists with at least 18 years old. The variables of interests were: sociodemographic data, data related to the profile of users, and data on the occurrence of all traumas and dental traumas. Descriptive and inferential statistical analyses were carried out (α=5%). Results: The mean age of participants was 31.38 ± 11.6 years, ranging from 14 to 67 years. The majority of the participants were male (62.8%), had attended higher education (45.7%), and had incomes equivalent to 1 to 3 times the minimum wage (39.3%). The main reason given for riding a bicycle was leisure (35.9%). Users of their own bicycles had fewer items of mandatory safety equipment fitted to their bicycles than users of rented bicycles (Student's t test, P<0.0001). However, study participants riding their own bicycles wore personal protective equipment more frequently than renters (Student's t test, P<0.0001). Moreover, 33.7% of the respondents reported having suffered an accident, and 25% had traumatized some part of the body. Among those who reported traumas, 20% (4/20) had suffered traumas to hard dental tissues and supporting structures. Discussion: Dental trauma was not frequent in a population predominantly from an urban area that uses bicycles, especially for leisure, despite the prevalence of accidents involving bicycle use. Conclusion: Health education campaigns should emphasize the importance of personal protective equipment for cyclists and of safety items fitted to bicycles, whether cyclists' own or rented.

Objetivo: avaliar o perfil dos ciclistas e a frequência de traumatismo dentário associado ao ciclismo em uma cidade do sul do Brasil. Materiais e Métodos: aplicou-se um questionário a 234 ciclistas com idade mínima de 18 anos. As variáveis ​​de interesse foram: dados sociodemográficos, dados relacionados ao perfil dos usuários e dados sobre a ocorrência de todos os traumatismos e traumas dentários. Foram realizadas análises estatísticas descritivas e inferenciais (α=5%). Resultados: A idade média dos participantes era de 31,38 ±11,6 anos, variando de 14 a 67 anos. A maioria dos participantes era do sexo masculino (62,8%), tinha curso superior (45,7%) e renda equivalente a 1 a 3 salários mínimos (39,3%). O principal motivo para andar de bicicleta foi lazer (35,9%). Usuários de suas próprias bicicletas tinham menos itens de equipamentos de segurança obrigatórios instalados do que os usuários de bicicletas alugadas (teste t de Student, P<0,0001). Porém, participantes do estudo que andavam em sua própria bicicleta usavam equipamentos de proteção individual mais frequentemente do que os locatários (teste t de Student, P<0,0001). Ainda, 33,7% dos entrevistados relataram ter sofrido algum acidente e 25% traumatizado alguma parte do corpo. Entre os que relataram traumatismos, 20% (4/20) sofreram traumas em tecidos duros dentais e estruturas de suporte. Discussão: O traumatismo dentário não foi frequente em uma população predominantemente de área urbana que utiliza bicicletas, principalmente para lazer, apesar da prevalência de acidentes envolvendo o uso de bicicletas. Conclusão: As campanhas de educação em saúde devem enfatizar a importância dos equipamentos de proteção individual dos ciclistas e dos itens de segurança instalados nas bicicletas, sejam elas próprias ou alugadas.

Effect of different disinfection protocols in bacterial viability of an intraradicular biofilm formed in situ.

