Cardiovascular effects of combined hyaluronidase and mepivacaine in dental anesthesia: A randomized clinical trial.

PURPOSE: To evaluate the effects of combined administration of mepivacaine with epinephrine and the diffusion agent hyaluronidase on hemodynamic and electrocardiographic parameters in healthy individuals undergoing dental surgery. METHODS: In a double-blind, split-mouth, randomized clinical trial, the cardiovascular effects induced by 2.7 mL of 2% mepivacaine with 1:100,000 epinephrine injected concomitantly with 1 mL of 75 TRU/mL hyaluronidase or placebo for inferior alveolar nerve block was evaluated in systemically healthy subjects that underwent bilateral third molar extraction in two separate sessions. Systolic and diastolic blood pressure and heart rate were monitored using oscillometric and photoplethysmographic methods in 10 clinical stages, while electrocardiographic records of 12 leads were obtained in four stages. RESULTS: Hyaluronidase injected concomitantly with local anesthetic did not induce changes in blood pressure and heart rate compared to placebo. There were no instances of ST segment depression or elevation, or wide or narrow QRS complex extrasystoles in ECG. The use of mepivacaine injected concomitantly with 75 TRU/mL hyaluronidase was safe, from a cardiovascular standpoint.

Hyaluronidase following buccal infiltrations of articaine with epinephrine for anesthesia of mandibular first molars: A split-mouth, double-blind, placebo-controlled randomized clinical trial.

Background: Adjunctive hyaluronidase has been widely used for ophthalmic anesthesia; however, in Dentistry, very few studies are available so far. Thus, the present study aimed to evaluate anesthetic outcomes of adjunctive hyaluronidase administration following buccal infiltration of articaine with epinephrine for anesthesia of mandibular first molars. Material and Methods: Twenty-eight patients received a buccal supraperiosteal infiltration of 4% articaine with 1:100,000 epinephrine for anesthesia of the mandibular first molars, in a split-mouth approach. Afterward, randomly and using the same technique, they received either 1.0 mL of hyaluronidase (150 UTR/mL) or a placebo solution. Considering patients' pain perceptions provoked by electric and mechanical stimulations, as well as using a pain scale, success rate, action onset time, duration of both pulpal and soft tissue anesthesia, and pain immediately after both punctures and on the 2nd day were assessed. Results: The pulpal anesthetic success rate was 85.7% for hyaluronidase and placebo groups. Soft tissue anesthesia showed a shorter action onset time and a longer duration when hyaluronidase was used; however, there was no difference between the groups regarding action onset time and duration of pulpal anesthesia. Pain at the puncture sites did not differ between the groups, regardless of the time point evaluated. Conclusions: Adjunctive hyaluronidase following buccal infiltration of articaine with epinephrine for mandibular first molars seems not to provide any advantage in anesthetic outcomes in which the nerve fibers are intraosseous (i.e., pulpal anesthesia). On the other hand, soft tissue anesthesia may be improved substantially by using this pharmacological strategy. Key words:Hyaluronidase, local anesthesia, dentistry.

Late hyaluronidase injection in local anesthesia: Morphofunctional evaluation in rat sciatic nerve block.

INTRODUCTION: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. OBJECTIVE: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. MATERIALS AND METHODS: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. RESULTS: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). CONCLUSIONS: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.

Guaiacol/ß-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair-an animal study.

PURPOSE: Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties. METHODS: An inclusion complex of guaiacol and ß-cyclodextrin (Gu/ßcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/ßcd was evaluated histologically after the treatment of DS in rats. RESULTS: ßcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/ßcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™). CONCLUSION: The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/ßcd complex as a future alternative for the treatment of DS.

Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks.

PURPOSE: To evaluate the duration of the effect of mepivacaine when hyaluronidase is injected immediately prior to the end of pulpal anesthesia. PATIENTS AND METHODS: Forty bilateral, symmetrical third molar surgeries were performed in 20 healthy patients. Inferior alveolar nerve block was induced using 2.8 mL 2% mepivacaine with epinephrine. Hyaluronidase (75 turbidity-reducing units) or a placebo was injected 40 minutes after the beginning of pulpar anesthesia (randomized and double-blind trial). The duration of effect in the pulpal and gingival tissues was evaluated by response to painful electrical stimuli applied to the adjacent premolar, and by mechanical stimuli (pin prick) to the vestibular gingiva, respectively. RESULTS: In both tissues, the duration of anesthetic effect with hyaluronidase was longer (P < .01) than with the placebo. CONCLUSION: Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks.

