Is silver diamine fluoride effective in reducing dentin hypersensitivity? A systematic review.

Background: The purpose of this systematic review was to assess the clinical efficacy (sensitivity reduction) and safety (gum damage) of silver diamine fluoride (SDF) as a tooth desensitizer for adults. Methods: The search strategy was developed and adapted from 12 databases. Two independent reviewers selected the studies in consensus with a third reviewer. Randomized clinical trials with adult volunteers affected by dentin hypersensitivity (DH), and receiving treatment with SDF were included. Studies with volunteers testing tooth whitening products, using some type of desensitizer, or taking analgesic or anti-inflammatory medication were excluded. The risk of bias was assessed according to the RoB 2 tool, and confidence in cumulative evidence, according to GRADE. Results: Only 3 articles were included. The average pain assessed using the visual analog scale was lower in the SDF groups than in the short-term control groups (24h to 7 days) (P=0.0134 and P=0.0015) of the two studies. The third study evaluated a combination of SDF and a CO2 laser, compared to using only SDF, and found no statistical difference between the two (P=0.74). Inflammation and gingival staining were also evaluated in two of the three studies. No adverse effects were reported. All the included studies had a high risk of bias, and the certainty of the evidence was very low. Conclusion: SDF can be used as a safe and effective tooth desensitizer in adults, with good results, as was achieved in a short-term follow-up. However, more studies with longer evaluation periods are required.

Does use of animal therapy during dental care help to reduce anxiety in children and adolescents? A systematic review.

BACKGROUND: Animal-assisted therapy (AAT) is considered a useful technique to reduce anxiety in children and adolescents in medical settings. AIM: To investigate whether the use of AAT helps to reduce anxiety during dental care in children and adolescents. DESIGN: Systematic review that included randomized and nonrandomized clinical trials with children up to 18-years of age undergoing dental appointments. The databases Embase, Cochrane, Pubmed/Medline, LILACS, PsycInfo, Scopus, and Web of Science were searched including gray literature. Random-effects meta-analyses using mean difference (MD) and narrative synthesis (vote counting) were implemented. Risk of bias was assessed using RoB2 for randomized clinical trials. The certainty of the evidence was performed using GRADE. RESULTS: A total of 1103 references were identified, and after a two-phase selection, three studies were included. Anxiety, behavior, and pain were the outcomes. A meta-analysis with 146 participants was performed for anxiety at three time points: before treatment (MD -0.40, CI: -1.06 to 0.26; I2  = 0%; p = .24), during treatment (MD -3.64, CI: -11.18 to 3.91; I2  = 94%; p = .34), and after treatment (MD -5.97, CI: -17.08 to 5.14; I2  = 98% p = .29). There was no difference during dental treatment with or without ATT (dogs), as well as for narrative analysis for any outcome. The risk of bias was high mainly because of the randomization and outcome measurement. CONCLUSION: There is no evidence to support or refute that the presence of AAT during dental care can help reduce anxiety in children (5-11 years). Studies with larger samples are suggested. Protocol registration (CRD42021293593).

A new approach for the analysis of facial growth and age estimation: Iris ratio.

The study of facial growth is explored in many fields of science, including anatomy, genetics, and forensics. In the field of forensics, it acts as a valuable tool for combating child pornography. The present research proposes a new method, based on relative measurements and fixed references of the human face-specifically considering measurements of the diameter of the iris (iris ratio)-for the analysis of facial growth in association with age in children and sub-adults. The experimental sample consisted of digital photographs of 1000 Brazilian subjects, aged between 6 and 22 years, distributed equally by sex and divided into five specific age groups (6, 10, 14, 18, and 22 year olds ± one month). The software package SAFF-2D® (Forensic Facial Analysis System, Brazilian Federal Police, Brazil) was used for positioning 11 landmarks on the images. Ten measurements were calculated and used as fixed references to evaluate the growth of the other measurements for each age group, as well the accumulated growth (6-22 years old). The Intraclass Correlation Coefficient (ICC) was applied for the evaluation of intra-examiner and inter-examiner reliability within a specific set of images. Pearson's Correlation Coefficient was used to assess the association between each measurement taken and the respective age groups. ANOVA and Post-hoc Tukey tests were used to search for statistical differences between the age groups. The outcomes indicated that facial structures grow with different timing in children and adolescents. Moreover, the growth allometry expressed in this study may be used to understand what structures have more or less proportional variation in function for the age ranges studied. The diameter of the iris was found to be the most stable measurement compared to the others and represented the best cephalometric measurement as a fixed reference for facial growth ratios (or indices). The method described shows promising potential for forensic applications, especially as part of the armamentarium against crimes involving child pornography and child abuse.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases / O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes

