Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review.

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review

Abstract: The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Effect of low-level laser therapy on postoperative endodontic pain: An updated systematic review.

OBJECTIVE: To evaluate the influence of low-level laser therapy (LLLT) on postoperative pain after endodontic treatment. METHODS: The PICOS strategy was used to identify randomized clinical trials comparing low-level laser therapy and mock laser therapy to manage postoperative pain after endodontic treatment, retreatment, and endodontic surgery. An electronic search was performed in MEDLINE through PubMed, Web of Science, LILACS, Scopus and Cochrane Library, OpenGrey and Google Scholar. Quality assessment was performed using the Cochrane Collaboration's tool for assessing the risk of bias. The quality of evidence was rated on the basis of the GRADE approach. RESULTS: Twelve studies were included in the qualitative synthesis. Within the 12 studies, 7 articles were classified as "low risk of bias," 4 studies were considered "unclear risk of bias" and 1 study was considered "high risk of bias." Six studies evaluated the postoperative pain after primary root canal treatment, two studies after root canal retreatment and four after periapical surgery. Most of the studies reported significantly less postoperative pain after LLLT in different time periods; two studies found no differences. The certainty of evidence was classified as low and very low to treatment / retreatment and endodontic surgery, respectively. CONCLUSIONS: Based on the limited quality evidence, most of the included studies reported significantly less postoperative pain after LLLT. However, the lack of standardization in laser parameters, use of medications and the certainty of evidence classified as low and very low indicate the need for further studies.

Is nutritional intervention an improvement factor in the management of periodontitis? A systematic review.

AIMS: This systematic review aimed to evaluate the effect of nutritional intervention in the management of periodontitis. METHODS: This study was registered on the Prospective International Registry of Systematic Reviews-PROSPERO, under the registration number CRD42017076674. The database searching was performed on: Pubmed, Scopus, Web of Science, Clinical Trials and Lilacs. The OpenGrey and Google Scholar were also assessed for searching the grey literature. The PICO framework was carried out, in which the participants (P) were humans with periodontitis receiving conventional periodontal therapy simultaneously with dietary supplements (I), compared (C) with those managed with conventional therapy only, having as an outcome (O) the influence-or not influence-of nutritional intervention in the management of periodontitis. After the searching, duplicates were removed and articles were first assessed by title and abstract, following the inclusion and exclusion criteria; then, the full text of the remaining articles were reviewed. All steps within the review process were performed independently by two reviewers and checked by a third-party disagreement evaluator. For quality/risk of bias assessment of the study selection, The Cochrane Collaboration's tool for randomized studies and Robins-TOOL for non-randomized studies (ROBINS-I) were performed. The Grading of recommendations, assessment, development and evaluation (GRADE) was used for assessing the level of evidence. RESULTS: A total of 2574 citations were recorded, but only four were considered eligible. The included studies reported different nutritional interventions such as fruit concentrate, vegetables and fruit juice powders, multivitamins, fish oil, and a customized dietary advice. The three studies using nutritional supplements showed improvements in at least one clinical parameter of periodontitis -reduction of probing depths, attachment gain, crevicular fluid decreased, reduced bleeding values on probing-after 2-6 months. Although, only two articles presented a moderate risk of bias, a very low level of evidence was found among the four studies taken together. CONCLUSIONS: Despite the results suggested that nutritional intervention is beneficial for periodontal therapy, the evidence in general, is inconsistent and imprecise. More interventional studies with longer periods of follow-up and the assessment of a specific nutritional intervention must be conducted.

Therapeutic Potential of Bauhinia forficata Link in Dental Biofilm Treatment.