[Dental anxiety in an emergency dental service]. / Ansiedade ao tratamento odontológico em atendimento de urgência.

OBJECTIVE: The purpose of the study was to assess the frequency of dental anxiety and/or fear among patients in an emergency dental service. METHODS: Research was based on interviews with 252 patients, aged 18 years old and over, attended at an emergency dentistry service of São Paulo, Brazil, from August to November, 2001. Two methods were used to measure dental anxiety: the Modified Dental Anxiety Scale (MDAS) and the Gatchel Fear Scale. The study group answered questions concerning major complaint, how much time had elapsed since their last visit to the dentist and since the initial symptoms leading to the current visit to the emergency service, level of education, family income and previous traumas. Statistical analysis (chi2 and Fisher exact test) was performed to evaluate these characteristics. RESULTS: It was found that 28.17% of this sample was dentally anxious, according to the MDAS, and 14.29%, felt fear related to dental treatment according to the Gatchel Fear Scale. Women were more anxious than men at a statistically significant rate (MDAS). The time elapsed since the onset of initial symptoms was more than 7 days for 44.44% of the participants. A large proportion of anxious women returned to treatment during the last year. A previous traumatic experience with dental was identified in 46.48% of the dentally anxious patients. No significant relation between level of education or income and dental anxiety was found. CONCLUSIONS: Dentally anxious patients frequent attend emergency care. Females are more likely to report high dental anxiety than males. Previous experience seems to be an important factor contributing to avoidance of dental care.

Antifungal effect of electrospun nanofibers containing cetylpyridinium chloride against Candida albicans.

It is known that cetylpyridinium chloride (CPC) has in vitro and in vivo antifungal action against Candida albicans, with advantages over other common antiseptics. A CPC delivery-controlled system, transported in polymer nanofibers (PVP/PMMA), was developed to increase the bioavailability of the drug in contact with the oral mucosa. The objectives of this study were to determine if CPC in nanofiber has antifungal action against C. albicans, and in what concentration it must be incorporated, so that the fraction released can yield an inhibitory concentration. The nanofiber was prepared by electrospinning, and sterilized with gamma irradiation. Nanofiber disks with 0.05%, 1.25%, 2.5% and 5% CPC, with 5% miconazole (MCZ) and with no drug, as well as filter paper disks with 5% CPC, with 5% MCZ and with no drug were used in this study. A Candida albicans suspension (ATCC 90028) was inoculated in Mueller-Hinton Agar plates. The disks were placed on the plates and the inhibition zone diameters were measured 48h later. The nanopolymeric disks contracted in contact with the agar. All the concentrations of CPC incorporated in the nanofiber presented inhibitory action against C. albicans. Concentrations of 2.5% and 5% CPC presented a significant advantage over the nanofiber with no drug, proving the antifungal action of CPC. Under these experimental conditions, 5% CPC has greater inhibitory action against C. albicans than 5% MCZ, both in nanofiber and in filter paper. A modification made in the polymer to decrease the contraction rate may allow a larger inhibition zone to be maintained, thereby increasing the clinical usefulness of the polymer.

Effects of opioids on local anesthesia in the rat: a codeine and tramadol study.

Opioids are central analgesics that act on the CNS (central nervous system) and PNS (peripheral nervous system). We investigated the effects of codeine (COD) and tramadol (TRAM) on local anesthesia of the sciatic nerve. Eighty Wistar male rats received the following SC injections in the popliteal fossa: local anesthetic with epinephrine (LA); local anesthetic without vasoconstrictor (LA WV); COD; TRAM; LA + COD; LA + TRAM; COD 20 minutes prior to LA (COD 20' + LA) or TRAM 20 minutes prior to LA (TRAM 20' + LA). As a nociceptive function, the blockade was considered the absence of a paw withdraw reflex. As a motor function, it was the absence of claudication. As a proprioceptive function, it was the absence of hopping and tactile responses. All data were compared using repeated-measures analysis of variance (ANOVA). Opioids showed a significant increase in the level of anesthesia, and the blockade duration of LA + COD was greater than that of the remaining groups (p < 0.05). The associated use of opioids improved anesthesia efficacy. This could lead to a new perspective in controlling dental pain.

