Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

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.

Treatment of dental biofilm with a tincture of Bauhinia forficata leaves: an ex-vivo study.

The inhibitory activity of a Bauhinia forficata tincture (TBF) was investigated against oral microorganism's strains and against a mature oral biofilm. The viability of planktonic cells was analyzed by Minimal Inhibitory and Microbicidal concentrations of TBF. Salivary samples from health volunteers were collected and mixed to form a saliva pool. An aliquot from this pool were seeded on membranes, which were incubated to form biofilm (48 h). The biofilm was treated according to the groups: G1-Chlorhexidine 0.12%; G2-TBF at the highest MMC; G3-Ethanol at the TBF highest MMC. G4 was the growth control. Streptococcus spp. (S) and total microorganisms (TM) from biofilm were counted. TBF was microbicidal against all oral pathogens. G2 was able to reduce the counts of S and TM from biofilm compared to G3 and G4, but less than G1 (p < 0.05). TBF is able to reduce the microbial levels from a mature oral biofilm.

Anti-Biofilm and Hemolytic Effects of Cymbopogon citratus (Dc) Stapf Essential Oil

Abstract Objective: To perform chemical analysis and to evaluate the anti-biofilm and hemolytic effect of the essential oil of Cymbopogon citratus. Material and Methods: Gaseous chromatography coupled to mass spectrometer was performed for chemical characterization of the essential oil. To verify the antimicrobial action, the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) and Minimum Fungicidal Concentration (MFC) were determined. From MIC, MBC and MFC data, concentrations were established to verify the anti-biofilm effect and for the hemolysis test on human erythrocytes. A multispecies biofilm was developed in vitro and mouthwash applications were simulated to determine the inhibition of biofilm formation or its removal. Results were analyzed through ANOVA statistical test, complemented by the Tukey test, considering a significance level of 5% Results: The major component of the essential oil is citral. MIC verified for Streptococcus mutans was 1mg / mL, while for Candida albicans, it was 125 μg/mL, presenting microbicidal effect for both microorganisms tested. The essential oil was able to inhibit biofilm formation (p<0.001), presenting non-toxic hemolysis percentage in concentration below 500 μg/mL Conclusion: The essential oil of Cymbopogon citratus is antimicrobial, antibiofilm and non-toxic to human erythrocytes, representing a natural product with potential for use in Dentistry.

Antifungal activity of the essential oil of cymbopogon citratus (DC) stapf: an in vitro study

Aim. to evaluate the antifungal potential of the essential oil of cymbopogon citratus by determining the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) for candida albicans (ATCC 90029), candida albicans (CBS 562), candida tropicalis (ATCC 705) and candida tropicalis strains (CBS 94), as well as to analyze the possible mechanism of action of the oil through the addition of sorbitol to the culture medium. methods. for the MIC determination, inocula were previously adjusted through spectrophotometry and 100µL were added to the wells of plates already containing the culture medium and 100µL of the serial dilutions of the oil, incubating them in aerobiosis for 24 hours, with subsequent staining by 1 percent TCT. for the MFC, 50µL of the supernatant from the MIC assay wells were dripped onto petri dishes and incubated in aerobiosis for 24 hours. tests were performed in triplicate and data analysed by descriptive statistics. results. It was determined that the MIC for C. albicans was 125 µg/mL while MIC for C. tropicalis was 250 µg/mL, with the essential oil presenting fungicidal effect for both analyzed yeasts. conclusion. the essential oil of cymbopogon citratus does not act at the cellular wall level and demonstrated an antimicrobial effect on candida albicans and candida tropicalis, therefore acting as a fungicide.

Atividade Antiaderente de Produtos Fitoterápicos sobre Streptococcus mutans / Anti-adherent activity of phytotherapic products on Streptococcus mutans

A cárie dentária ainda é um dos problemas de saúde bucal mais prevalentes, sendo importante odesenvolvimento de novas terapêuticas para controle dadoença. Objetivo: Avaliar o efeito antiaderente de diferentesfitoterápicos sobre Streptococcus mutans (ATCC 25175).Material e Métodos: Foram analisadas as tinturas dePlectrantus amboinicus, Conyza bonariensis e Cymbopogoncitratus, adiquiridas em farmácia de manipulação, utilizadasem diferentes diluições para determinação da ConcentraçãoInibitória Mínima de Aderência (CIMA). A clorexidina 0,12%constituiu o controle positivo, enquanto o álcool de cereais ocontrole negativo. Para determinar a CIMA, o S. mutans foiinoculado em caldo Mueller Hinton enriquecido com 10% desacarose, na presença de concentrações variadas dosprodutos, sendo os tubos de ensaio posicionados eminclinação de 30º e incubados em microaerofilia por 48 horas,proporcionando a verificação visual da formação da películade aderência ao vidro. Após incubação, os tubos foramlavados com solução tampão fosfato e corados comevidenciador ReplaK®. Todos os testes foram realizados emduplicata, sendo os dados analisados por meio da estatísticadescritiva. Resultados: Os S. mutans não ficaram aderidosao vidro por ação das tinturas, com CIMA de 200 μg/mL.Conclusão: As tinturas analisadas mostraram-se efetivasna inibição de aderência contra S. mutans ao vidro...