ABSTRACT Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

RESUMO Manifestações orofaciais ocorrem com frequência nas doenças reumáticas e, comumente, representam sinais iniciais ou de atividade da doença que ainda são negligenciados na prática clínica. Entre as doenças reumáticas autoimunes com possíveis manifestações orais, incluem-se a artrite reumatoide (AR), miopatias inflamatórias (MI), esclerose sistêmica (ES), lúpus eritematoso sistêmico (LES), policondrite recidivante (PR) e síndrome de Sjögren (SS). Sinais e sintomas orofaciais como hipossalivação, xerostomia, disfunções temporomandibulares, lesões na mucosa bucal, doença periodontal, disfagia e disfonia podem ser a primeira expressão dessas doenças reumáticas. Esse artigo revisa as principais manifestações orofaciais das doenças reumáticas que podem ser de interesse do reumatologista, para diagnóstico e acompanhamento das doenças reumáticas autoimunes.

Oral Microbial Colonization in Pediatric Intensive Care Unit Patients.

PURPOSE: The purpose of this study was to assess oral microbial colonization before and after the implementation of an oral hygiene protocol in children admitted to a pediatric intensive care unit (PICU) using nonhospitalized healthy children as a control group. METHODS: Two groups were analyzed in this clinical study: Group G1 (dentate children admitted to the PICU); and Group G2 (nonhospitalized, healthy, dentate children). The G1 group underwent oral assessments before (G1i) and after (G1f) a three-day oral hygiene protocol using 0.12 percent chlorhexidine applied at 12-hour intervals. RESULTS: Several pathogenic bacteria were identified in group G1i, which was significantly higher than in group G2 (P<.001). There were significant differences between groups G1i and G1f regarding the presence of pathogenic bacteria (P<.001) and a tongue coat (P<.001). The G1f and G2 groups were comparable concerning the presence of pathogenic bacteria (P=.14). CONCLUSIONS: Pathogenic bacteria were present in the oral cavity of almost all hospitalized children and were significantly decreased after an appropriate oral hygiene protocol was incorporated in their daily care. Therefore, regular oral hygiene protocols are warranted in PICUs.

Oral care practices for patients in Intensive Care Units: A pilot survey.

OBJECTIVE: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs). STUDY POPULATION AND METHODS: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages). A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. RESULTS: Most participants were nursing professionals (80.3%) working 12-h shifts in the ICU (70.4%); about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05). Most reported using spatulas, gauze, and toothbrushes (49.3%) or only toothbrushes (28.2%) with 0.12% chlorhexidine (49.3%) to sanitize the oral cavity of ICU patients (P < 0.01). Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05). However, most professionals (56.4%) reported feeling that the oral cavity was difficult to clean (P < 0.05). CONCLUSION: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

Volume derramado, saturação de oxigênio e frequência cardíaca durante a alimentação de recém-nascidos prematuros: comparação entre dois métodos alternativos de oferta / Spilled volum, oxygen saturation, and heart rate during feeding of preterm newborns: comparison between two alternative feeding methods