Effects of opioids on local anesthesia in the rat: a codeine and tramadol study

Opioids are central analgesics that act on the CNS (central nervous system) and PNS (peripheral nervous system). We investigated the effects of codeine (COD) and tramadol (TRAM) on local anesthesia of the sciatic nerve. Eighty Wistar male rats received the following SC injections in the popliteal fossa: local anesthetic with epinephrine (LA); local anesthetic without vasoconstrictor (LA WV); COD; TRAM; LA + COD; LA + TRAM; COD 20 minutes prior to LA (COD 20' + LA) or TRAM 20 minutes prior to LA (TRAM 20' + LA). As a nociceptive function, the blockade was considered the absence of a paw withdraw reflex. As a motor function, it was the absence of claudication. As a proprioceptive function, it was the absence of hopping and tactile responses. All data were compared using repeated-measures analysis of variance (ANOVA). Opioids showed a significant increase in the level of anesthesia, and the blockade duration of LA + COD was greater than that of the remaining groups (p < 0.05). The associated use of opioids improved anesthesia efficacy. This could lead to a new perspective in controlling dental pain.

Validation of computed tomography protocols for simulated mandibular lesions: a comparison study.

Computed tomography is the choice technique to assess oral and maxillofacial osseous lesions because it provides hard and soft tissues visualization in one examination without superimposition of surrounding structures. This examination offers a significant advance in maxillofacial lesions detection with an excellent anatomic resolution. The aim of this research was to evaluate the validity of two protocols, in axial sections, in simulated mandibular lesions. Two CT protocols were obtained in dry mandibles in which perforations were done simulating lesions. Two observers, previously calibrated, evaluated the images according to different parameters. The results indicated that the sensitivity and specificity in lesion detection were 100% for both protocols, but the detection of loci number of multilocular lesions and the location and detection of medullar invasion obtained reduced validity values, which were influenced by the acquisition protocol. We concluded that thinner axial slices and reconstructions were more effective in detecting early medullar invasion and loci number. Thicker protocols were not considered appropriate to detect multilocular lesions and early stages of medullar invasion.

Complicações decorrentes da utilização do piercing bucal: avaliação e conduta clínica / Complications due use of oral piercing: clinical evaluation and management

Objetivo: apresentar três casos clínicos de pacientes portadores de piercing bucal, nos quais foram motivados a remover os adornos e, quando não admitiram a remoção, foram orientados preventivamente para evitar maiores complicações. Descrição do caso: a conduta do Cirurgião-dentista frente ao paciente portador do piercing na cavidade bucal foi descrita. O estudo ainda enalteceu a importância da intervenção do Cirurgião-dentista no esclarecimento dos possíveis prejuízos à saúde ocasionados pelo piercing bucal. Conclusão: o Cirurgião-dentista e particularmente o periodontista desempenham papel relevante na orientação evitando a instalação do piercing bucal, ou na recomendação de cuidados quando o paciente não aceita a remoção do adorno.

Aim: present 3 clinical cases of patients with oral piercing, who was guided to remove the ornaments, and when the patient did not admit the piercing removal, the patient was preventively warned to avoid more complications. Case description: the dentist management on the patient with oral piercing was described. This study also enhances the importance of the dentist intervention in the explanation of possible health injury occasioned by oral piercing. Conclusion: the dentist and particularly the periodontist play relevant role in guiding avoiding the installation of oral piercing, or the recommendation of care when the patient does not accept the removal of adornment.

Validation of computed tomography protocols for simulated mandibular lesions: a comparison study

Computed tomography is the choice technique to assess oral and maxillofacial osseous lesions because it provides hard and soft tissues visualization in one examination without superimposition of surrounding structures. This examination offers a significant advance in maxillofacial lesions detection with an excellent anatomic resolution. The aim of this research was to evaluate the validity of two protocols, in axial sections, in simulated mandibular lesions. Two CT protocols were obtained in dry mandibles in which perforations were done simulating lesions. Two observers, previously calibrated, evaluated the images according to different parameters. The results indicated that the sensitivity and specificity in lesion detection were 100 percent for both protocols, but the detection of loci number of multilocular lesions and the location and detection of medullar invasion obtained reduced validity values, which were influenced by the acquisition protocol. We concluded that thinner axial slices and reconstructions were more effective in detecting early medullar invasion and loci number. Thicker protocols were not considered appropriate to detect multilocular lesions and early stages of medullar invasion.

