Pre-operative use of dexamethasone does not reduce incidence or intensity of bleaching-induced tooth sensitivity. A triple-blind, parallel-design, randomized clinical trial.

OBJECTIVES: This study evaluated the effect of the administration of pre-operative dexamethasone on tooth sensitivity stemming from in-office bleaching. MATERIALS AND METHODS: A triple-blind, parallel-design, randomized clinical trial was conducted on 70 volunteers who received dexamethasone or placebo capsules. The drugs were administered in a protocol of three daily 8-mg doses of the drug, starting 48 h before the in-office bleaching treatment. Two bleaching sessions with 37.5% hydrogen peroxide gel were performed with a 1-week interval. Tooth sensitivity (TS) was recorded on visual analog scales (VAS) and numeric rating scales (NRS) in different periods up to 48 h after bleaching. The color evaluations were also performed. The absolute risk of TS and its intensity were evaluated by using Fisher's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney U test and a two-way repeated measures ANOVA and Tukey's test, respectively. RESULTS: In both groups, a high risk of TS (Dexa 80% x Placebo 94%) was detected. No significant difference was observed in terms of TS intensity. A whitening of approximately 3 shade guide units of the VITA Classical was detected in both groups, which were statistically similar. CONCLUSIONS: It was concluded that the administration pre-operatively of dexamethasone, in the proposed protocol, does not reduce the incidence or intensity of bleaching-induced tooth sensitivity. CLINICAL RELEVANCE: The use of dexamethasone drug before in-office bleaching treatment does not reduce incidence or intensity of tooth sensitivity. CLINICAL TRIAL REGISTRATION NUMBER: NCT02956070.

Targeting Alpha Toxin To Mitigate Its Lethal Toxicity in Ferret and Rabbit Models of Staphylococcus aureus Necrotizing Pneumonia.

The role broad-spectrum antibiotics play in the spread of antimicrobial resistance, coupled with their effect on the healthy microbiome, has led to advances in pathogen-specific approaches for the prevention or treatment of serious bacterial infections. One approach in clinical testing is passive immunization with a monoclonal antibody (MAb) targeting alpha toxin for the prevention or treatment of Staphylococcus aureus pneumonia. Passive immunization with the human anti-alpha toxin MAb, MEDI4893*, has been shown to improve disease outcome in murine S. aureus pneumonia models. The species specificity of some S. aureus toxins necessitates testing anti-S. aureus therapeutics in alternate species. We developed a necrotizing pneumonia model in ferrets and utilized an existing rabbit pneumonia model to characterize MEDI4893* protective activity in species other than mice. MEDI4893* prophylaxis reduced disease severity in ferret and rabbit pneumonia models against both community-associated methicillin-resistant S. aureus (MRSA) and hospital-associated MRSA strains. In addition, adjunctive treatment of MEDI4893* with either vancomycin or linezolid provided enhanced protection in rabbits relative to the antibiotics alone. These results confirm that MEDI4893 is a promising candidate for immunotherapy against S. aureus pneumonia.

Improved Protection in a Rabbit Model of Community-Associated Methicillin-Resistant Staphylococcus aureus Necrotizing Pneumonia upon Neutralization of Leukocidins in Addition to Alpha-Hemolysin.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), especially the USA300 pulsotype, is a frequent cause of skin and soft tissue infections and severe pneumonia. Despite appropriate antibiotic treatment, complications are common and pneumonia is associated with high mortality. S. aureus strains express multiple cytotoxins, including alpha-hemolysin (Hla) and up to five bicomponent leukocidins that specifically target phagocytic cells for lysis. CA-MRSA USA300 strains carry the genes for all six cytotoxins. Species specificity of the leukocidins greatly contributes to the ambiguity regarding their role in S. aureus pathogenesis. We performed a comparative analysis of the leukocidin susceptibility of human, rabbit, and mouse polymorphonuclear leukocytes (PMNs) to assess the translational value of mouse and rabbit S. aureus models. We found that mouse PMNs were largely resistant to LukSF-PV, HlgAB, and HlgCB and susceptible only to LukED, whereas rabbit and human PMNs were highly sensitive to all these cytotoxins. In the rabbit pneumonia model with a USA300 CA-MRSA strain, passive immunization with a previously identified human monoclonal antibody (MAb), Hla-F#5, which cross-neutralizes Hla, LukSF-PV, HlgAB, HlgCB, and LukED, provided full protection, whereas an Hla-specific MAb was only partially protective. In the mouse USA300 CA-MRSA pneumonia model, both types of antibodies demonstrated full protection, suggesting that Hla, but not leukocidin(s), is the principal virulence determinant in mice. As the rabbit recapitulates the high susceptibility to leukocidins characteristic of humans, this species represents a valuable model for assessing novel, cytotoxin-targeting anti-S. aureus therapeutic approaches.