RESUMO Objetivo Comparar o uso da seringa e da técnica sonda-dedo para a oferta de dieta a prematuros, considerando-se volume de dieta oferecido e volume derramado, variação da saturação de oxigênio periférico e frequência cardíaca. Métodos Estudo quasi-experimental, com 30 prematuros, 13 do gênero feminino e 17 do masculino. As médias das idades gestacionais ao nascimento e no momento da avaliação (idade corrigida) foram de 33 4/7±4/7 e 36±4/7, respectivamente. Os pesos médios ao nascimento e na avaliação foram de 1.800±140 e 1.972±88 gramas. Foi avaliado um momento de alimentação com a seringa e outro com a sonda-dedo para a mesma criança, sendo caso e controle de si mesma. Utilizou-se oxímetro de pulso portátil para verificar a variação da saturação de oxigênio e a frequência cardíaca. Uma gaze foi colocada sob o queixo do bebê como anteparo da dieta derramada. Foram utilizados os testes ANOVA, t de Student pareado, Comparação Múltipla de Tukey e Correlação de Pearson, com nível de significância de 5%. Resultados Houve diferença para o volume oferecido e para o volume de leite derramado com os dois valores, sendo maiores quando a seringa foi utilizada. A frequência cardíaca foi diferente: antes/durante e antes/depois para ambas as formas de oferta, mas com valores considerados normais, assim como a saturação de oxigênio, que apontou aumento entre os momentos antes e depois da oferta para a seringa. Conclusão A técnica sonda-dedo proporciona menor derramamento da dieta, sendo as variações da saturação de oxigênio e frequência cardíaca consideradas normais para o neonato.

ABSTRACT Purpose To compare the use of syringe and finger feeding to feed preterm newborns considering amount of milk offered, amount of milk spilled, variation of oxygen saturation, and heart rate. Methods Quasi-experimental study with 30 preterm newborns. Thirteen infants were females and 17 were males. The mean gestational age at birth and during evaluation (corrected age) was 33 4/7 ± 4/7 and 36 ± 4/7, respectively. Newborns’ mean birthweight and mean weight when evaluated was 1,800 ± 140 and 1,972 ± 88 grams. We assessed one feeding session using a syringe and another feeding session using the finger feeding technique. Both techniques were used in the same infant, so that the preterm newborns were controls for themselves. A portable pulse oximeter was used to check the variation of oxygen saturation and heart rate. A gauze pad was placed under the infants’ chin to absorb the spilled milk. The statistical tests used were: ANOVA, paired Student’s t test, Tukey Multiple Comparison test, and Pearson Correlation Coefficient. The level of significance was set at 5%. Results We found a difference between the techniques in terms of both amount of milk offered and amount of milk spilled. These amounts were larger when the syringe was used. Heart rate was different at two specific times: before/during and before/after feeding for both techniques. However, the values were within normal limits. Oxygen saturation values were also different, showing higher values after syringe feeding. Conclusions Finger feeding proved to cause less spillage, whereas the variations of oxygen saturation and heart rate were within normal limits.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. / O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes.

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

Oral health promotion in patients with chronic renal failure admitted in the Intensive Care Unit.

Oral hygiene deficiency is common in patients treated in ICUs and it enables biofilm colonization by microorganisms that lead to respiratory infections. A 30-year-old female patient with chronic renal failure was hospitalized. Dental procedures were performed in the ICU and contributed to the patient's health after a few days.

Efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo em dentes decíduos e permanentes in vivo / Remineralizing effect of casein fosfopeptideo amorphous calcium phosphate in primary and permanent teeth in vivo

O presente estudo in vivo avaliou o efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo (CPP-ACP) tooth mousse em lesões de mancha branca em dentes decíduos e permanentes. Dezoito crianças de 4 a 8 anos apresentaram 81 lesões de mancha branca, as quais foram divididas de maneira randômica. Estas foram tratadas com verniz de flúor 2,26% (controle) e CPP-ACP mousse (teste), duas vezes por semana, durante seis e quatro semanas, respectivamente. Um examinador cego avaliou as lesões de mancha branca no período inicial (T0) e após 3 (T1) e 12 (T2) semanas de tratamento. Os dados de índice de placa visível, índice de sangramento gengival, índice ICDAS foram coletados. Em adição, foram realizadas tomadas fotográficas das lesões em todos os períodos analisados. Os dados foram analisados por testes qui-quadrado e t de Student. Resultados não demonstraram diferença entre os grupos controle e teste durante os períodos, a partir do índice ICDAS (p>0,05). No entanto, a partir do mesmo índice, o grupo teste demonstrou diferença significante entre os períodos analisados (p<0,05). A área das manchas brancas, em pixels, dos grupos controle e teste não demonstrou diferença estatística de cada grupo, em qualquer dos períodos analisados (p>0,05). Dessa forma, concluiu- se que a terapia de remineralização de lesões de manchas brancas foi efetiva em ambos os grupos. No entanto, devido ao número amostral reduzido e o curto período de análise do presente estudo, são necessários maiores esclarecimentos em relação a este efeito.

