Validation of an educational comic book to guide conducts in situations of dental trauma.

BACKGROUND/AIM: Childhood dental trauma poses a prevalent concern, and the limited knowledge of lay caregivers toward the needed immediate actions can adversely affect a child's well-being. This study aimed to create and validate an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases, and assess its effects toward enhancing reader knowledge. METHODOLOGY: The four-stage study involved: (1) Literature review and script development; (2) Version 1 of the comic book creation (including illustrations, layout, and design) and Flesch Readability Index (FI) calculation; (3) Version 1 validation by expert judges, assessed by the Content Validity Index (CVI); (4) Version 1 refinement based on the judges' feedback, recalculation of FI, and a pilot test (CVI) involving lay individuals who validated the final material (Version 2). The validation process involved 67 participants, including 13 specialist judges and 54 elementary school teachers. RESULTS: The CVI for Version 1 was calculated at 0.89 (89%), indicating a favorable level of agreement on the evaluated criteria. The FI was determined as 91.1%, indicating a high level of readability. The FI for Version 2 was 92.1% (indicating a very easy level of comprehension). The CVI calculated for the target audience after the pilot test was 0.99 (99%), denoting a substantial agreement among the participants. In assessing the level of knowledge, a significant increase was observed in the rate of correct answers after the comic book was read by lay individuals (p < 0.05), inasmuch as the percentage rose from 50.5% before to 81.2% after reading it. CONCLUSION: The educational comic book proved valid in terms of readability, appearance, and content. Furthermore, it had a positive impact on gaining the knowledge needed to take the appropriate actions, thus making it a valuable tool for guiding the lay population in cases of dental trauma.

Antimicrobial Potential of Papain Chemomechanical Agent on Streptococcus Mutans and Lactobacillus Casei Followed by the Use of Self-Etching Adhesive Systems.

OBJECTIVE: This study evaluated the antimicrobial effect of papain-based gel (Papacárie/ P) followed by self-etching adhesive systems with MDPB monomer (Clearfil Protect Bond/ PB) and without (Clearfil SE Bond/ Cl) on Streptococcus mutans (Sm) and Lactobacillus casei (Lc). STUDY DESIGN: The dentin of twenty human teeth was exposed to prepare four cylindrical cavities in each tooth. The cavities were incubated with Sm or Lc. One cavity from each tooth served as contamination control (positive control group); the other three were treated with P, P+CL and P+PB. The cavities were sealed and after 72 h, dentin samples were collected and microbial cultivation was performed. Microbial count was undertaken (CFUs/mg) according to the morphological characteristics for Sm and Lc. Analysis of variance and Tukey's test were applied (α=5%). RESULTS: For Sm, groups P+Cl and P+PB had lower microbial count than group P (no statistical differences between P+Cl and P+PB). For Lc, group P+Cl had microbial count similar to group P. There was statistical difference between cavities treated with P and P+PB but none between groups P+Cl and P+PB. After using P, both self-etching adhesives showed antimicrobial potential, although Clearfil Protect Bond proved better against Lc. CONCLUSIONS: Both self-etching adhesives used after application of Papacárie showed antimicrobial potential, although Clearfil Protect Bond proved more effective against Lactobacillus casei.

In vitro evaluation of calcium and phosphorus concentrations in enamel submitted to an in-office bleaching gel treatment containing calcium.