The oral cytotoxicity, antimicrobial and anti-demineralizing effects of a tincture from Bauhinia forficata Link tincture (BFLT) were evaluated in vitro and ex vivo. Susceptibility tests (minimum inhibitory and microbicidal concentrations-MIC and time-kill assay-MMC) were performed against planktonic oral microorganisms. The contents of phenolic compounds were investigated. Cytotoxic potential was evaluated on oral fibroblasts after 1-5 min exposure to BFLT. Blocks of sound bovine enamel (N = 60) were inoculated with a saliva pool and sustained in a multiple plaque growth system for 48 h to form a biofilm. Biofilm blocks were randomly divided into groups-G (n = 10): G1-Baseline (48 h maturation biofilm), G2-BFLT 23.2 mg/mL, G3-Ethanol 81.20 g/mL, G4-Chlorhexidine 0.12%, G5-Growth control, and G6-Blank control. Treatments (50 µL/1 min) were performed once a day for a week. Streptococcus spp. (S) and total microorganism (TM) counts were expressed as Log10 CFU/mL. Biofilm height was evaluated by confocal microscopy analyses (CMA). Final surface hardness was assessed and percentage of microhardness loss (% MHL) was calculated. Results were significant when P < .05. BFLT inhibited all tested microorganisms (MIC = 1.3-23.2 mg/mL) and promoted optical reduction (0.05-0.22 nm) of all microorganisms after 48-h treatment compared with controls. After 5-min treatment, BFLT showed low values of cell death (3.20%). G2-BFLT reduced S (6.61 ± 0.20) and TM (7.14 ± 0.38) compared with G1-Baseline (S = 7.82 ± 0.28; TM = 8.81 ± 0.67) and G5-Growth control (S = 7.48 ± 0.39; TM = 7.89 ± 0.68); but G4-chlororexidine (S = 6.11 ± 0.48; TM = 6.45 ± 0.16) showed the highest antibiofilm activity. CMA was not different among treatment groups. G2 showed lower % MHL compared with G5, although G4 presented the lowest. Results suggest BFLT is beneficial against dental caries, showing antimicrobial effects against a mature dental biofilm and no cytotoxicity.

Antioxidants as Adjuvants in Periodontitis Treatment: A Systematic Review and Meta-Analysis.

This systematic review with meta-analysis aimed to evaluate the effect of antioxidants as an adjuvant in periodontitis treatment. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane, Lilacs, OpenGrey, and Google Scholar. Based on the PICO strategy, the inclusion criteria comprised interventional studies including periodontitis patients (participants) treated with conventional therapy and antioxidants (intervention) compared to patients treated only with conventional therapy (control) where the periodontal response (outcome) was evaluated. The risk of bias was evaluated using the Cochrane RoB tool (for randomized studies) and ROBINS-I tool (for nonrandomized studies). Quantitative data were analyzed in five random effects meta-analyses considering the following periodontal parameters: clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing depth (PD). After all, the level of certainty was measured with the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool. Among the 1884 studies identified, only 15 interventional studies were according to the eligibility criteria and they were included in our review. From them, 4 articles presented a high risk of bias. The meta-analysis showed a statistically significant difference for CAL (SMD 0.29 (0.04, 0.55), p = 0.03, I 2 = 13%), PI (SMD 0.41 (0.18, 0.64), p = 0.0005, I 2 = 47%), and BOP (SMD 0.55 (0.27, 0.83), p = 0.0001, I 2 = 0%). The GRADE tool showed a moderate to high certainty in the quality of evidence depending on the clinical parameter and antioxidants used. These results suggest that the use of antioxidants is an adjunct approach to nonsurgical periodontal therapy which may be helpful in controlling the periodontal status.

Homeopathic medicine of Melissa officinalis combined or not with Phytolacca decandra in the treatment of possible sleep bruxism in children: A crossover randomized triple-blinded controlled clinical trial.

PURPOSE: The present randomized controlled clinical trial evaluated the efficacy of homeopathic medicines of Melissa officinalis (MO), Phytolacca decandra (PD), and the combination of both in the treatment of possible sleep bruxism (SB) in children. STUDY DESIGN: Patients (n = 52) (6.62 ± 1.79 years old) were selected based on the parents report of SB. The study comprised a crossover design that included 4 phases of 30-day treatment (Placebo; MO 12c; PD 12c; and MO 12c + PD 12c), with a wash-out period of 15 days between treatments. METHODS: At baseline and after each phase, the Visual Analogic Scale (VAS) was used as the primary outcome measure to evaluate the influence of treatments on the reduction of SB. The following additional outcome measures were used: a children's sleep diary with parent's/guardian's perceptions of their children's sleep quality, the trait of anxiety scale (TAS) to identify changes in children's anxiety profile, and side effects reports. Data were analyzed by ANOVA with repeated measures followed by Post Hoc LSD test. RESULTS: Significant reduction of SB was observed in VAS after the use of Placebo (-1.72 ± 0.29), MO (-2.36 ± 0.36), PD (-1.44 ± 0.28) and MO + PD (-2.21 ± 0.30) compared to baseline (4.91 ± 1.87). MO showed better results compared to PD (p = 0.018) and Placebo (p = 0.050), and similar result compared to MO+PD (p = 0.724). The sleep diary results and TAS results were not influenced by any of the treatments. No side effects were observed after treatments. CONCLUSION: MO showed promising results in the treatment of possible sleep bruxism in children, while the association of PD did not improve MO results.