Dental caries remains one of the most prevalentoral diseases, which encourages the development of newtherapeutic alternatives aiming at its control. Objective: Toevaluate the anti-adherent effects of phytotherapic agentsagainst Streptococcus mutans (ATCC 25175). Material andMethods: The tinctures of Plectrantus amboinicus, Conyzabonariensis and Cymbopogon citratus, obtained incompounding pharmacy, were used in this study fordetermination of their Minimum Inhibitory Concentration ofAdherence (MICA). Chlorhexidine (0.12%) and grain alcoholwere used as the positive and negative controls,respectively. In order to determine the MICA, S. mutans wasinoculated in Mueller Hinton broth supplemented with 10%sucrose in the presence of different concentrations of theproducts. Then the test tubes were placed in an incubatorwith a 30° tilt angle under microaerophilic atmosphere for 48h. This procedure allowed for the development of an adhesivepellicle onto the glass. Subsequently, the tubes were washedwith phosphate buffer solution and dyed with plaquedisclosing solution (Replac). All tests were performed induplicate and the data were analyzed using descriptivestatistics. Results: The MICA of the tinctures that preventedS. mutans adherence to the glass tubes was 200 μg/mL.Conclusion: The tinctures proved to be effective in preventingS. mutans adherence to glass tubes...

Physical properties and antibacterial activity of herbal tinctures of calendula (Calendula officinalis L) and cashew tree (Anacardium occidentale L)

Objective: To evaluate in vitro the pH, Brix and antibacterial activity of herbal tinctures of calendula (Calendula officinalis L.) and cashew tree (Anacardium occidentale L.) against the following bacterial strains: Streptococcus mutans (ATCC 25175), Streptococcus oralis (ATCC 10557), Streptococcus salivarius (ATCC 9758), Enterococcus faecalis (ATCC 29212) and Eikenella corrodens (ATCC 23834). Material and Method: The strains were reactivated in agar Brain Heart Infusion (BHI) and seeded in blood agar with BHI. Susceptibility tests were performed and the strains were incubated in microaerophilia (37 °C) for 48 h. Chlorhexidine at 0.12% was used as a positive control and distilled water as a negative control. Dilution of the tinctures was carried out from 1:1 (pure form) to 1:64 in alcohol 70%, which is found in their composition, in order to evaluate a possible influence of alcohol on the antibacterial activity of the tinctures. O Bx readings were made by refractometry using an Abbe refractometer and the pH was measured using a digital pH meter. Results: The calendula tincture had pH=5.43 and 18 °Brix and cashew tree tincture had pH=7.2 and 17 °Brix. The cashew tree tincture did not presentantibacterial activity against S. oralis, but it inhibited the growth of all other bacteria up to the 1:64 dilution. The calendula tincture presented antibacterial activity against S. oralis up to 1:16 dilution (6.5 mm halo diameter); against S. mutans and S. salivarius up to 1:32 dilution (7 and 7.5 mm halo diameter, respectively); and against E. faecalis and E. corrodens up to 1:64 dilution. Alcohol 70% did not show any antibacterial activity against the bacterial strains. Conclusion: The tinctures of calendula and cashew tree have soluble solids, have different pH values and present a significant antibacterial activity against several bacterial strains, except for the cashew tree tincture against S. oralis, which was ineffective...

Avaliação da atividade antibacteriana das tinturas de Hamamelis virginiana L. e Stryphnodendron rotundifolium Mart. frente a bactérias bucais / Evaluation of the antibacterial activity of Hamamelis virginiana L. andStryphnodendron rotundifolium Mart. tinctures against oral bacteria