The aim of this in vitro study was to evaluate the calcium and phosphorus concentrations in enamel surfaces before, during, and after treatment with in-office 35% hydrogen peroxide bleaching agents with 2% calcium gluconate (WCa) or without calcium gluconate (W). Twenty sound human third molars were divided into 2 groups of 10. The bleaching agents were applied to the tooth surfaces in accordance with the manufacturer's instructions: WCa, 40 minutes per day at 3 sessions with 7-day intervals; W, 3 × 15 minutes per day at 3 sessions with 7-day intervals. Enamel microbiopsies were performed prior to the bleaching treatment, immediately after each bleaching session (first, second, and third applications), and 7 and 14 days following the last bleaching treatment. The concentration levels of calcium and phosphorus in the microbiopsy specimens were recorded spectrophotometrically. There was a statistically significant decrease in the calcium concentration 7 days after the last bleaching treatment, but there was a recovery to baseline values at 14 days, regardless of the bleaching agent used (WCa and W). When W was used, there was no difference in the phosphorus concentration over time. The phosphorus concentration in the WCa group decreased after the third application, showing a significant difference from the W group at this time. However, an increase in the phosphorus concentration was observed in the posttreatment period, and no significant differences were observed between values at baseline and those at 14 days posttreatment. The in-office bleaching gel containing 2% calcium gluconate did not affect the calcium and phosphorus concentrations in enamel as compared to a calcium-free bleaching agent.

In Vitro Effects of 2.5% Titanium Tetrafluoride on Streptococcus Mutans and Lactobacillus Casei in Dentin Followed by Self-Etching Adhesive Systems.

The aim was to evaluate the effect of a 2.5% titanium tetrafluoride (TiF4) solution followed by self-etching adhesives against Streptococcus mutans/Sm and Lactobacillus casei/Lc. Four cylindrical-shaped cavities were performed on each dentin surface of 40 third molars and contaminated with Sm or Lc. Each one of the four cavities received one of the following treatments (n = 10): 1) control; 2) TiF4; 3) Clearfil SE Bond/CSE or Adper EasyOne/AEO; 4) TiF4 followed by CSE or AED. ANOVA was applied to data. The TiF4 solution showed an antimicrobial effect, although the TiF4 used for dentin pretreatment before CSE or AEO showed no influence on antimicrobial effect.

Influence of mouthguards on the physical performance of soccer players.

AIM: To evaluate the influence of different types of mouthguard (MG) on physical performance of female soccer players. MATERIAL AND METHODS: The sample was composed of 25 female soccer players from 'Guarani Futebol Clube', age range 18-22 years. For data collection, two tests were performed: agility test (shuttle run) and aerobic capacity and VO2 (Cooper test), in addition to application of a perception questionnaire after wearing mouthguards during the tests. RESULTS: Data analysis showed that mouthguard type III presented better results in the VO2 and aerobic capacity tests (P < 0.05). In relation to difficulties experienced when wearing MGs, there were no reports of pain, discomfort, or nausea. However, 100% of athletes affirmed that it was not possible to speak with MG type I, 80% (n = 20) with type II, and no athlete found difficulty in speaking when wearing MG type III. Distractions were reported by 35% (n = 6) only when athletes wore MG types I and II. CONCLUSIONS: Among the three types evaluated, the customized MG (type III) presented better results in the athletes' physical performance evaluation, even taking into account physical tests performed without the use of mouthguards.

Analysis of total microbiota in dentin after mechanical or papain-based chemomechanical caries removal.

Chemomechanical caries removal, when compared with removal using conventional rotary instruments, seems to preserve healthy tooth structure with less trauma to the patient. This study performed in vivo analysis of the total number of microorganisms in dentin after the use of conventional or chemomechanical (papain gel) caries removal methods. Analyses were performed before caries removal (baseline), immediately after caries removal, and 45 days after caries removal and temporary cavity sealing. Sixty patients were selected for this study, each with two mandibular molars (one on each side) with occlusal caries of moderate depth, for a total of 120 teeth. For each patient, the carious lesion of one tooth was removed by conventional methods using low speed drills (Group 1). For the other tooth, a chemomechanical method was used (Group 2). Dentin samples were collected at the three intervals and subjected to microbiological culture in blood agar. For the total number of microorganisms in both groups, ANOVA and Tukey tests (which considered the baseline values as a covariable) showed a higher microbial count immediately after the preparation of the cavity compared to the count at 45 days (P < 0.05). For both groups, the total count of microorganisms in dentin decreased 45 days after placing the temporary cavity sealing.

Burnout syndrome in higher education health professionals working in indigenous health in Brazil. / Prevalência e fatores associados à síndrome de burnout em profissionais da saúde indígena no Brasil.