Critical Role of Alpha-Toxin and Protective Effects of Its Neutralization by a Human Antibody in Acute Bacterial Skin and Skin Structure Infections.

Methicillin-resistant Staphylococcus aureus (MRSA) causes large-scale epidemics of acute bacterial skin and skin structure infections (ABSSSI) within communities across the United States. Animal models that reproduce ABSSSI as they occur in humans are urgently needed to test new therapeutic strategies. Alpha-toxin plays a critical role in a variety of staphylococcal infection models in mice, but its role in the pathogenesis of ABSSSI remains to be elucidated in rabbits, which are similar to humans in their susceptibility to S. aureus superantigens and certain bicomponent pore-forming leukocidins. We report here a new rabbit model of ABSSSI and show that those infected with a mutant deficient in expression of alpha-toxin (Δhla) developed a small dermonecrotic lesion, whereas those infected with isogenic USA300 MRSA wild-type or complemented Δhla strains developed ABSSSI that mimic the severe infections that occur in humans, including the large central dermonecrotic core surrounded by erythema, induration, and marked subcutaneous hemorrhage. More importantly, immunoprophylaxis with MEDI4893*, an anti-alpha-toxin human monoclonal antibody, significantly reduced the severity of disease caused by a USA300 wild-type strain to that caused by the Δhla mutant, indicating that this toxin could be completely neutralized during infection. Thus, this study illustrates a potential high standard for the development of new immunotherapeutic agents in which a toxin-neutralizing antibody provides protection to the same degree achieved with a toxin gene knockout. When MEDI4893* was administered as adjunctive therapy with a subtherapeutic dose of linezolid, the combination was significantly more efficacious than either agent alone in reducing the severity of ABSSSI.

IVIG-mediated protection against necrotizing pneumonia caused by MRSA.

New therapeutic approaches are urgently needed to improve survival outcomes for patients with necrotizing pneumonia caused by Staphylococcus aureus One such approach is adjunctive treatment with intravenous immunoglobulin (IVIG), but clinical practice guidelines offer conflicting recommendations. In a preclinical rabbit model, prophylaxis with IVIG conferred protection against necrotizing pneumonia caused by five different epidemic strains of community-associated methicillin-resistant S. aureus (MRSA) as well as a widespread strain of hospital-associated MRSA. Treatment with IVIG, either alone or in combination with vancomycin or linezolid, improved survival outcomes in this rabbit model. Two specific IVIG antibodies that neutralized the toxic effects of α-hemolysin (Hla) and Panton-Valentine leukocidin (PVL) conferred protection against necrotizing pneumonia in the rabbit model. This mechanism of action of IVIG was uncovered by analyzing loss-of-function mutant bacterial strains containing deletions in 17 genes encoding staphylococcal exotoxins, which revealed only Hla and PVL as having an impact on necrotizing pneumonia. These results demonstrate the potential clinical utility of IVIG in the treatment of severe pneumonia induced by S. aureus.

Ability of eugenol to reduce tongue edema induced by Dieffenbachia picta Schott in mice.

