Atenção integral à população trans: panorama da atuação do cirurgião-dentista na atenção primária à saúde / Comprehensive care for the trans population: importance of the dentist's role in primary health care

A sigla LGBTQIA+ engloba identidades relacionadas à orientação sexual e de gênero, representando aqueles que se desviam dos padrões cis heteronormativos e binários. Esta população, em especial a trans, enfrenta silenciamento e estigmatização no acesso aos serviços de saúde, incluindo a saúde bucal, devido à discriminação e à falta de conhecimento dos profissionais. Estudos apontam que a saúde bucal dessa população é pior do que a média da população em geral e transtornos mentais são mais comuns nessa população, afetando os cuidados com a higiene bucal e se relaciona a condições como disfunção temporomandibular (DTM) e dor orofacial. Além disso, a população trans apresenta taxas mais altas de abuso de substâncias nocivas à saúde bucal, como álcool, tabaco e drogas ilícitas, que estão associados ao desenvolvimento de neoplasias orais. A terapia hormonal de afirmação de gênero (THAG), utilizada por trans, pode afetar a saúde bucal, levando à inflamação gengival e dor. A adoção de abordagem multidisciplinar é fundamental para fornecer cuidados adequados e inclusivos, sendo essencial considerar também os impactos psicossociais na saúde bucal. Na busca por cuidados de saúde, é crucial a abordagem do risco de infecções sexualmente transmissíveis (ISTs) e da violência interpessoal. É fundamental que os cirurgiões-dentistas estejam preparados para o acolhimento e tratamento dessa população de forma inclusiva, oferecendo cuidados preventivos, diagnóstico precoce e encaminhamento adequado. Ainda, um olhar sensível deve ser voltado às questões de identidade de gênero, uso correto de pronomes e nome social e a criação de ambiente seguro e livre de discriminação

The acronym LGBTQIA+ encompasses identities related to sexual orientation and gender, representing those who deviate from cis-heteronormative and binary standards. The LGBTQIA+ population, especially the transgender persons, faces silencing and stigmatization in accessing health services, including oral health, due to discrimination and a lack of knowledge of professionals. Studies indicate that the oral health of this population is worse than the average of the general population and mental disorders are more common in this population, affecting oral hygiene care and being related to conditions such as temporomandibular disorders (TMD) and orofacial pain. In addition, transgender persons have higher rates of substance abuse that are harmful to oral health, such as alcohol, tobacco, and illicit drugs, which are associated with the development of oral neoplasms. Gender-affirming hormone therapy (GAHT), used by transgender person, can affect oral health, leading to gum inflammation and pain. The adoption of a multidisciplinary approach is essential to provide adequate and inclusive care, and it is essential to consider the psychosocial impacts on oral health. In seeking healthcare, addressing the risk of sexually transmitted infections (STIs) and interpersonal violence is crucial. It is essential that dentists are prepared to receive and treat this population in an inclusive way, offering preventive care, early diagnosis, and appropriate referral. In addition, a sensitive look must be turned to questions of gender identity, social names, correct pronouns, and creating a safe and discrimination-free environment

How to improve root canal filling in teeth subjected to radiation therapy for cancer.

The aim of this study was to evaluate the influence of radiation therapy on root canal sealer push-out bond strength (BS) to dentin and the sealer/dentin interface after different final irrigation solutions (NaOCl, EDTA, and chitosan). Sixty-four maxillary canines were distributed into two groups (n=30): non-irradiated and irradiated with 60 Gy. Canals were prepared with Reciproc-R50 and subdivided (n=10) for final irrigation (NaOCl, EDTA, chitosan) and filled. Three dentin slices were obtained from each root third. The first slice of each third was selected for BS evaluation, and the failure mode was determined by stereomicroscopy. SEM analysis of the sealer-dentin interface was performed in the remaining slices. Two-way ANOVA and Tukey's tests (α=0.05) were used. Lower BS (P<0.0001) was obtained after irradiation (2.07±0.79 MPa), regardless of the final irrigation solution used. The NaOCl group (P<0.001) had the lowest BS in the irradiated (1.68±0.72) and non-irradiated (2.39±0.89) groups, whereas the EDTA (irradiated: 2.14±0.77 and non-irradiated: 3.92±1.54) and chitosan (irradiated: 2.37±0.73 and non-irradiated: 3.51±1.47) groups demonstrated a higher BS (P<0.05). The highest values were observed in the coronal third (3.17±1.38) when compared to the middle (2.74±1.36) and apical ones (2.09±0.97)(P<0.0001). There were more cohesive failures and more gaps in irradiated specimens, regardless of the final solution. The present study showed that radiation was associated with a decrease in BS, regardless of the final solution used, whereas chitosan increased BS in teeth subjected to radiation therapy.