The aim of this study was to investigate the prevalence of burnout syndrome in higher education health professionals working in indigenous health in Brazil, and to identify associated factors. This is an observational, analytical, and cross-sectional study. Data collection was based on the application of a questionnaire (personal profile and MBI-HSS) and included 513 professionals. The prevalence of burnout was 65%. Greater likelihood of emotional exhaustion was observed among younger professionals, who had worked in indigenous health for longer time, in the care function and with lower level of tranquility when working during the pandemic. Lower likelihood of having low personal accomplishment at work was observed among older professionals, professionals who had worked in indigenous health for shorter time, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. Greater likelihood of depersonalization was found among married professionals, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. This study contributes with an important assessment of the existence of BS predictors in health professionals working in indigenous health.

O objetivo foi investigar a prevalência da síndrome de burnout (SB) em profissionais de nível superior atuantes na saúde indígena no Brasil e fatores associados. Trata-se de um estudo observacional, transversal e analítico. O questionário foi aplicado (perfil e MBI-HSS) a 513 profissionais. A presença da SB foi identificada em 65% dos profissionais. Foi verificada maior chance de exaustão emocional entre os profissionais mais novos, com mais tempo de atuação na saúde indígena, em função assistencial e com menor nível de tranquilidade ao trabalhar durante a pandemia. Mais chance de apresentar baixa realização pessoal no trabalho foi observada entre os profissionais mais velhos, com menos tempo de atuação na saúde indígena, que estavam em atendimento clínico durante a pandemia e que relataram menor nível de tranquilidade ao trabalhar durante a pandemia. Maior chance de despersonificação em profissionais casados, em atendimento clínico durante a pandemia e com menor nível de tranquilidade ao trabalhar durante a pandemia. O estudo contribui com uma importante avaliação da existência de preditores da SB nos profissionais atuantes na saúde indígena.

Size effect in observational studies in Public Oral Health: importance, calculation and interpretation. / Tamanho do efeito em estudos observacionais na área de Saúde Bucal Coletiva: importância, cálculo e interpretação.

The objective of this study was to analyze the scientific literature in public oral health regarding calculation, presentation, and discussion of the effect size in observational studies. The scientific literature (2015 to 2019) was analyzed regarding: a) general information (journal and guidelines to authors, number of variables and outcomes), b) objective and consistency with sample calculation presentation; c) effect size (presentation, measure used and consistency with data discussion and conclusion). A total of 123 articles from 66 journals were analyzed. Most articles analyzed presented a single outcome (74%) and did not mention sample size calculation (69.9%). Among those who did, 70.3% showed consistency between sample calculation used and the objective. Only 3.3% of articles mentioned the term effect size and 24.4% did not consider that in the discussion of results, despite showing effect size calculation. Logistic regression was the most commonly used statistical methodology (98.4%) and Odds Ratio was the most commonly used effect size measure (94.3%), although it was not cited and discussed as an effect size measure in most studies (96.7%). It could be concluded that most researchers restrict the discussion of their results only to the statistical significance found in associations under study.

O objetivo deste estudo foi analisar a literatura científica da área de saúde bucal coletiva quanto ao cálculo, apresentação e discussão do tamanho do efeito em estudos observacionais. A literatura cientifica na área (2015 a 2019) foi analisada quanto: a) informações gerais (periódico e diretrizes aos autores, número de variáveis e desfechos), b) objetivo e coerência com o cálculo amostral apresentado; c) tamanho do efeito (apresentação, medida utilizada e coerência com a discussão dos dados e conclusão). Foram analisados 123 artigos, de 66 periódicos. A maioria dos artigos avaliados apresenta um único desfecho (74%) e não menciona a realização de cálculo amostral (69,9%). Dentre os que realizaram, para 70,3% havia coerência entre o cálculo amostral utilizado e o objetivo. Apenas 3,3% dos artigos mencionam o termo tamanho do efeito e 24,4% não o consideram na discussão dos resultados, apesar de terem calculado. A regressão logística foi a metodologia estatística mais utilizada (98,4%) e o Odds Ratio a medida de tamanho do efeito mais utilizada (94,3%), embora não tenha sido citada e discutida como uma medida de tamanho do efeito na maioria dos estudos (96,7%). Os pesquisadores, em sua maioria, restringiram a discussão dos resultados apenas à significância estatística encontrada nas associações testadas.