The present study aimed to evaluate bacterial viability after the use of different disinfection protocols in root canals infected with a multispecies biofilm (MB) formed in situ. Palatal roots with a single canal were obtained from extracted maxillary molars and sterilized before being inserted into the mouth. The roots were contaminated with a MB in an intraoral appliance worn by ten volunteers. All volunteers wore six roots simultaneously in two intraoral devices for 21 days. One root from each volunteer was assigned to each group (n=10): PUI - passive ultrasonic irrigation; EC - Easy Clean; XPF - XP-endo Finisher; aPDT - antimicrobial photodynamic therapy; CI - conventional irrigation; and NC - negative control. The samples were evaluated under confocal laser scanning microscopy. The percentage of viable cells (VC) was calculated over the total percentage of MB biovolume. Data were statistically analyzed (α=5%). The cell viability in the entire root canal or for each third was compared between groups (Kruskal-Wallis test, Dunn post-hoc test) and for the same group (Friedman test, Dunn post-hoc test). Disinfection protocols were not significantly different from each other (P>.05). Samples in EC, PUI, and aPDT had lower cell viability than in NC (P<.05). In the coronal third of samples in the EC, XPF, PUI and aPDT, the percentage of VC biovolume was lower than in the NC (P<.05). The percentage of VC in EC samples was lower in the coronal and middle thirds than in the apical third (P<.05). EC, PUI and aPDT had significant effects on cell viability in intraradicular multispecies biofilm formed in situ when compared with untreated samples.

Effect of different disinfection protocols in bacterial viability of an intraradicular biofilm formed in situ

Abstract The present study aimed to evaluate bacterial viability after the use of different disinfection protocols in root canals infected with a multispecies biofilm (MB) formed in situ. Palatal roots with a single canal were obtained from extracted maxillary molars and sterilized before being inserted into the mouth. The roots were contaminated with a MB in an intraoral appliance worn by ten volunteers. All volunteers wore six roots simultaneously in two intraoral devices for 21 days. One root from each volunteer was assigned to each group (n=10): PUI - passive ultrasonic irrigation; EC - Easy Clean; XPF - XP-endo Finisher; aPDT - antimicrobial photodynamic therapy; CI - conventional irrigation; and NC - negative control. The samples were evaluated under confocal laser scanning microscopy. The percentage of viable cells (VC) was calculated over the total percentage of MB biovolume. Data were statistically analyzed (α=5%). The cell viability in the entire root canal or for each third was compared between groups (Kruskal-Wallis test, Dunn post-hoc test) and for the same group (Friedman test, Dunn post-hoc test). Disinfection protocols were not significantly different from each other (P>.05). Samples in EC, PUI, and aPDT had lower cell viability than in NC (P<.05). In the coronal third of samples in the EC, XPF, PUI and aPDT, the percentage of VC biovolume was lower than in the NC (P<.05). The percentage of VC in EC samples was lower in the coronal and middle thirds than in the apical third (P<.05). EC, PUI and aPDT had significant effects on cell viability in intraradicular multispecies biofilm formed in situ when compared with untreated samples.

Resumo O presente estudo teve como objetivo avaliar a viabilidade bacteriana após o uso de diferentes protocolos de desinfecção em canais radiculares infectados com um biofilme multiespécies (MB) formado in situ. Raízes palatinas com canal único foram obtidas de molares superiores extraídos e esterilizadas antes de serem inseridas na boca. As raízes foram contaminadas com MB em um aparelho intraoral usado por dez voluntários. Todos os voluntários usaram seis raízes simultaneamente em dois dispositivos intrabucais por 21 dias. Uma raiz de cada voluntário foi atribuída a cada grupo (n=10): PUI - irrigação ultrassônica passiva; EC - Easy clean; XPF - XP-endo Finisher; aPDT - terapia fotodinâmica antimicrobiana; IC - irrigação convencional; e, NC - controle negativo. As amostras foram avaliadas em microscopia confocal de varredura a laser. A porcentagem de células viáveis (VC) foi calculada sobre a porcentagem total do biovolume de MB. Os dados foram analisados estatisticamente (α=5%). A viabilidade celular em todo o canal radicular ou em cada terço foi comparada entre os grupos (teste de Kruskal-Wallis, teste post-hoc de Dunn) e no mesmo grupo (teste de Friedman, teste post-hoc de Dunn). Os protocolos de desinfecção não foram significativamente diferentes entre si (P>0,05). Amostras dos grupos EC, PUI e aPDT apresentaram menor viabilidade celular do as do NC (P<0,05). No terço cervical das amostras do EC, XPF, PUI e aPDT, a porcentagem de biovolume de VC foi menor do que no NC (P<0,05). A porcentagem de VC nas amostras do EC foi menor nos terços cervical e médio do que no terço apical (P<0,05). EC, PUI e aPDT tiveram efeitos significativos na viabilidade celular do biofilme multiespécies intrarradicular formado in situ quando comparado com amostras não tratadas. Estudos clínicos devem investigar o papel da redução de cargas bacterianas viáveis no sistema de canais radiculares para o sucesso do tratamento endodôntico.