Dieffenbachia picta Schott (Araceae), known in Brazil as "comigo-ninguém-pode" is an ornamental plant with toxic properties. Its juice, when chewed, causes a painful edema of the oral mucous membranes, buccal ulcerations and tongue hypertrophy. This acute inflammation sometimes becomes severe enough to produce glottis obstruction, respiratory compromise and death. Eugenol (4-alil-2-metoxiphenol), the essential oil extracted from Caryophyllus aromaticus (Myrtaceae) is widely used in odontology. In this study, our objective was to standardize, in mice, a measurable methodology for the tongue edema induced by the topical application of the D. picta stem juice; evaluate the effects of eugenol in this model and compare the results with emergency treatment used in hospitals. Our results show that in spite of a small increase in edema a few minutes after administration, emergency treatment reduced by 70% the overall edema. When compared with the combination of the above drugs, eugenol, even at the smallest dose of 5 microg/kg, regardless of the chosen administration route, or the moment the treatment began, presents better results in the reduction and inhibition of the tongue edema induced by the D. picta juice.

Hypernociception and wound healing after application of cyanoacrylate ester as a tissue adhesive in rats.

OBJECTIVE: The present study assessed and compared postoperative hypernociception and skin healing after cyanoacrylate and classic suture as well as analyzed morphologic features of the tissue repair. STUDY DESIGN: The intensity of hypernociception was measured with an electronic pressure-meter test. Rats were given an incised wound in the middle of the palms of the right and left paws. The left side was treated with a silk suture, and the right with cyanoacrylate. Control groups were treated locally with dipyrone or received a systemic pretreatment with valdecoxib. RESULTS: Cyanoacrylate was associated with less inflammation (first week), and the healing wound site was rich in collagenous extracellular matrix and neovascularization. Dipyrone in combination with cyanoacrylate greatly increased the antinociceptive effect. These results were not repeated after systemic treatment with valdecoxib, suggesting that the antinociceptive effect seen in the tissue adhesive was due to formation of a physical barrier.

Clinical management of childhood bruxism / Manejo clínico do Bruxismo na infância

This paper aims to report the case of a 9-year-old male patient presented to the Pain Clinic at the education institution with a severe complaint of headache and clenching. During clinical examination, facets of tooth wear and accentuated overjet were observed. There were no joint and / or muscle anomalies. Therapy adopted was an occlusal splint with occlusal adjustments in centric performed every fifteen days in order not to impair bone growth and eruption of permanent teeth. After one month of treatment, the patient showed pain remission and remained in monitoring of dental and psychological care.

Este trabalho objetiva relatar o caso clínico de um paciente do sexo masculino, nove anos de idade, que compareceu a Clínica da Dor de uma instituição de ensino superior com queixa principal de cefaléia e apertamento dentário em vigília. Ao exame clínico, observou-se facetas de desgaste dentário e transpasse horizontal acentuado. Não foram observadas alterações articulares e/ou musculares. A terapêutica adotada foi à confecção de placa miorrelaxante em resina acrílica termoplastificável com ajustes oclusais em cêntrica realizados a cada quinze dias de forma não prejudicar o crescimento ósseo e a erupção dos dentes permanentes. Após um mês de tratamento o paciente apresentou remissão da dor e foi orientado a reduzir o tempo de uso da placa miorrelaxante. O paciente mantém-se em acompanhamento odontológico e psicológico.

Associação entre paralisia facial de Bell e disfunção temporomandibular: manejo clínico / Bell?s palsy and temporomandibular disorder association: clinical treatment

Objetivo: O objetivo deste artigo é relatar o caso clínico de um paciente do gênero masculino, de 29 anos de idade, atendido na Clínica da Dor de uma instituição de ensino superior, diagnosticado como portador de paralisia facial de Bell e desordem temporomandibular, bem como de descrever a conduta terapêutica adotada. Relato de caso: O paciente relatava como queixa principal dor contínua e localizada, no lado direito da face, na região da articulação temporomandibular (ATM), com início há dois anos e piora durante os movimentos de abertura bucal e a mastigação. Apresentava ainda prurido, lacrimejamento, zumbido e parestesia. O quadro da paralisia de Bell do tipo periférica, previamente diagnosticado, caracterizou-se pela impossibilidade de oclusão voluntária das pálpebras do lado direito, paralisia dos mús culos orbiculares da boca, risório e bucinador. Associado a essa patologia, o paciente recebeu o diagnóstico de disfunção temporomandibular do tipo mialgia mediada centralmente. A conduta terapêutica adotada foi terapia oclusal, farmacoterapia, fisioterapia, fonoaudiologia e laserterapia. Após duas semanas o paciente obteve melhora significativa do quadro doloroso e estabilização da desordem muscular. Quanto à função motora do nervo facial, pequeno ganho foi observado na mímica facial do paciente. Considerações finais: A conduta terapêutica mostrou-se satisfatória e o paciente está em acompanhamento na instituição.