Antibacterial and Cytotoxic Potential of a Brazilian Red Propolis

Objective: To evaluate in vitro the effect of a red propolis ethanolic extract (RPE) in the prevention of growth of a cariogenic biofilm and its cytotoxic potential. Material and Methods: Minimum inhibitory and bactericidal concentrations (MIC and MBC) of RPE against Streptococcus mutans and Lactobacillus casei were determined. The cytotoxic potential of 0.4% RPE in oral fibroblasts was observed after 1, 3 and 5 min of contact. Cellulose membrane disks (13 mm, N=12) were used for biofilm formation (24 h) of S. mutans and L. casei, which were treated (1 min) with 0.4% RPE or 0.12% Chlorhexidine (CHX). The control group of biofilm formation was not submitted to any treatment. Serial dilutions were then made to evaluate microbial viability. Descriptive data analysis and, for microbial viability, Mann Whitney test were performed (p≤0.05). Results: RPE showed similar MIC and MBC (4.46 mg/mL) against S. mutans and, for L. casei, they were 8.92 mg/mL (MIC) and 17.85 mg/mL (MBC). CHX presented MIC and MBC <0.00002 mg/mL for S. mutans and 0.00047 mg/mL for L. casei. After 1, 3 and 5 min, the RPE exhibited, respectively, 69.38%, 43.91% and 40.36% of viable cells. The RPE (6.55) and CHX (6.87) presented similar efficacy to reduce the total number of viable bacteria (p>0.05). Regarding the total number of viable bacteria (Log10 CFU/mL), the RPE (6.55) and CHX (6.87) presented similar efficacy (p>0.05). Conclusion: Red propolis extract showed antibacterial activity against the tested strains, exhibited acceptable cytotoxicity and reduced the colonization of S. mutans and L. casei in a biofilm membrane model.

Homeopathic therapy for sleep bruxism in a child: Findings of a 2-year case report.

Bruxism is a sleep disorder characterized by grinding and biting teeth with multifactorial etiology, resulting in deleterious effects on teeth, periodontium, and temporomandibular joint. There is a lack of scientific evidence evaluating the effectiveness of medicines in treating this parafunction. The present case report was drafted under the rules of CARE checklist. An 8-year-old male patient with sleep bruxism and associated symptoms received a combined homeopathic therapy of Phytolacca decandra 12c and Melissa officinalis 12c for 2 months. After this period of combined homeopathic therapy, the bruxism and associated symptoms completely disappeared. After 2 years of clinical follow-ups, the patient had no recurrences. The use of homeopathic therapy was successful and should be seen as an alternative to treat sleep bruxism and its associated symptoms in children.

Does Smear Layer Removal Influence Root Canal Therapy Outcome? A Systematic Review.

OBJECTIVE: The aim of this systematic review was to determine whether the smear layer (SL) removal procedure influences the outcome of root canal treatment. STUDY DESIGN: We performed a search on Pubmed, Scopus, ISI Web of Science, Cochrane Library, Lilacs and SIGLE. We included randomized controlled clinical trials (RCT), with clinical and radiographic outcomes, conducted on subjects who had undergone root canal therapy. The protocol differed only in the SL removal or maintenance procedure. We evaluated the papers for risk of bias according to the Cochrane assessment tool. RESULTS: A total of 1,983 articles were found, after removal of duplicates, 892 remained. We included two studies in this review. One study revealed a low risk of bias and a high success rate for the SL removal group compared to the non SL removal group (P = 0.04), while the other study had a high risk of bias and found no difference between the SL removal and non SL removal groups (P = 1.00). CONCLUSION: We concluded that the SL removal for root canal treatment of primary teeth with initial clinical signs and symptoms or pulpal necrotic status, could benefit the outcome, although further RCT should be performed to achieve evidence.