Understanding the Diurnal Oscillation of the Gut Microbiota Using Microbial Culture.

The composition of the gut microbiota oscillates according to the light-dark cycle. However, the existing literature demonstrates these oscillations only by molecular methods. Microbial cultures are an interesting method for studying metabolically active microorganisms. In this work, we aimed to understand the diurnal oscillation of the intestinal microbiota in Wistar male rats through microbial culture analysis. Over a 24 h period, three animals were euthanized every 6 h. Intestinal segments were dissected immediately after euthanasia and diluted in phosphate-buffered saline (PBS) for plating in different culture media. The CFU/mL counts in feces samples cultured in the Brucella medium were significantly higher at ZT0, followed by ZT6, ZT18, and ZT12 (p = 0.0156), which demonstrated the diurnal oscillation of metabolically active anaerobic bacteria every 6 h using microbial culture. In addition, quantitative differences were demonstrated in anaerobic bacteria and fungi in different gastrointestinal tract tissues.

Análise da prática endodôntica realizada em clínicas odontológicas em uma cidade do Sul do Brasil / Analysis of endodontic practices in dental clinics in a Southern Brazilian city

Introdução: O desenvolvimento de novas técnicas, tecnologias e materiais influenciam a prática clínica da endodontia e impactam consideravelmente a forma como o tratamento do canal radicular é realizado. Embora existam informações sobre as várias formas de tratamentos praticados por dentistas em outras cidades e/ou países, muito pouco se sabe sobre as endodontias realizadas em clínicas odontológicas na cidade de Porto Alegre/RS. Objetivo: Analisar a prática endodôntica realizada por dentistas nas clínicas odontológicas na cidade de Porto Alegre/RS, visando explorar as técnicas, materiais e equipamentos empregados durante o tratamento. Material e método: Foi aplicado um questionário online, por meio da Plataforma Google Forms, com vinte e seis questões abertas e fechadas aos dentistas que realizam tratamentos endodônticos em clínicas odontológicas. O questionário foi estruturado a fim de analisar os materiais, técnicas e equipamentos que estão presentes nos tratamentos endodônticos realizados pelos dentistas nas clínicas odontológicas aqui avaliadas. Os dados coletados nos questionários foram transferidos para uma planilha Excel®. A análise dos dados foi feita de duas formas: frequência absoluta e relativa para as questões fechadas, e descritiva para as questões abertas. Resultado: 15,57% das clínicas odontológicas registradas no CRO/RS participaram da presente pesquisa. Foi possível verificar que a maioria dos materiais e técnicas aplicadas no tratamento endodôntico são os mesmos recomendados pela literatura científica. Conclusão: Os protocolos clínicos em endodontia seguidos pelos participantes do presente estudo apresentam embasamento clínico e científico na literatura.

Introduction: The evolution of new techniques, technologies, and materials significantly influences the clinical practice of endodontics, thus profoundly impacting the approach to root canal treatments. While information about various treatment methods practiced by dentists in other cities or countries is available, there is a notable gap in our understanding of endodontic practices in the Porto Alegre city. Objective: The objective of this study is to analyze the endodontic practices employed by dentists in dental clinics located in Porto Alegre city. We aimed to explore the techniques, materials, and equipment routinely utilized during endodontic treatments. Material and method: An online questionnaire using the Google Forms platform was administered, consisting of twenty-six open and closed questions to dentists performing endodontic treatments in dental clinics. The questionnaire was structured to assess the materials, techniques, and equipment employed during endodontic procedures. Data collected from the questionnaires were recorded in an Excel® spreadsheet. Data analysis encompassed both absolute and relative frequency for closed questions and also a descriptive approach for open-ended questions. Results: Participation was obtained from 15.57% of dental clinics registered with CRO/RS. The findings indicated that the majority of materials and techniques applied in endodontic treatment could be aligned with recommendations found in the scientific literature. Conclusion: The clinical protocols observed by the participants in endodontic practice demonstrated a solid foundation in both clinical and scientific literature.