Ester de cianocrilato (Super Bonder®) e sutura tradicional na implantodontia: relato de casos clínicos / Cyanocrylate esther (Super Bonder®) and standart suture in buccal implant: clinical cases reports

O artigo descreve dois casos clínicos de pacientes submetidos à cirurgia para inserção de implantes osseointegráveis e enxerto ósseo, onde foi utilizado éster de cianocrilato (Super Bonder®) como sutura. Alternativas técnicas e protocolos cirúrgicos menos invasivos minimizam as intercorrências pós-operatórias e são resultados do avanço tecnológico em biomateriais. Os resultados observados neste estudo confirmam as vantagens do uso do adesivo biológico sintético como sutura em tecidos operados que não estejam sob tensão ou sangramento profuso. Quando comparados com a sutura tradicional com fio de seda e agulha, o uso do ester de cianocrilato despendeu menor tempo cirúrgico para o fechamento da ferida, houve melhor aceitação do paciente e menor aderência de placa bacteriana no local operado.

This article describes two clinical reports of patients submitted to osteointegrated implants and bone exert with cyanocrilate ester (Super Bonder®) as suture. Less invasive tactics and cirurgic protocols minimize pos operative complications and come from biomaterials innovations. Our results confirm the advantage of tissue adhesives as suture in wounds with no tissue tensor or bloodiness. When compared to traditional nylon suture, the cyanocrilate ester dispend less operative time, patient compliance and less bacterial placa adherence in chirurgic wound.

Influência dos anti-inflamatórios na movimentação ortodôntica / The influence of antinflammatory drugs on orthodontical movement

Foi realizada revisão bibliográfica quanto à influência dos anti-inflamatórios e da dieta na fisiologia óssea e taxa de movimentação dentária. Os trabalhos analisados mostraram que quando diferentes classes de medicamentos são utilizadas por longo tempo ocorre influência na remodelação óssea, mas as modificações na taxa de movimentação dentária dependem também de parâmetros cinéticos do fármaco e do metabolismo basal do animal experimental ou do ser humano estudado. Esta relação não se mostrou linear, sendo importante para o ortodontista ter exatidão no planejamento e no controle clínico radiográfico, individualizando o tratamento ortodôntico dos pacientes que utilizam medicações sistêmicas de uso contínuo.

Hipoclorito de sódio: influência da alcalinidade cáustica na dissoluçäo do tecido pulpar / Sodium hypochlorite: influence of caustic alkalinity on the dissolution of pulpal tissue

Estudou-se a influência da alcalinidade cáustica de duas marcas comerciais de águas sanitárias - Clorox com baixa e Brilhante com alta alcalinidade cáustica -, na dissoluçäo do tecido pulpar bovino. Para o teste de dissoluçäo, confeccionou-se um um dispositivo conectado a uma bomba peristáltica que permitia a manutençäo das soluçöes anteriores e posteriores à dissoluçäo do tecido pulpar em banho-maria a 37ºC. Analisou-se a determinaçäo de aminoácidos por meio de reaçöes coradas nas soluçöes posteriores à dissoluçäo. Os resultados demonstram que näo houve diferenças estatísticas quanto ao tempo ou capacidade de dissoluçäo. Parece lícito concluir que a alta alcalinidade cáustica näo interfere na dissoluçäo do tecido pulpar, sendo confiável e menos tóxica a utilizaçäo da água sanitária Clorox como substância química auxiliar no preparo químico-mecânico dos canais radiculares