This in vivo study was conducted to evaluate the remineralization effects of CPP-ACP Tooth Mousse on white-spot lesion in primary and permanent teeth. Eighteen children (age from 4-8) exhibiting 81 white-spot lesions sites were randomly divided into two different treatments protocols: test group received applications of the remineralizing mousse twice a week for six weeks; control group received applications of a 2.26% fluoridated coating once a week for four weeks. A blind examiner evaluated the children at baseline, 3 and 12 weeks after the first visit, recorded visible plaque, gingival bleeding, ICDAS index and photographed the lesions. Data was analyzed with chi-square and Student t-test. According to ICDAS index, the control group was not statistically different from the treated group (p>0.05), in each time. However, results from treated group demonstrated that ICDAS index was statistically different from times (p<0.05). The area of the white spots (in pixels) of samples from control and treated groups were not statistically different from each group in any time (p>0.05). It was concluded that the remineralizing therapy of white spot lesions was efficient in the two groups. Nevertheless, due to the small sample size and the brief time for conducting the study, new research is necessary to increase the findings.

Caries Diagnosis in the Mixed Dentition Using ICDAS II

To assess the dental caries prevalence with ICDAS II in the mixed dentition, 40 children aged 7 to 11 years old, participating in a social program, whose parents and/or guardians signed a informed consent form.Material and Methods:Clinical examination was carried out after brushing. A single researcher performed the examination and the diagnosis consistency was obtained by Kappa coefficient in 12% of the sample. All dental surfaces were examined receiving a two-digit code. The first one refers to the presence of restoration/sealant and the second, the severity of carious lesions. The data was processed at SPSS software version 10.0 and analyzed using descriptive statistics (absolute distribution, percentage, mean and standard deviation). Results:The coefficient intra-examiner agreement was 0,83.Caries prevalence was considered high because 100% of the children had some surface with non-cavitated caries lesion. ICDAS II can be easily transformed to dmf-s or DMF-S without compromising its integrity. For dmf-s/DMF-S decayed surfaces were consideredICDAS codes 3 to 6, resulting in a dmf-s = 6,57 where 11 children (27,5%) presented no decayed deciduous teeth surface. DMF-S = 2,0 showed that 15 children (37,5%) had none decayed permanent surface, determining a underestimation of the caries disease when using dmf-d/dmf-s and DMF-S indexes.Conclusion:A careful viewing of initial caries lesions makes ICDAS II usefull in evaluating the health promotion actions impact, supporting the planning process, implementation and evaluation of program activities...

Prevalence, Etiology and Treatment Needs of Traumatic Dental Injuries in Schoolchildren aged 12 years at Brasília, Brazil

To investigate the prevalence of dental trauma, its causes, sites and age at the occurrence of injuries and treatment needs related to dental trauma in schoolchildren aged 12 years at Brasília, DF, Brazil.Material and Methods:A cross-sectional, population-based study was conducted on a sample of 1,389 schoolchildren of public and private schools. Two questionnaires were used: one targeted to parents/legal caretakers and the other responded by the schoolchildren. The criteria for classification of trauma used in the ChildrenÆs Dental Survey in the United Kingdom were adopted. The examinations were performed by two trained and calibrated examiners (inter and intra-examiner kappa: 0.85 to 1.00). The association between dental trauma and the study variables was evaluated by the chi-square test.Results:A total of 1,445 students were examined, with a response rate of 80.48%. Prevalence of 14.63% (public schools) and 23.40% (private schools) of dental trauma was found...(AU)