Perception of the clinical endodontic practice of Dentistry graduates in their first years in the job market in southern Brazil

Introduction: Knowledge about the clinical endodontic practices of dental school graduates in the first years of their professional life may contribute to the discussions about Dentistry teaching. Methods: An online questionnaire with seven open and closed questions hosted on the Google forms platform was applied to dentists trained in the first half of 2019 in a School of Dentistry in southern Brazil. The questionnaire is structured to analyze how clinical Endodontics has been practiced in the labor market. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analyzed as absolute and relative frequencies for closed questions and descriptions for open questions. Results: Molars and two-rooted teeth are the dental groups most frequently treated endodontically (64.3% and 35.7%). Both retreatment and conservative treatment of the pulp corresponded to up to 25% of all procedures in the graduates' clinical practice. The endodontic protocol learned in their dental school was used by 64.3% of the graduates who provided endodontic treatments, and 42.9% reported the occurrence of at least one accident. The difficulty in access reported by the participants suggests that more training should be provided for this operative stage. Conclusions: After two years in the job market and having faced the initial difficulties existing in any profession, more than half of the graduates still performed endodontics in their dental clinical practice and used the same protocols learned in dental school.

Cost-related variables in the public purchase of dental materials for endodontic application: 10-year analysis

Aim: This study analyzed public procurements for different endodontic materials used in the Brazilian public health system and evaluated the variables related to their cost. Methods: A time-series study was performed by screening materials for endodontic application in the public Brazilian Databank of Healthcare Prices from 2010 to 2019. Data were categorized according to material composition and clinical application. The collated variables were used in a multiple linear regression model to predict the impact of unit price in procurement processes. Results: A total of 5,973 procurement processes (1,524,693 items) were evaluated. Calcium hydroxides were found in 79% of the observations (4,669 processes). Prices drop each year by US$1.87 while MTAs and epoxy resins are increasingly purchased at higher prices (US$50.87; US$67.69, respectively). The microregion, the procurement modality, and the type of institution had no influence on unit prices in the adjusted model (p > 0.05). Conclusions: Calcium hydroxide-based materials were the cheapest and most frequently purchased endodontic materials in the public health care system. Novel formulations are being implemented into clinical practice over time and their cost may be a barrier to the broad application of materials such as MTAs, despite their effectiveness

Resistance profiles to antifungal agents in Candida albicans isolated from human oral cavities: systematic review and meta-analysis.

AIM: To identify the antifungal susceptibility profile of Candida spp. isolated from the human oral cavity was assessed with meta-analyses of observational studies that collected samples from the oral cavity of human subjects. MATERIAL AND METHODS: Isolated Candida albicans tested by E-test®; disk diffusion test; microdilution and macrodilution; Sensititre YeastOne; and/or FungiTest. Search strategies were conducted on the MEDLINE, Embase, CINAHL, Dentistry, and Oral Sciences, Central, Scopus, and LILACS databases, and gray literature sources. Articles were initially screened by title and then their abstracts. Articles that met the conditions for inclusion were read in full, followed by data extraction. A descriptive analysis was conducted of each study, and the data were tabulated. A first meta-analysis was conducted to assess the resistance of antifungals regardless of systemic comorbidities. An additional stratified analysis was conducted by systemic comorbidity groups for the outcome "resistance" to the antifungals. RESULTS: When not grouping Candida albicans isolates by systemic conditions, the lowest resistance rates to the antifungals tested were observed for amphotericin B, nystatin, flucytosine, and caspofungin. In contrast, the highest resistance rates were observed for miconazole and econazole. There was a high degree of heterogeneity and low resistance in general in all analyses, except for the "several associated comorbidities" group, which had high resistance rates. CONCLUSIONS: Clinical C. albicans isolates had low antifungal resistance. CLINICAL RELEVANCE: The presence of concomitant systemic comorbidities appears to be an essential factor that should be considered when evaluating resistance to antifungals for oral isolates.