Influence of pH cycling on the microtensile bond strength of self-etching adhesives containing MDPB and fluoride to dentin and microhardness of enamel and dentin adjacent to restorations.

PURPOSE: To evaluate the influence of pH cycling on microtensile bond strength (µTBS) and fracture pattern of MDPB- and fluoride-containing self-etching adhesive systems to dentin, and on the cross-sectional Knoop microhardness (CSMH) of enamel and dentin adjacent to restorations. MATERIALS AND METHODS: The two-step self-etching adhesive Clearfil SE Bond (SE; Kuraray), the two-step MDPBand fluoride-containing adhesive Clearfil Protect Bond (PB; Kuraray), and the one-step fluoride-containing adhesive One-Up Bond F Plus (OU; Tokuyama) were used to bond resin composite to midcoronal dentin surfaces (for µTBS testing) or to Class V cavities (for CSMH testing). µTBS and CSMH tests were performed after a 15-day period of pH cycling or storage in artificial saliva. RESULTS: µTBS to dentin was not affected by pH cycling or storage in artificial saliva; however, µTBS values found for PB were higher than those observed for OU. No difference existed among the µTBS values shown by PB, OU, and SE. The fracture pattern was affected by both pH cycling and adhesive system. In enamel, there was no difference in CSMH values provided by the different adhesive systems and storage media, regardless of the distance and depth from restoration. In dentin, PB and SE showed the highest CSMH values, which differed from those obtained for OU. Significantly higher CSMH values were found 100 µm from the restoration margin for all adhesive systems tested. CONCLUSION: The bond strength and microhardness in the vicinity of restorations were adhesive dependent, with MDPB and fluoride exerting no effect on the performance of the adhesive systems.

Effect of home-use and in-office bleaching agents containing hydrogen peroxide associated with amorphous calcium phosphate on enamel microhardness and surface roughness.

STATEMENT OF THE PROBLEM: The effects of amorphous calcium phosphate (ACP)-containing bleaching agents on enamel surface have not been clarified yet. PURPOSE: The study aims to evaluate the effects of different bleaching agents, either associated with ACP, or not, on enamel Knoop microhardness (KHN) and surface roughness (SR). MATERIALS AND METHODS: The home-use hydrogen peroxide (HP) bleaching agents PolaDay 7.5% (HP7.5; SDI Limited, Bayswater, Victoria, Australia), PolaDay 9.5% (HP9.5; SDI Limited); DayWhite ACP-7.5% (ACP7.5; Discus Dental, Culver City, CA, USA) and DayWhite ACP 9.5% (ACP9.5; Discus Dental), and the in-office agents PolaOffice 35% (HP35; SDI Limited) and Opalescence XtraBoost 38% (HP38; Ultradent Products, South Jordan, UT, USA) were applied to polished enamel slabs (N = 10) for 30 minutes/day for 21 consecutive days (home-use) or in one session a week, for 3 weeks (in-office). KHN and SR were tested before (baseline), during (7, 14, 21 days), and after (7 and 14 days in artificial saliva) the bleaching treatment. RESULTS: KHN evaluation revealed no significant difference among bleaching agents (p > 0.05); however, there was a significant decrease during bleaching treatment (p < 0.0001). KHN values attained in the post-treatment phase were statistically similar to baseline values (p > 0.05). SR was not altered during and after treatment, with the exception of PH38, which showed an increase in SR during bleaching treatment and a recovery after treatment. The ACP7.5 showed a trend to decreasing SR values during the bleaching treatment, but this decrease was only significant when associated with 14 days of immersion in artificial saliva, when the enamel was less rough than at baseline. CONCLUSIONS: Bleaching agents caused a decrease in enamel KHN, but values were recovered after treatment, showing the importance of saliva in recovering mineral content. SR was altered during or after treatment, depending on HP concentration/association with ACP. The beneficial effects of adding ACP to bleaching formulas on SR may be restricted to lower HP concentrations in association with the remineralizing effect of saliva. CLINICAL SIGNIFICANCE: No beneficial effects of adding ACP to bleaching formulas on enamel microhardness were observed, but these observations may be attributable to the lower hydrogen peroxide concentrations in association with the remineralizing effect of saliva, when considering the enamel roughness.