Influence of root dentin treatment on the push-out bond strength of fibre-reinforced posts

This study evaluates the influence of root dentin treatment with NaOCl alone and combined with EDTA, with and without ultrasound activation, on the push-out bond strength (BS) of fiber-reinforced posts in weakened roots, cemented with RelyX or Panavia. The root canals of 42 maxillary canines were instrumented with Reciproc and 2.5% NaOCl. In the coronal 12mm of all canals, experimental weakening of the roots was produced by reducing dentin thickness with 2.44mm diameter diamond burs. The roots were assigned to 3 groups (n = 14) according to root dentin treatment: 2.5% NaOCl; 2.5% NaOCl + 17% EDTA; and 2.5% NaOCl + 17% EDTA, with solutions agitated using passive ultrasonic irrigation. After cementation of the fiber-reinforced posts the roots were divided in thirds. The first slice of each third was used for the push-out BS test, the second slice for confocal laser scanning microscopy and dentin microhardness (Knoop) analysis. Data were analysed by a two-way ANOVA and Tukey test (a = 0.05). NaOCl + EDTA provided highest BS values than NaOCl (p < 0.0001). Specimens cemented with Panavia presented significantly higher BS than those with RelyX in the three root thirds (p < 0.0001). The highest BS values occurred in the cervical third (p < 0.001). Ultrasound-activated NaOCl + EDTA promoted the greatest reduction in dentin microhardness, followed by NaOCl/EDTA and NaOCl. Ultrasonic activation of NaOCl and EDTA reduced root dentin microhardness, but did not improve the push-out BS of resin-based cements. Panavia presented higher BS than RelyX. RelyX was not influenced by the root dentin treatment protocols.

Influence of root dentin treatment on the push-out bond strength of fibre-reinforced posts

Abstract This study evaluates the influence of root dentin treatment with NaOCl alone and combined with EDTA, with and without ultrasound activation, on the push-out bond strength (BS) of fiber-reinforced posts in weakened roots, cemented with RelyX or Panavia. The root canals of 42 maxillary canines were instrumented with Reciproc and 2.5% NaOCl. In the coronal 12mm of all canals, experimental weakening of the roots was produced by reducing dentin thickness with 2.44mm diameter diamond burs. The roots were assigned to 3 groups (n = 14) according to root dentin treatment: 2.5% NaOCl; 2.5% NaOCl + 17% EDTA; and 2.5% NaOCl + 17% EDTA, with solutions agitated using passive ultrasonic irrigation. After cementation of the fiber-reinforced posts the roots were divided in thirds. The first slice of each third was used for the push-out BS test, the second slice for confocal laser scanning microscopy and dentin microhardness (Knoop) analysis. Data were analysed by a two-way ANOVA and Tukey test (a = 0.05). NaOCl + EDTA provided highest BS values than NaOCl (p < 0.0001). Specimens cemented with Panavia presented significantly higher BS than those with RelyX in the three root thirds (p < 0.0001). The highest BS values occurred in the cervical third (p < 0.001). Ultrasound-activated NaOCl + EDTA promoted the greatest reduction in dentin microhardness, followed by NaOCl/EDTA and NaOCl. Ultrasonic activation of NaOCl and EDTA reduced root dentin microhardness, but did not improve the push-out BS of resin-based cements. Panavia presented higher BS than RelyX. RelyX was not influenced by the root dentin treatment protocols.