Frequency and characterization of potential drug interactions in dentistry-a cross-sectional study.

AIM: This study aimed to identify medications taken by patients before dental appointments and to simulate and characterize their interactions with medications often prescribed by dental surgeons. MATERIALS AND METHODS: A retrospective cross-sectional study evaluated 320 medical records, 118 from the Emergency Service (ES) archives, and 202 from elective appointments at the Dental Clinic (DC) of a university in southern Brazil. Drug interactions were identified and classified according to severity using the Medscape® application into four grades: (1) Minor, (2) Monitor closely, (3) Serious, or (4) Contraindicated. Descriptive and inferential statistical analyses were carried out (α = 5%). RESULTS: Preexisting systemic conditions were noted in 55.9% of the medical records from the ES and 64.35% from the DC. In the ES records, 47.45% contained information on continuous use medication for treatment of systemic conditions and 59.40% of DC records contained such information. A total of 359 potential interactions were found. Drug interactions with analgesics were most frequent, accounting for 50.41% of the sample. CONCLUSIONS: The most prevalent drug interaction severity was grade 2: monitor or use with caution. Many patients take medications to treat systemic conditions and seek dental care, generating a significant possible source of drug interactions. CLINICAL RELEVANCE: Prescribers must carefully analyze the patients' medical histories and obtain accurate data regarding their use of medications to be able to assess the risk-benefit relationships of possible combinations.

Can the method of cbct interpretation influence endodontic diagnosis? / O método de interpretação da tcfc pode influenciar o diagnóstico endodôntico?

Objetivo: Este estudo avaliou a influência do método de visualização e análise do exame de tomografia computa-dorizada de feixe cônico (TCFC) no diagnóstico de afecções endodônticas. Materiais e métodos: Vinte casos clínicos contendo doze diferentes afecções endodônticas foram ana-lisados por dois especialistas em radiologia odontológica e um especialista em endodontia. Inicialmente, os avaliadores visualizaram os casos em Portable Document Format (PDF) contendo uma seleção de imagens digitais e, por consenso, descreveram suas hipóteses diagnósticas para cada caso. Após uma semana, os avaliadores reavaliaram os casos, desta vez utilizando reconstrução multiplanar em um visualizador de imagens no formato Digital Imaging and Communications in Medicine (DICOM). Novamente, por consenso, eles indicaram suas hipóteses diagnósticas. Resultados: Em 10% dos casos, houve discrepância entre os diagnósticos realizados utili-zando as seleções de imagens digitais em PDF e utilizando a reconstrução multiplanar. A visualização das imagens em PDF obteve sensibilidade de 0.714, especificidade de 0.966, e acurácia de 90%. Discussão: Na maioria destes casos, as afecções endodônticas identificadas utilizando o visuali-zador de imagens DICOM (reconstrução multiplanar) não foram detectadas quando visualizados os PDF de imagens pré-selecionadas. Conclusão: Embora mais estudos sejam necessários, os autores reiteram que a utilização de recons-truções multiplanares sempre são preferíveis comparadas à outras formas de análise da TCFC, para que se atinja o máximo potencial diagnóstico do exame de imagem.