The most common cause of dental trauma was fall (7.87%), followed by collision with objects or persons(5.03%), inadequate use of the teeth (2.33%), sports accidents (2.11%) and car accidents (0.66%). It was observed that 256 students presented injury to at least one tooth, with predominance of enamel fracture (88.67%) followed by discoloration (5.47%), enamel and dentin fracture (3.90%) and tooth loss (1.95 %). The teeth most affected by trauma were the maxillary central incisors. The accidents occurred predominantly at home (44.25%) and at the school (26.99%). Only 28.51% had received treatment for the injuries.Conclusion:Dental trauma in the study population was significant, presenting diverse etiology and expressive treatment needs, indicating the importance of preventive programs to inform the population on the possible complications after trauma, as well as the need to follow-up traumatized teeth to avoid subsequent problems...

Evaluation of therapeutic decision for treatment of carious lesions by dental students

Objective: to evaluate the therapeutic decision making for the academic of the last year of dentistry at the universities of the Distrito Federal, on dental caries in deciduous teeth and permanent young. Material and Methods: the evaluation was obtained through the application of a questionnaire containing a diagram representing five different stages of deep carious lesions on interproximal radiographs. Were selected through census of students enrolled last semester of each institution and concluded that the theoretical discipline of pediatric dentistry in accordance with the curriculum offered by the University. Data were analyzed statistically by the chi-square test the 5% level of significance. Results: we analyzed 132 questionnaires of which 30.3% of respondents opted for immediate restorative treatment for the injuries to deciduous teeth in the dentin-enamel junction to the permanent tooth, the percentage rose to 31.1%, revealing that there was similarity between universities about which strategy to use. Regarding caries removal there was a discrepancy in an institution compared the other in choosing the more invasive treatment (p = 0.0014). Conclusion: we see the need to implement teaching strategies for the training of a professional within the philosophy of minimum intervention.

Socio-economic indicators and predisposing factors associated with traumatic dental injuries in schoolchildren at Brasília, Brazil: a cross-sectional, population-based study.

BACKGROUND: This study assessed the prevalence of traumatic dental injuries (TDI) and its association with sociodemographic and physical characteristics in the anterior permanent teeth of 12-year-old schoolchildren at the city of Brasília - DF, Brazil. METHODS: A cross-sectional, population-based study was conducted on a sample of 1,389 boys and girls aged 12 years, enrolled in public and private fundamental schools at the Administrative Region (RA) of Brasília, Brazil, from October 2011 to September 2012. The demographic details were achieved by a structured questionnaire. The study recorded the type of damage, the size of incisal overjet, and whether lip coverage was inadequate. Sociodemographic data included sex, income and educational level of the parents or caretakers. RESULTS: A total of 1118 schoolchildren were examined, yielding a response rate of 80.48%. The prevalence of TDI was 14.63% in public schools and 23.40% in private schools. The students did not differ according to sex, income and educational level of the parents or caretakers concerning the occurrence of traumas in permanent anterior teeth. Increased overjet and inadequate lip coverage were found to be important contributing factors for TDIs. CONCLUSION: In conclusion, this study showed an expressive prevalence of TDI in 12-year-old in schoolchildren at Brasília DF, Brazil. Sex and educational level of the parents were not associated with trauma. The increased overjet and inadequate lip coverage were significantly associated with dental trauma.

Sialometria: aspectos de interesse clínico / Sialometry: aspects of clinical interest