Orofacial trauma in Brazilian basketball players and level of information concerning trauma and mouthguards.

Orofacial injuries are increasingly considered a public health problem in high impact sports. The purposes of this study were: to assess orofacial trauma (OT) history in basketball players, in relation to wearing mouthguards (MG), facial types, presence of mouth breathing and player's position in the game, also to check athletes' level of knowledge about trauma and MGs. Questionnaires were given to category A-1 adult athletes registered in 2006/07 in the State of São Paulo and Brazilian Basketball Confederation Championships, and National Team members. Of the total sample (n=388), 50% of athletes sustained orofacial injuries; dental trauma accounted for 69.7%, with emphasis on maxillary central incisors, followed by soft tissue (60.8%), in which lip injuries were the most prevalent. No relationship was found between trauma history and player's position (P=0.19), facial type (P=0.97), presence of mouth breathing (P=0.98), but there was statistically significant association between the prevalence of OT and lack of MG use (P≤0.0001). Of all the athletes affected, only 1% wore a MG at the time of the trauma, 26.5% did not know about the MGs and 10.6% did not know their functions. When trauma occurred, 79.6% replied one must look for the tooth at the accident site, 50% knew it must be stored in liquid, as replantation was possible (62.3%) and 75.8% believed elapsed time could influence prognosis. Basketball is a high impact sport with high prevalence of OT, particularly maxillary central incisor and lip injuries, but athletes did not use MGs. There should be more educational campaigns to inform players about orofacial injuries and their prevention in Brazilian basketball.

Microtensile bond strength of etch-and-rinse and self-etch adhesive systems to demineralized dentin after the use of a papain-based chemomechanical method.

PURPOSE: To evaluate the in vitro microtensile bond strength (microTBS) of etch-and-rinse and self-etch adhesive systems to demineralized dentin after the use of a papain-based chemomechanical method. METHODS: 36 demineralized human dentin slabs were randomly distributed into two groups according to the method of caries removal: (1). Mechanical removal with manual excavators; (2) Chemomechanical removal with a papain-based gel (Papacárie). Subsequently, three adhesive systems were applied (n=6): (a) an etch-and-rinse adhesive system (Single Bond); (b) a two-step self-etch adhesive system (AdheSE); (c) a one-step self-etch adhesive system (Adper Prompt). The slabs were restored with a microhybrid resin composite and each resin-dentin block was sectioned into 1.0 mm2 thick slabs, which were kept in receptacles containing distilled water at relative humidity, for 24 hours, at 37 degrees C. After that, they were subjected to tensile stress in a universal testing machine at a speed of 0.5 mm/minute. Data were submitted to two-way ANOVA and Tukey's test at a 0.05 level of significance. The fractured specimens were observed under a stereomicroscope to assess the failure mode. RESULTS: The application of both chemomechanical and mechanical methods on demineralized dentin yielded microTBS values that were statistically similar among them, regardless of the adhesive system used. Caries removal with a chemomechanical papain-based method did not interfere in the adhesion of the tested adhesive systems to demineralized dentin.

In situ anticariogenic effect of adhesive systems containing fluoride and MDPB.