Objetivo: Avaliar, in vitro, a atividade antibacteriana dastinturas de Hamamélis (Hamamelis virginiana L.) eBarbatimão (Stryphnodendron rotundifolium Mart.) sob as bactérias Streptococcus mutans (ATCC 25175),Streptococcus oralis (ATCC 10557) e Streptococcussalivarius (ATCC 9758). Materiais e Metodos: Utilizou-se aclorexidina 0,12% como controle positivo. Água destilada e álcool 70% foram escolhidos como controles negativos.Efetivou-se a diluição das tinturas desde 1:1 (forma pura)até 1:64 (D6) em álcool 70%, o qual está presente na fórmula das tinturas fitoterápicas. O meio de cultura bacteriana utilizado foi o Brain Heart Infusion (BHI), havendo as emeadura em placas de petri com auxílio de swabs.Realizou-se o teste de suscetibilidade e, em seguida, foram incubadas a 37°C, em microaerofilia, por 48 horas. O estudo foi realizado em duplicata e os halos foram mensurados como auxílio de um paquímetro manual. Resultados: O controle positivo apresentou halos de inibição de 16, 15, e 16 mmpara S. mutans, S. oralis e S. salivarius, respectivamente.Nenhuma das tinturas avaliadas, em quaisquer formas,diluídas ou puras, obteve halos de inibição para estas bactérias bucais. A água destilada e o álcool também não promoveram atividade. Conclusão: As tinturas da Hamamélise Barbatimão não apresentam atividade antibacteriana sobreS. mutans, S. oralis e S. salivarius.

Objective: To evaluate the in vitro the antibacterial activity ofthe Hamamelis (Hamamelis virginiana L.) and Barbatimão(Stryphnodendron rotundifolium Mart.) tinctures againstStreptococcus mutans (ATCC 25175), Streptococcus oralis(ATCC 10557) and Streptococcus salivarius (ATCC 9758).Material and Methods: Chlorhexidine (0.12%) was used aspositive control. Distilled water and 70% alcohol were chosenas negative controls. The dilution of the tinctures was carriedout from 1:1 (pure form) to 1:64 (D6) in 70% alcohol, which isfound in the tinctures formula. The culture medium Brain Heart Infusion (BHI) was used, and microorganisms were inoculatedon petri plates using swabs. Plates were incubated at 37 ºC,in microaerophilia, for 48 hours. Tests were performed induplicate and halos were measured using a manual caliper.Results: The positive control showed inhibition halos of 16,15, and 16 mm on S. mutans, S. oralis and S. salivarius,respectively. None of the tinctures evaluated, in any form(diluted or pure), were found to show inhibition halos onthese oral bacteria. Distilled water and 70% alcohol did not exhibit activity. Conclusion: The tinctures of Hamamelis and Barbatimão did not demonstrated antibacterial activity on S.mutans, S. oralis and S. salivarius.

Atividade antimicrobiana de produtos naturais frente a bactérias formadoras do biofilme dentário / Antimicrobial activity of herbal products against dental biofilm forming bacteria

Objeti vo: Verifi car, in vitro, o efeito anti microbiano do pólen e dos extratos alcoólico e aquoso da própolis em suas formas pura e diluídas sobre cepas de referência Streptococcus mutans ATCC25175, Streptococcus salivarius ATCC 7073, Streptococcus mitis ATCC 903 e Lactobacillus casei ATCC 9595 pela determinação da Diluição Inibitória Máxima (DIM). Método: Uti lizou-se a clorexidina como controle positivo e água desti lada e álcool de cereais 70% como controles negativos. Efetuou-se a diluição das soluções de 1:1 até 1:64dos extratos alcoólico e aquoso da própolis diluídos em álcool 70% e água desti lada, respecti vamente. O pólen foi diluído em álcool, por ser uma substancia apolar, nas concentrações de 5% (quanti dade presente na composição química da própolis) e 50%. Cada linhagem bacteriana foi reati vada em caldo nutritivo Brain Heart Infusion (BHI) e semeadas as placas com auxílio de swabs, procedendo-se com testes de susceti bilidade, em duplicata, por meio do método da difusão em ágar e técnicado ágar recortado. Em seguida, foram incubadas a 37°C, em microaerofilia, por 48h. Resultados: Constatou-se que todas as diluições da própolis alcoólica inibiram o crescimento bacteriano enquanto a própolis aquosa mostrou os menores resultados tendo efeitoapenas sobre S. miti s na forma pura e nas diluições de 1:1 até 1:4. O pólen a 5% foi efi ciente sobre todas as bactérias, porém o pólen a 50% teve ação apenas sobre S. mitis. Os controlesnegati vos não apresentaram ati vidade. Conclusão: Apesar da própolis e do pólen apresentarem atividade anti microbiana contra as cepas de referência superiorà do placebo, esta, porém, foi inferior à da clorexidina.