A saliva total é um complexo de secreções multiglandulares composto de fluido gengival, células epiteliais descamadas, microrganismos, produtos do metabolismo bacteriano, resíduos alimentares, leucócitos, muco da cavidade nasal e da faringe. A saliva possui diversas funções, incluindo reparação tecidual, tamponamento, proteção, digestão, gustação, ação antimicrobiana, manutenção da integridade do dente e sistema de defesa antioxidante. A redução do fluxo salivar (hipossalivação) é um distúrbio comum, e estima-se que cerca de 20% da população geral tenham esta alteração. A hipossalivação pode ser decorrente de diabetes mellitus, hipotireoidismo, desidratação, comprometimento do parênquima glandular por processos infecciosos, doenças granulomatosas ou condições autoimunes e inflamatórias (como a síndrome de Sjögren e a artrite reumatoide), radioterapia da região cefálica e/ou cervical, bem como pode estar associada a distúrbios do humor, efeitos adversos ocasionados pelo uso de algumas medicações ou, ainda, ser de causa idiopática. As terapias convencionais para o tratamento da redução do fluxo salivar, com o uso de sialogogos gustatórios e químicos, ainda apresentam restrições. Contudo, novas alternativas têm mostrado grande perspectiva no tratamento deste problema. Diagnosticar um paciente como hipossalivador crônico é um desafio na prática clínica, e os métodos de avaliação do fluxo salivar são pouco conhecidos pelos reumatologistas. A avaliação seriada do fluxo salivar é importante para o correto diagnóstico e prognóstico de determinadas condições bucais e sistêmicas. Esta revisão aborda alguns aspectos relacionados à função da saliva, às consequências da hipossalivação e aos métodos de medição da taxa de fluxo salivar, conceitos úteis na prática diária do reumatologista.

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Sialometry: aspects of clinical interest.

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Decreased phagocytic function in neutrophils and monocytes from peripheral blood in periodontal disease.

UNLABELLED: Phagocytosis by neutrophils and monocytes constitutes the main defense mechanism against bacterial challenges in periodontitis. Phagocytosis by neutrophils has already been evaluated, whereas phagocytic function of monocytes has hardly been addressed so far. OBJECTIVES: The aim of this study was to assess phagocytosis by neutrophils and monocytes in periodontitis. MATERIAL AND METHODS: The sample included 30 subjects with severe periodontitis and 27 control subjects without periodontal disease. The phagocytic index (PhI) was calculated as the mean number of adhered/ingested Saccharomyces cerevisiae per phagocytozing monocyte or neutrophil multiplied by the percentage of phagocytes involved in phagocytosis. RESULTS: A significant reduction in phagocyte functions was observed in individuals with periodontitis. The median of PhI of neutrophils using nonsensitized S. cerevisiae was 3 for the control group, and 1.5 for the periodontitis group (p=0.01, Mann-Whitney test). The median of PhI of monocytes with non-sensitized S. cerevisiae was 26.13 for the control group, and 13.23 for the periodontitis group (p=0.03, Mann Whitney test). The median of PhI of monocytes assessed with sensitized S. cerevisiae was 97.92 for the control group and 60.1 for the periodontitis group (p=0.005, t-test). CONCLUSION: The data demonstrated a reduction in the function of phagocytes, suggesting a decrease in immune defenses in periodontitis.

Decreased phagocytic function in neutrophils and monocytes from peripheral blood in periodontal disease

Phagocytosis by neutrophils and monocytes constitutes the main defense mechanism against bacterial challenges in periodontitis. Phagocytosis by neutrophils has already been evaluated, whereas phagocytic function of monocytes has hardly been addressed so far. Objectives: The aim of this study was to assess phagocytosis by neutrophils and monocytes in periodontitis. Material and Methods: The sample included 30 subjects with severe periodontitis and 27 control subjects without periodontal disease. The phagocytic index (PhI) was calculated as the mean number of adhered/ingested Saccharomyces cerevisiae per phagocytozing monocyte or neutrophil multiplied by the percentage of phagocytes involved in phagocytosis. Results: A significant reduction in phagocyte functions was observed in individuals with periodontitis. The median of PhI of neutrophils using nonsensitized S. cerevisiae was 3 for the control group, and 1.5 for the periodontitis group (p=0.01, Mann-Whitney test). The median of PhI of monocytes with non-sensitized S. cerevisiae was 26.13 for the control group, and 13.23 for the periodontitis group (p=0.03, Mann Whitney test). The median of PhI of monocytes assessed with sensitized S. cerevisiae was 97.92 for the control group and 60.1 for the periodontitis group (p=0.005, t-test). Conclusion: The data demonstrated a reduction in the function of phagocytes, suggesting a decrease in immune defenses in periodontitis.