A tomografia Computadorizada é a técnica de escolha no exame de lesões ósseas orais e maxilo-faciais porque proporciona a visualização de tecidos duros e moles em aquisição única e sem sobreposição de estruturas adjacentes. Este exame oferece um avanço significativo na detecção de lesões maxilo-faciais, com excelente resolução anatômica. O objetivo desta pesquisa foi avaliar a validade de dois protocolos, em secções axiais, em lesões simuladas de mandíbula. Dois protocolos de TC foram obtidos em mandíbulas secas em que foram feitas perfurações, simulando lesões. Dois observadores previamente calibrados avaliaram as imagens seguindo parâmetros diversos. Como resultados pudemos observar que a sensibilidade e a especificidade foram de 100 por cento para detecção de lesões para ambos os protocolos, mas a detecção do número de lojas das lesões multiloculares e a localização e detecção de invasão medular obtiveram valores reduzidos em sua validade, o que foi influenciado pelo protocolo de aquisição. Concluiu-se que secções axiais e reconstruções mais finas foram mais efetivas na detecção de invasão medular precoce e de lojas tumorais. Protocolos mais espessos não foram considerados apropriados para a detecção de lesões multiloculares e estágios iniciais de invasão medular.

Efeitos cardiovasculares da anestesia local de prilocaína 3 por cento com felipressina e lidocaína 2 por cento em normotensos / Cardiovascular effects of local anesthetic prilocaine with felypressin 3 per cent and licocaine 2 per cent in normotensive patients

Este estudo avaliou os efeitos cardiovasculares da anestesia via infiltrativa intrabucal de cloridrato de lidocaína a 2 por cento (20mg/mL) e cloridrato de prilocaína a 3 por cento (30 mg/mL) associado ao cloridrato de felipressina (0,03 U.1/mL) em pacientes normotensos. Foram selecionados 20 pacientes que sofreram dois procedimentos básicos de periodontia (RACR) bilateralmente, na região de molares superiores em consultas separadas com intervalo de uma semana. Na etapa de controle clínico foram monitoradas as pressões arterial sistólica (PAS), arterial distólica (PAD), arterial média (PAM) e a frequência cardíaca (FC) Ppor meio dos métodos oscilométrico e fotopletismográfico. Foram administrados dois tubetes na primeira sessão de Xilocaína 2 por cento (Grupo I) e dois tubetes de Citanest 3 por cento na última sessão (Grupo II). Os valores médios avaliados foram as nove etapas: 1) semana anterior (20 minutos); 2) na sala de espera (5 minutos); 3) na cadeira odontológica (5 minutos); 4) segundo minuto durante a primeira anestesia local (AL); 5) quinto minuto após a remoção da agulha; 6) segundo minuto durante a segunda AL; 7) quinto minuto após a remoção da agulha; 8) durante a execução do porcedimento clínico; 0) cinco minutos em repouso. A análise de variância (ANOVA) demonstrou que a lidocaína isolada não diferiu significativamente (p maior que 0,01) com a prilocaína com felipressina em relação à PS, PD, PM e FC, e mesmo entre as etapas clínicas. Para essa dose e via de administração, ambas soluções se mostram seguras clinicamente.

Efeitos cardiovasculares da mepivacaína com epinefrina seguida de hialuronidase: ensaio clínico parcialmente randomizado duplo-cego, controlado em cirurgias bilaterais de terceiros molares inferiores / Cardiovascular effects of mepivacaine with epinephrine followed by hyaluronidase: a double-blind controlled partially randomized clinical trial in bilateral lower third molar surgery