Aim: This study evaluated the influence of the method used for visualization and analysis of cone-beam com-puted tomography (CBCT) on the diagnosis of endodontic conditions. Materials and methods: Twenty clinical cases containing twelve different endodontic conditions were analyzed by two specialists in dental radiology and one specialist in endodontics. Initially, the evaluators viewed the cases in Portable Document Format (PDF) containing a selection of digital images and, by consensus, described their diagnostic hypotheses for each case. One week la-ter, the evaluators reassessed the cases, this time using multiplanar reconstructions with a Digital Imaging and Communications in Medicine (DICOM) format image viewer. Once more, by consensus, they recorded their diagnostic hypotheses. Results: In 10% of the cases there was a discrepancy between the diagnoses made using preselected digital images in PDFs and by viewing multiplanar reconstructions. The visualization of the PDF images obtained a sensitivity of 0.714, specificity of 0.966, and 90% accuracy. Discussion: In the majority of these cases, endodontic conditions identified using the DICOM image viewer (multiplanar reconstruction) were not detected using the PDFs of preselected images. Conclusion: Although more studies are needed, the au-thors reiterate that using multiplanar reconstructions should always be preferred to other forms of analysis for CBCT, so that the maximum diagnostic potential of the imaging exam can be achieved.

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic.

OBJECTIVE: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. METHODS: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. RESULTS: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). CONCLUSION: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

The Impact of Cone-beam Computed Tomography on Diagnostic Thinking, Treatment Option, and Confidence in Dental Trauma Cases: A Before and After Study.

INTRODUCTION: The aim of this study was to identify whether cone-beam computed tomographic (CBCT) imaging affects endodontists' diagnostic thinking, treatment option, and confidence in dental trauma cases. METHODS: Twelve endodontists reviewed 15 dental trauma cases with clinical histories and periapical radiography (PR) and answered questions regarding their diagnostic thinking and treatment decisions and their confidence in both. One month later, the same participants reviewed the same cases and answered similar questionnaires with the aid of CBCT imaging. A statistical analysis of their responses was conducted. RESULTS: Differences were observed in diagnostic thinking when using PR or CBCT imaging (P < .05), and the use of PR was associated with a higher number of "unsure" answers to questions about diagnoses. After reviewing periapical radiographic images, the approach most frequently endorsed was "don't start conventional endodontic treatment and order CBCT," whereas the most common decision made after analyzing the CBCT images was "start conventional endodontic treatment." Clinical interventions were proposed more often when participants evaluated the clinical case using CBCT imaging than when using PR (P < .05). The participants' degree of confidence in their diagnostic thinking was not different after analysis using PR or CBCT imaging (P > .05). However, there was a difference between PR and CBCT imaging in participants' confidence in their treatment decisions (P < .05). Participants who initially indicated a lack of confidence in their diagnosis or treatment option gained confidence when CBCT images were available. However, the inverse behavior was also observed for participants who were initially confident on the basis of PR (P < .05). Participants who decided to start treatment after CBCT analysis were less confident than when using PR (P < .05). CONCLUSIONS: In dental trauma cases, CBCT imaging influenced participants' diagnostic thinking and choice of treatment modality and affected their confidence in the decision-making process.

How is working length determination taught? A survey to assess what is recommended in undergraduate Schools of Dentistry in Brazil.

INTRODUCTION: To analyse what are the methods for working length (WLD) determination taught for undergraduate students in Brazilian Dental Schools and the perception of professors about the use of electronic WL determination in the clinical practice. METHODS: An online questionnaire with eighteen closed questions was sent to 209 Schools of Dentistry in Brazil using the Google Forms Platform. The questionnaire was structured to analyse the perception of professors in the department of endodontics about the method of working length determination taught in undergraduate courses in Dentistry. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analysed using absolute and relative frequencies. The non-parametric Mann-Whitney test was used to compare groups. RESULTS: Of the 209 schools contacted, 41 (19.61%) returned answers to the questionnaire. According to professors, electronic working length (WL) determination had a shorter length of time to perform it (p < .001), WL measurement accuracy (p < .001) and ease of performance (p < .001). Professors felt safer when maintaining patency when using electronic WL determination (p = .0020). CONCLUSIONS: Both radiographic and electronic methods of WL determination are taught in Brazilian Schools of Dentistry. The electronic method was used more frequently, especially in undergraduate clinical courses.