PURPOSE: To evaluate in situ the anticariogenic effect of fluoride and MDPB containing adhesive systems at the restoration interface, by microhardness tests. METHODS: 120 fragments containing preparations for resin composite restorations performed at the cemento-enamel junction were randomly distributed among the adhesive systems to be tested. The adhesive systems were applied in accordance with the manufacturers' instructions: Optibond FL, Adper Single Bond 2, Prime & Bond 2.1, Optibond Solo Plus, Adper Prompt, Clearfil Protect Bond and restored with the nanoparticulate resin composite Z350. Twenty volunteers used a palatal appliance containing fragments restored with each adhesive system for 21 days, and applied 20% sucrose on them eight times a day to simulate a high cariogenic challenge. Microhardness tests were performed at different depths (20 microm, 40 microm and 60 microm from the occlusal margin of the restoration) and at different distances (100 microm, 200 microm and 300 microm from the adhesive interface). RESULTS: ANOVA showed that for enamel, there was significant difference between the adhesive systems (P=0.0106); the interaction adhesive system*distance was a significant (P=0.0006), and the one-step self-etching adhesive system containing fluoride (Adper Prompt) presented a higher anticariogenic effect. However, for dentin, the adhesive system used did not interfere in decreasing the severity of caries formation.

Use of Water by Schoolchildren: Impact of Indirectly Supervised Daily Toothbrushing-A Pilot Study.

AIM: This present longitudinal, quantitative, and analytical pilot study evaluated the impact of daily indirectly supervised toothbrushing on water consumption. MATERIALS AND METHODS: The study was carried out in a social center that provided care to children aged 5-14 years in Campinas in the state of São Paulo. Calibrated hydrometers were installed on taps used by the children, and the daily volume of water used was measured for 25 school days (T0). An educational program was then implemented (T1), where supervised toothbrushing was explained, encouraged, and put into action. The next phase (T2) incorporated a recreational approach to the rational use of water, and the consumption was measured for another 25 school days. After six months (T3) without further educational interventions by the researchers, water consumption was measured for the same period of 25 school days. The data were analyzed based on the mixed models methodology for measures repeated over time. RESULTS: The water consumption did not change significantly (p > 0.05) between the different phases of the study (T0 = 0.43 ± 0.19, T1 = 0.38 ± 0.17, T2 = 0.39 ± 0.15, T1 = 0.48 ± 0.21 dm3/day/child). CONCLUSION: The introduction of toothbrushing into the routine of the children, in the context of recreational and sustainable health education, did not have a detrimental impact on water consumption. CLINICAL SIGNIFICANCE: Among the many recommendations for the introduction and implementation of supervised toothbrushing programs in school environments, there is no mention of the measures taken during such procedures aimed at economizing water, the rational use of which should be a daily practice irrespective of the water conditions of the surrounding region. The findings of this study contribute to the enhancement of educational and pedagogical activities in schools. HOW TO CITE THIS ARTICLE: Flório FM, dos Santos Klee L, Brandão Ramos AP, et al. Use of Water by Schoolchildren: Impact of Indirectly Supervised Daily Toothbrushing-A Pilot Study. Int J Clin Pediatr Dent 2020;13(5):513-517.

Effect of 10% sodium ascorbate and 10% alpha-tocopherol in different formulations on the shear bond strength of enamel and dentin submitted to a home-use bleaching treatment.

This in vitro study assessed the shear bond strength of human enamel and dentin submitted to a bleaching treatment with 10% carbamide peroxide and treatment with antioxidant agents containing 10% alpha-tocopherol and 10% sodium ascorbate formulated in solution and gel. Sixty human dental enamel slabs (E) and 60 human dental dentin slabs (D) were randomly divided into six groups (n = 10). Groups E1 and D1 were negative control groups and the bleaching agent was not applied. The bleaching agent was applied daily for two-hours on the dental slabs of all the other groups and, during the remaining 22 hours, the specimens were stored in an artificial saliva solution for a total of 14 days. Groups E2 and D2 were positive control groups and they only received application of the bleaching agents. Antioxidant agents were applied in Groups E3 and D3 (10% sodium ascorbate solution), E4 and D4 (10% alpha-tocopherol solution), E5 and D5 (10% sodium ascorbate gel) and E6 and D6 (10% alpha-tocopherol gel) for two hours. Cylinders were made with microhybrid resin composite and a total-etch adhesive system for shear bond strength tests. These tests were performed in a universal testing machine at a speed of 0.5 mm/minute to obtain the values in MPa. ANOVA (p > 0.05) showed no significant differences among groups E4, E5, E6 and E1. However, groups E3, E5 and E6 presented statistically similar values to group E2. The Kruskal-Wallis test showed no significant differences among D1 and all the other experimental groups; the same values occurred with D2, which did not differ from the experimental groups. Antioxidant treatment with 10% alpha-tocopherol solution was the only effective agent to revert the oxidizing effects of the bleaching treatment on enamel.