O objetivo deste estudo controlado e duplo-cego foi avaliar, em 16 pacientes, os efeitos cardiovasculares induzidos pelo bloqueio pterigomandibular com o anestésico local (AL) mepivacaína 2%, associado à epinefrina, seguido da injeção de hialuronidase 75 UTR ou placebo, antes da regressão do efeito AL, para realização de cirurgia de terceiros molares inferiores bilaterais e simétricos. Os parâmetros cardiovasculares pressões sistólica (PS), diastólica (PD), média (PM) e freqüência cardíaca (FC) foram monitorados pelos métodos oscilométrico e fotopletismográfico, em 12 etapas clínicas. A hialuronidase injetada isoladamente depois do AL não induziu a alterações cardiovasculares significantes (p>0,01), comparado ao placebo. Houve diferença significativa (p<0,01) entre os valores médios da PS, PD e FC durante as etapas clínicas antes do uso da hialuronidase. Conclui-se que as alterações cardiovasculares estão relacionadas com o procedimento cirúrgico. O uso de AL, seguido de hialuronidase injetada isoladamente antes da regressão do efeito anestésico, mostrou-se seguro para essa dose e via de administração.

Aspectos epidemiológicos e sociodemográficos do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo / Epidemiologic and sociodemographic aspects of Urgency Service of Sao Paulo University Dental School

O objetivo deste trabalho foi realizar um estudo retrospectivo do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo (SU-FOUSP) para determinar o número de pacientes atendidos e os procedimentos clínicos realizados em 16 anos (1990-2005). Também foi investigada, em uma amostra de 1000 pacientes, a presença de dor como motivo da consulta, a frequência de consulta do mesmo paciente ao Setor, as características sociodemográficas dos pacientes e se estavam em tratamento odontológico. Foram atendidos 158.598 pacientes e realizados 209.945 procedimentos, com média anual de 9.912 pacientes e de 13.121 procedimentos realizados. Houve predomínio daqueles que procuraram o Setor pela primeira vez e que não estavam em tratamento odontológico regular, do gênero feminino, entre 20-29 anos, leucodermas, que não chegaram ao ensino médio, sem renda pessoal e com renda familiar de um a três salários mínimos. O SU-FOUSP cumpre com sua função principal que é proporcionar o alívio imediato da dor. Os procedimentos realizados em decorrência da cárie e suas sequelas são os mais frequentes.

Ansiedade ao tratamento odontológico em atendimento de urgência / Dental anxiety in an emergency dental service

OBJETIVO: Avaliar a freqüência de pacientes com ansiedade ou medo do tratamento odontológico em um setor de urgência. MÉTODOS: Participaram do estudo 252 pacientes, com 18 anos ou mais, que compareceram ao setor de urgência de uma faculdade de odontologia, de São Paulo, SP, entre agosto e novembro de 2001. Para avaliar a ansiedade, foram utilizadas a Modified Dental Anxiety Scale (MDAS), e a Escala de Medo de Gatchel. O grupo estudado respondeu a questöes sobre: tempo decorrido desde a última visita ao dentista e desde o início dos sintomas, escolaridade, renda familiar e história prévia de trauma. Os resultados foram analisados pelos testes estatísticos (chi2 e Teste Exato de Fisher). RESULTADOS: Foram identificados 28,2 por cento de indivíduos com algum grau de ansiedade, segundo a MDAS, na qual as mulheres foram consideradas mais ansiosas que os homens (chi2=0,01); e 14,3 por cento de pacientes com alto grau de medo segundo a Escala de Medo de Gatchel. Em 44,4 por cento da amostra a demora para procura de alívio dos sintomas foi > sete dias. Mulheres ansiosas procuraram atendimento mais rapidamente e em maior número. Experiência traumática anterior ocorreu em 46,5 por cento dos pacientes ansiosos. Näo foi possível relacionar escolaridade e renda familiar com ansiedade e/ou medo. CONCLUSÕES: Pacientes ansiosos, com destaque para as mulheres, säo freqüentes no atendimento odontológico de urgência. Experiência prévia traumática mostrou-se importante para o desenvolvimento da ansiedade em relaçäo ao atendimento odontológico.

Desfalecimento do paciente no consultório odontológico: informações que o Cirurgião dentista deve conhecer / Fanting fit in the dentistry office: information for Dentists

As emergências médicas podem ocorrer nos consultórios odontológicos, e os Cirurgiões-dentistas deveriam estar preparados para atendê-las. Em algumas dessas emergências pode ocorrer perda de consciência. O objetivo deste trabalho é descrever o quadro clínico da síncope, lipotímia, hipotensão ortostática e hiperventilação e informar sobre as medidas preventivas e as condutas a serem seguidas frente ao desfalecimento do paciente.