Effect of Coffea canephora aqueous extract on microbial counts in ex vivo oral biofilms: a case study.

In the present study, the ex vivo antimicrobial effect of brewed coffee was tested on oral biofilms. For this, unsweetened and sweetened (10 % sucrose) brewed light-roasted Coffea canephora at 20 % was used in biofilms formed by non-stimulated saliva from three volunteers. After 30 min contact with unsweetened and sweetened brews, the average microorganism count in the biofilms reduced by 15.2 % and 12.4 %, respectively, with no statistical difference among them. We also observed a drop of microorganisms in the biofilms after treatment with sucrose solution at 5 % compared to control (saline) and to sucrose at 1 % and 3 %. In conclusion, Coffea canephora extract reduces the microbial count in oral biofilm, and our data suggest that sucrose concentration in coffee brew can influence its antimicrobial property against the referred biofilm.

In vitro alterations in dental enamel exposed to acidic medicines.

OBJECTIVE: To evaluate the effect of acidic medicines (Klaricid(®), Claritin(®), and Dimetapp(®)) on surface enamel in vitro. METHODS: Enamel blocks (n=104) were randomly distributed into two groups: G1 (pH-cycling simulating physiological oral conditions) and G2 (erosive conditions). Each group was divided into four subgroups, three to be immersed in the medicines and the control in deionized water. Specimen surfaces were evaluated for roughness and hardness at baseline and again after the in vitro experimental phase, which included 30 min immersions in the medicines twice daily for 12 days. Scanning electron microscopy (SEM) was also performed after the in vitro experimental phase. RESULTS: All medicines produced a significant reduction in hardness in G1 after 12 days (P<0.05). The three medicines promoted greater roughness after both pH-regimens - G1 and G2 (P<0.01), except for Claritin in G1. Scanning electron microscopy analysis showed erosive patterns in all subgroups. Dimetapp(®) showed the most erosion and Klaricid(®) the least, in both groups. CONCLUSION: Dimetapp(®) (lowest pH and viscosity) and deionized water (control) showed the most pronounced erosive patterns. Klaricid(®) (highest pH and viscosity) presented an in vitro protective effect against acid attacks perhaps due to its mineral content and viscosity.

Conceitos atuais sobre utilização de suplementos fluoretados no período gestacional / Actual concepts about the use of fluoride supplements during pregnancy

A utilização de fluoretos tem levado à redução na incidência e na prevalência da doença cárie. As formas de emprego desse composto têm sido bastante discutidas, principalmente no que se refere à suplementação fluoretada pré-natal. Apesar de a ingestão de fluoreto no período gestacional não ter tido o seu poder preventivo contra cárie cientificamente comprovado, estes suplementos são, ainda, amplamente utilizados e prescritos por profissionais da saúde. Assim, este trabalho visa a discutir os benefícios e os riscos do uso de suplemento fluoretado durante a fase pré-natal.

The use of fluoride has reduced the incidence and prevalence of caries. The substance ways of administration have been discussed, especially as prenatal supplements. Although the ingestion of fluoride during the pregnancy is not universally accepted, these supplements are widely used and prescribed by health care professionals. Thus, this work aims to review benefits and risks of using fluoride supplements during pregnancy.

Observaçöes atuais da prescriçäo de medicamentos em odontologia / A study on the medicines actually prescriptions on the clinic dental

O objetivo do trabalho foi identificar os medicamentos mais empregados atualmente na clínica odontológica, bem como suas reaçöes adversas mais comuns e incomuns, näo só pela administraçäo isolada, mas também pelas interaçöes medicamentosas em tratamentos simultâneos com outros fármacos. Foram documentadas ainda as condutas dos profissionais diante de tais fatos e discutidas algumas implicaçöes na prescriçäo medicamentosa e na farmacovigilância