Influence of in situ post-bleaching times on resin composite shear bond strength to enamel and dentin.

PURPOSE: To evaluate in situ the influence of time after treatment with a 16% carbamide peroxide home-use bleaching agent on the shear bond strength of resin-based composite to human enamel and dentin. METHODS: 80 enamel slabs (E) and 80 dentin slabs (D) were obtained, embedded, flattened, sterilized and randomly fixed on the buccal surface of teeth in 20 volunteers. These specimens were submitted to treatment with a 16% carbamide peroxide bleaching agent (Pola Night) for 2 hours a day, for 3 weeks. The control group (C) consisted of slabs that were fixed on buccal tooth faces that did not receive any bleaching treatment. For the experimental groups, three slabs of E and three slabs of D were fixed to teeth of the same volunteers, and after bleaching treatment, the slabs were removed at different times: EI--immediate removal; E7--removal 7 days after treatment ended; E14--removal 14 days after treatment ended. After removal, the slabs were again embedded and microhybrid composite resin cylinders (Filtek Z250) were constructed and bonded using a one-bottle adhesive system (Single Bond) for shear bond strength tests. These tests were performed in a universal testing machine, with a speed of 0.5 mm/minute, with the data returned in MPa. The results were submitted to the ANOVA test. RESULTS: There were no significant differences with regards to the timespan for the E and D groups (P > 0.05). For the fracture mode analysis, there was a predominance of adhesive failures for Groups C, EI and E14 in enamel, with the same adhesive failures occurred for all groups in dentin. It was concluded that restorative procedures may be performed immediately after the end of the bleaching treatment.

Effect of surface sealants on marginal microleakage in Class V resin composite restorations.

PURPOSE: Surface sealants may reduce or avoid problems related to the marginal interface. The aim of this study was to evaluate the microleakage in resin composite Class V restorations sealed with an adhesive system (Xeno III [Dentsply, Konstanz, Germany]), a sealant for exposed dentin (Seal & Protect [Dentsply]), and two surface sealants (Fortify [Bisco, Lombard, IL, USA]; Optiguard [Kerr, Orange, CA, USA]). MATERIALS AND METHODS: Fifty cavities with margins in enamel were prepared on crowns of bovine teeth and restored with an adhesive system (Prime and Bond NT/Dentsply) and resin composite (Esthet X/Dentsply). They were separated into four groups for the application of the surface sealants, and a control group (without surface sealing). Thermal cycling with baths of 5 degrees C +/- 2 degrees C and 55 degrees C +/- 2 degrees C were performed in 600 cycles. The teeth were made impermeable, except for a 3-mm window around the restoration and immersed in a 50% silver nitrate solution for 8 hours. The crown was sectioned longitudinally and the cuts were analyzed by three independent evaluators, using a stereoscopic loupe with 10x magnification that attributed representative scores. Agreement among the examiners was evaluated by the Kappa test. RESULTS: The Kruskal-Wallis test and Dunn Method showed that there was significant difference between the Control and Seal & Protect groups. The Seal & Protect group presented the lowest degree of microleakage, followed by the Optiguard and Xeno III groups. The highest scores were obtained in the Control group. CONCLUSION: The sealant materials evaluated presented different rates of effectiveness, and Seal & Protect was the most effective in decreasing the degree of marginal microleakage. CLINICAL SIGNIFICANCE Although surface sealants or covering agents have been used to diminish microleakage, they may present different rates of effectiveness with regard to reducing the degree of marginal leakage. (J Esthet Restor Dent 21:397-406, 2009).