Análise da influência da hialuronidase 75 UTR/mL no bloqueio pterigomandibular, abertura bucal e edema pós-operatório / Influency of Hyaluronidase 75TRU/ml in inferior alveolar nerve block, trismus and edema postoperative

O adjuvante hialuronidase (H) em associação ao anestésico local (AL) é largamente utilizado em oftamologia por melhorar a eficácia anestésica. Em Odontologia, a H 150 UTR/mL utilizada concomitantemente ao AL não melhorou o índice de sucesso anestésico e induziu ao trismo. Talvez, a redução da concentração da H pela metade evite efeitos adversos e melhore a eficácia anestésica. Este estudo avaliou a influência da H 75 UTR/mL associada ao AL na latência, duração de ação e índice de sucesso anestésico, edema e abertura bucal pós-operatória. Foram realizadas, em 25 pacientes saudáveis, 50 cirurgias (n = 25) de terceiros molares inferiores, bilaterais, utilizando 1,8 mL de lidocaína a 2% associada à epinefrina 1 : 100.000 com a hialuronidase ou placebo (veículo) de modo duplo-cego para o bloqueio do nervo alveolar inferior e 1,0 mL para o nervo bucal. Para a latência e duração na polpa, foi utilizado estímulo elétrico e na gengiva, estímulo mecânico (picada). O edema foi avaliado por meio de medidas faciais (entre pontos) e a abertura bucal pela distância interincisal, obtidas nos tempos: T basal, T0, T 2 dias e T 7 dias. A latência e duração anestésica não diferiram entre as soluções (p > 0,05). O índice de sucesso não foi alterado. A H não alterou o edema e a abertura bucal (p> 0,05), porém foram maiores no T 2 dias (p< 0,05). Embora a H nessa concentração não tenha causado efeitos adversos, também não melhorou a eficácia. Nessas condições experimentais, a hialuronidase 75 UTR/mL administrada concomitantemente ao AL não apresenta vantagem clínica.

Antimicrobianos locais coadjuvantes ao tratamento periodontal / Co-adjuvant local antimicrobials to the periodontal treatment

É conhecido o papel da microbiota como principal fator etiológico das doenças periodontais, baseado na teoria da especificidade do biofilme. Considera-se ainda a resposta do hospedeiro associada ao agente agressor, com variáveis clínicas da severidade da doença periodontal. Atualmente, a incidência e severidade das doenças periodontais pode ser estabilizada por diversas modalidades terapêuticas, optando-se inicialmente por um paradigma conservador e variando até os procedimentos cirúrgicos mais invasivos. Independentemente das condutas escolhidas, embora particularizado em cada caso, o uso de antimicrobianos desempenha uma satisfatória modalidade coadjuvante no tratamento das doenças periodontais, especialmente na periodontite. A proposta deste trabalho é de revisar e discutir os fármacos de uso local coadjuvante ao tratamento periodontal. Pode-se concluir que a administração de antimicrobianos de uso tópico, como coadjuvante ao tratamento periodontal, apresenta diversos benefícios como a manutenção da concentração do fármaco por período prolongado, redução dos efeitos colaterais e da possibilidade de resistência bacteriana. A tetraciclina apresentou melhores resultados clínicos em comparação com os outros fármacos.

The role of the bacteria is known as the main etiological factor of periodontal diseases, based on the biofilm specificity theory. The hostÆs answer to the aggressor agent is also considered, with clinical variables of the periodontal disease severity. Nowadays, the incidence and the severity of the periodontal diseases can be stabilized through many therapeutic modalities, as the first step choosing conservative paradigms, and even ranging the most invasive surgical procedures. Independently on the chosen procedure, although it is particularized case by case, the antimicrobial therapy represents a satisfactory coadjuvant modality in the treatment of periodontal diseases, specially in cases of periodontitis. The purpose of this paper is to review and to discuss the role of the topical antimicrobial drugs in the periodontal treatment. It is possible to conclude that topic antimicrobials administration, as a coadjuvant for periodontal treatment, presents many benefits like concentration drug maintenance for extended time, reduction of side effects and bacterial resistance possibility. The tetracycline has presented better clinical results when it was compared with other drugs.