Objective: To evaluate, in vitro, the antimicrobial effect of pollen and alcoholic and aqueous propolis extracts in their pure and diluted forms against reference strains Streptococcus mutans ATCC 25175, Streptococcus salivarius ATCC 7073, Streptococcus mitis ATCC 903 and Lactobacillus casei ATCC 9595, by determination of Maximum Inhibitory Dilution (MID). Methods: Chlorhexidine was used as a positive control and distilled water and 70% grain alcohol as negative controls. The alcoholic and aqueous propolis extracts were subjected to dilutions from 1:1 to 1:64 in 70% alcohol and distilled water, respectively. For being an apolar substance, pollen was diluted in alcohol at the concentrations of 5% (amount present in the chemical composition of propolis) and 50%. Each bacterial strain was reactivated in Brain Heart Infusion (BHI) broth and seeded onto plates with swabs, and the susceptibility tests were performed in duplicate by the agar diffusion method using the agar well technique. Next, the plates were incubated at 37øC in microaerophilia during 48 hours. Results: All dilutions of alcoholic propolis extract inhibited the bacterial growth while the aqueous propolis extract showed less efficient results, being effective only against S. mitis in its pure form and in the 1:1 to 1:4 dilutions. Pollen at 5% was efficient against all bacteria, but pollen at 5% had action only against S. mitis. The negative controls did not present antimicrobial activity. Conclusion: The antimicrobial activity of propolis and pollen against the reference strains was higher than that of placebo but lower than that of chlorhexidine.

Terapêutica medicamentosa adotada por cirurgiões-dentistas para pacientes pediátricos na atenção básica à saúde na cidade de João Pessoa - PB / Drug therapy taken by dentists for pediatric patients in primary health care

Objetivo: O presente trabalho teve como objetivo identificar a terapêutica medicamentosa adotada por cirurgiões-dentistas na atenção básica em saúde, na cidade de João Pessoa – PB, voltada para pacientes pediátricos. Material e métodos: De um universo de 180 cirurgiões-dentistas que atuam nas Unidades de Saúde da Família da cidade de João Pessoa, a amostra foi composta de 30 por cento destes profissionais (n=54), selecionados aleatoriamente, mediante sorteio. Utilizou-se como instrumento de coleta de dados um formulário contendo perguntas sobre os medicamentos prescritos para pacientes pediátricos, as situações clínicas nas quais os medicamentos são prescritos e respectivas posologias. Os dados foram analisados descritivamente. Resultados: Constatou-se que os antibióticos foram os medicamentos mais prescritos para pacientes pediátricos (96,3 por cento), sendo a amoxicilina (76,9 por cento) o fármaco de eleição, apontado como indicado preferencialmente para quadros de abscesso e/ou fístula (72,2 por cento). O ibuprofeno foi o antiinflamatório de eleição (45,6 por cento), sendo ele prescrito, com maior freqüência, para situações em haja presença de inflamação e dor (22,7 por cento). Dentre os analgésicos, o paracetamol foi o preferido pelos profissionais (45,6 por cento), recaindo sua principal indicação em quadros de dor sem infecção (34,8 por cento). Os tranqüilizantes e os fitoterápicos se mostraram pouco utilizados pelos cirurgiões-dentistas, sendo seu uso apontado por dois profissionais e, no primeiro grupo medicamentoso, a indicação apontada foi para crianças com quadro de nervosismo no pré-operatório. Conclusão: Os antibióticos foram os medicamentos mais prescritos para pacientes pediátricos. Dentre os antibióticos, antiinflamatórios e analgésicos, os grupos de fármacos mais utilizados, foram, espectivamente, as penicilinas (particularmente a amoxicilina), o ibuprofeno e o paracetamol. Os ansiolíticos e fitoterápicos se mostraram pouco indicados pelos cirurgiões-dentistas.

Avaliação da atividade antimicrobiana de tinturas fitoterápicas sobre porphyromonas gingivales e prevotella melaninogênica / Evaluation of photherapy antimicrobial activity against porphyronomas gingivales and prevotella melaninogênica

O objetivo do presente trabalho foi verificar, in vitro, o efeito antimicrobiano dessas soluções sobre duas espécies bacterianas causadoras de doença periodontal. Método: As tinturas e as soluções de clorexidina a 0,12 por cento como grupo controle positivo, e álcool de cereais, utilizado no preparo das tinturas, como controle negativo, foram diluídas em solução salina de 1:2 até 1:128. Utilizando o método da difusão em agar,as cepas de referência Porphyromonas gingivales ATCC 49417 e Prevotella melaninogenica ATCC 25845, foram semeadas em meio BHI agar enriquecido com extrato de levedura (0,5 por cento) e incubadas em anaerobiose, à 37º C durante 3 dias.Resultados: Os resultados demonstraram que a Tanchagem e a Sálvia possuem ação antibacteriana sobre as duas cepas em teste, assim como a clorexidina. Porém a tintura de Ipê-roxonão interferiu no crescimento de P. gingivales, sendo P.melaninogenica única sensível a esta tintura. As cepas apresentaram-se resistentes ao álcool de cereais. Conclusão:Conclui-se que as tinturas de tanchagem e sálvia apresentam maior espectro de atuação antibacteriana, quando comparadas à tintura de Ipê-roxo, sendo seu efeito não influenciado pelo álcool utilizado na sua fabricação