Satisfaction of users of Psychosocial Care Centers.

OBJECTIVE: evaluate the satisfaction of users with the care provided at the Psychosocial Care Centers and its association with clinical and sociodemographic factors. METHOD: this cross-sectional study was conducted with 55 users from 5 Psychosocial Care Centers. The sociodemographic and clinical characteristics were obtained through an individual structured interview. The abbreviated version of the Mental Health Services Satisfaction Scale (SATIS-BR) was used for data collection. RESULTS: were descriptively analyzed and simple and multiple logistic regression models were adjusted for analysis of associations, estimating the gross and adjusted odds ratio, with the respective confidence intervals of 95%. Results: the age average of the sample was 40.1 (±12.4) years and the degree of satisfaction average was 4.56 (±0.45). Users with less education (primary school) had 5 times more chance of having less satisfaction (p<0.05). Users with frequency of intensive monitoring were 5 times more likely to have less satisfaction than users who receive monthly monitoring (p<0.05). CONCLUSION: the majority of users are satisfied with the service and factors such as low education and higher frequency of monitoring influenced the satisfaction.

Effectiveness of indirect composite resin silanization evaluated by microtensile bond strength test.

PURPOSE: To assess the effectiveness of using silane before cementing laboratory resins, by means of microtensile bond strength test. METHODS: 40 human molars were selected, cleaned and stored in a 0.1% thymol solution. The occlusal surfaces of these teeth were removed and flattened until dentin was exposed. Next, the laboratory resin blocks were cemented (Adoro or Artglass) with Single Bond and Rely X adhesive cementing systems, by the same cementing protocol, the only difference between the groups being whether or not silane was applied. The teeth to which the blocks were cemented were prepared to obtain stick-shaped test specimens with an approximate area of 1.00 mm2 (+/- 0.12 mm2) for the microtensile bond strength tests. Afterwards, under x2.5 magnification, the fracture modes were visually classified as adhesive, cohesive or mixed. RESULTS: ANOVA (P < or = 0.05) showed that there were significant differences in the microtensile values between the indirect composites studied. The highest microtensile bond strength values were found with the Artglass (58.08 MPa without silane, 49.76 MPa with silane), and lowest values with Adoro (37.08 MPa without silane, 39.52 MPa with silane). There were no differences in the microtensile bond strength values, with or without silane application. The fractures were considered predominantly adhesive in 68.3%, mixed in 25.8% and cohesive in 5.9% of cases. The use of silane did not contribute significantly to increasing microtensile bond strength during laboratory resin cementation.

Influence of time on bond strength after bleaching with 35% hydrogen peroxide.

AIM: The aim of this in vitro study was to evaluate the influence of time after treatment with a 35% hydrogen peroxide bleaching agent on the shear bond strength between composite resin and sound enamel and dentin. METHODS AND MATERIALS: Eighty dental slabs - 40 enamel (E) slabs and 40 dentin (D) slabs - were embedded, flatted, and divided into four groups (n=10). In G1 the E and D slabs were kept in artificial saliva for 14 days. For the G2, G3, and G4 groups the E and D slabs were submitted to bleaching treatment with a 35% hydrogen peroxide bleaching agent. At different times after bleaching treatments (G2=immediate; G3=seven days; G4= fourteen days), composite resin cylinders were made using an adhesive system. Tests were performed in a universal testing machine at a speed of 0.5 mm/min to obtain the values in MPa. RESULTS: For enamel, the Kruskal-Wallis test and Dunn Method showed G1 differed significantly from G2 (G1=13.40 a; G2=6.64 b; G3=16.76 a; G4=11.64 ab). For dentin, the analysis of variance (ANOVA) and Tukey tests showed that G1 differed significantly from G2 and G3 (G1=12.11 a; G2=4.97 b; G3=8.67 c; G4=11.86 ac). CONCLUSION: It is recommended adhesive restorative procedures in enamel be delayed for seven days post-bleaching treatment with 35% hydrogen peroxide, while restorations in dentin should be delayed for 14 days following bleaching treatment.