Efficiency of a digital electrofulguration system in contaminated root canals in vitro.

Decontamination of the root canal (RC) system is essential for successful endodontic therapy. In this in vitro study, it was evaluated the disinfection potential of an electrofulguration device, the Endox® Endodontic System (EES), in RC infected with Enterococcus faecalis. Sixty-five human lower premolars were instrumented with MTwo® system. The specimens were distributed into six experimental groups (n = 10), according to the irrigation protocol: 2% chlorhexidine gel (CHX); CHX + EES; 5.25% sodium hypochlorite (NaOCl); NaOCl + EES; saline solution (SS); and SS + EES. Five specimens were untreated (control). RC samples were collected before (C1) and after EES treatment (C2), after chemo-mechanical preparation (CMP) (C3), and after final EES treatment (C4). All samples were plated for colony forming units (CFU/mL) onto solid media. The data were analyzed by Wilcoxon and Friedman tests for intragroup comparisons and by Kruskal Wallis test followed by Dunn's test for intergroup comparisons (α = 0.05). Treatment with the EES did not significantly reduce the number of CFU/mL as compared to baseline levels (C1 vs. C2, p> 0.05). After CMP (C3), all groups showed a significantly reduced amount of CFU/mL (p <0.05), with no difference between CHX- and NaOCl-treated samples (p >0.05). Lastly, treatment with the EES following CMP (C4) did not significantly reduce the amount of CFU/mL (C3 vs. C4, p> 0.05). To conclude, the use of the Endox® Endodontic System did not result in considerable bacterial reduction at all operative times, while treatment with NaOCl and CHX was equally efficient for this purpose.

Efficiency of a digital electrofulguration system in contaminated root canals in vitro

Abstract Decontamination of the root canal (RC) system is essential for successful endodontic therapy. In this in vitro study, it was evaluated the disinfection potential of an electrofulguration device, the Endox® Endodontic System (EES), in RC infected with Enterococcus faecalis. Sixty-five human lower premolars were instrumented with MTwo® system. The specimens were distributed into six experimental groups (n = 10), according to the irrigation protocol: 2% chlorhexidine gel (CHX); CHX + EES; 5.25% sodium hypochlorite (NaOCl); NaOCl + EES; saline solution (SS); and SS + EES. Five specimens were untreated (control). RC samples were collected before (C1) and after EES treatment (C2), after chemo-mechanical preparation (CMP) (C3), and after final EES treatment (C4). All samples were plated for colony forming units (CFU/mL) onto solid media. The data were analyzed by Wilcoxon and Friedman tests for intragroup comparisons and by Kruskal Wallis test followed by Dunn's test for intergroup comparisons (α = 0.05). Treatment with the EES did not significantly reduce the number of CFU/mL as compared to baseline levels (C1 vs. C2, p> 0.05). After CMP (C3), all groups showed a significantly reduced amount of CFU/mL (p <0.05), with no difference between CHX- and NaOCl-treated samples (p >0.05). Lastly, treatment with the EES following CMP (C4) did not significantly reduce the amount of CFU/mL (C3 vs. C4, p> 0.05). To conclude, the use of the Endox® Endodontic System did not result in considerable bacterial reduction at all operative times, while treatment with NaOCl and CHX was equally efficient for this purpose.

Resumo A descontaminação do sistema do canal radicular (CR) é essencial para o sucesso da terapia endodôntica. Neste estudo in vitro, foi avaliado o potencial de desinfecção de um dispositivo de eletrofulguração, o Endox® Endodontic System (EES), em CR infectado com Enterococcus faecalis. Sessenta e cinco pré-molares inferiores humanos foram instrumentados com o sistema MTwo®. As amostras foram distribuídas em seis grupos experimentais (n = 10), de acordo com o protocolo de irrigação: clorexidina gel a 2% (CHX); CHX + EES; Hipoclorito de sódio 5,25% (NaOCl); NaOCl + EES; solução salina (SS); e SS + EES. Cinco amostras não foram tratadas (controle). As amostras de CR foram coletadas antes (C1) e após o tratamento com EES (C2), após preparo químico-mecânico (PQM) (C3) e após o tratamento final com EES (C4). Todas as amostras foram plaqueadas para unidades formadoras de colônias (CFU / mL) em meio sólido. Os dados foram analisados pelos testes de Wilcoxon e Friedman para comparações intragrupos e pelo teste de Kruskal Wallis, seguidos pelo teste de Dunn para comparações intergrupos (α = 0,05). O tratamento com o EES não reduziu significativamente o número de CFU / mL em comparação com os níveis basais (C1 vs. C2, p> 0,05). Após PQM (C3), todos os grupos apresentaram uma quantidade significativamente reduzida de CFU / mL (p <0,05), sem diferença entre as amostras tratadas com CHX e NaOCl (p> 0,05). Por fim, o tratamento com o EES após PQM (C4) não reduziu significativamente a quantidade de CFU / mL (C3 vs. C4, p> 0,05). Concluindo, o uso do Endox® Endodontic System não resultou em redução bacteriana considerável em todos os momentos operatórios, enquanto os tratamentos com NaOCl e CHX foram igualmente eficientes para esse fim.

Analysis of treatments performed at a university dental trauma service in southern Brazil / Análise dos tratamentos realizados em um serviço universitário de trauma dental no sul do Brasil

This retrospective observational study aimed to analyze cases assisted at the Dentoalveolar Trauma Clinic of the School of Dentistry of the Federal University of Rio Grande do Sul (FO-UFRGS) from March 2015 to March 2018, according to the treatments performed on traumatized permanent teeth and the results after one year of follow-up. The sample was based on information collected from clinical records of 92 patients, referring to a) data before treatment, b) data on the diagnosis and proposed treatment, and c) data on the follow-up period. Descriptive and inferential statistical analyses were performed. Most patients were male (56.5%) and aged six to 11 (30.4%) and older than 18 (29.1%) years. The prevalent cause of trauma was falling, and 59% of patients were first assisted within 24 hours. The most frequent traumas were enamel and dentin fractures with and without pulp exposure (6.3%), lateral luxation (1.4%), and avulsion (1.9%). Endodontic treatment was usually performed on traumatized teeth (7.2%). Of the 92 patients, 58 returned for maintenance visits with a mean follow-up of one year. Most patients had successful treatments. Prompt care and patient follow-up were essential for the good prognosis of traumatized teeth.(AU)

O objetivo do presente estudo observacional retrospectivo foi analisar os casos atendidos na clínica de trauma dentoalveolar da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS) no período de março de 2015 a março de 2018, de acordo com os tratamentos realizados em dentes permanentes traumatizados, assim como os resultados observados após 1 ano de seguimento. A amostra foi baseada na coleta de informações em prontuários clínicos de 92 pacientes, referentes a: a) dados anteriores ao tratamento; b) dados referentes ao diagnóstico e ao tratamento proposto; e c) dados referentes ao período de acompanhamento. Foi realizada análise estatística descritiva e inferencial. A maioria dos pacientes era do sexo masculino (56,5%), com idades entre 6 e 11 anos (30,4%) e mais de 18 anos (29,1%). A principal causa do trauma foi queda, sendo que 59% dos pacientes receberam o primeiro atendimento em 24 horas. Os traumas mais frequentes foram fratura de esmalte e dentina, com e sem exposição pulpar (6,3%), luxação lateral (1,4%) e avulsão (1,9%). O tratamento endodôntico foi frequentemente realizado nos dentes traumatizados (7,2%). Dos 92 pacientes, 58 retornaram para consultas de manutenção com um acompanhamento médio de 1 ano. A maioria dos pacientes apresentou sucesso após o tratamento. O atendimento no tempo correto, assim como o acompanhamento dos pacientes, foi fator fundamental para o bom prognóstico dos dentes traumatizados.(AU)