Effect of association of non-steroidal anti-inflammatory and antibiotic agents with calcium hydroxide pastes on their cytotoxicity and biocompatibility.

OBJECTIVES: Evaluate the cytotoxicity and biocompatibility of calcium hydroxide paste [Ca (OH)2] associated with 5% diclofenac sodium, ibuprofen, or amoxicillin. MATERIALS AND METHODS: Pre-osteoblast-like cells were cultivated and the MTT test was used to determine the cytotoxicity of the paste extracts after time intervals of 24, 48, 72 h, and 7 days. Tubes containing Ca (OH)2 pastes associated with the drugs and empty tubes were implanted in subcutaneous tissue of 30 rats. After 7 and 30 days, the specimens were removed and submitted to histological analysis. The data obtained were submitted to Kruskal-Wallis and Dunn tests (p ≤ 0.05). RESULTS: All the Ca (OH)2 pastes promoted cell viability after all periods. At 7 days, there was greater inflammatory tissue reaction adjacent to the implants. At 30 days, there was a significant reduction in the number of inflammatory cells, and increase in fibroblasts in all groups. In this period, a lower number of inflammatory cells and a higher number of fibroblasts were observed in the capsules adjacent to the association with diclofenac, when compared with the other mixtures (p ≤ 0.05); the capsule thickness was greater at 7 days than at 30 days. CONCLUSIONS: The Ca (OH)2 pastes associated with the drugs were not cytotoxic and presented biocompatibility after implantation in rat subcutaneous tissues. CLINICAL RELEVANCE: Ca (OH)2 pastes with anti-inflammatory or antibiotic may be clinical alternatives as intracanal medication to reduce resistant microorganisms in root canal system.

In vitro treatment of Enterococcus faecalis with calcium hydroxide impairs phagocytosis by human macrophages.

OBJECTIVE: Monocyte-derived macrophages (MDMs) ability to phagocytize and produce nitric oxide (NO) was tested against root-canal strains of Enterococcus faecalis submitted to alkaline stress. Root-canal strains were also compared with urine Enterococci. MATERIALS AND METHODS: Enterococcus faecalis were stressed with alkaline-BHI broth and incubated in vitro at a cell/bacteria ratio of 1:5. Phagocytosis was analyzed by fluorescence microscopy using acridine orange stain, and NO concentration was measured in supernatants. RESULTS AND CONCLUSIONS: Alkaline-stress significantly impaired MDMs phagocytosis of E. faecalis strains analyzed, except in ATCC4083 isolated from a pulpless tooth, but NO production was unchanged. Comparison of different strains showed the urine isolate had higher NO levels than root canal strains. Alterations in the bacterial cell wall structures after alkaline-stress possibly made bacteria less recognizable and phagocytized by MDMs but did not affect their ability to activate NO production. Furthermore, root canal strains elicited different responses by immune cells compared with strains from urine. Clinically, impaired phagocytosis of E. faecalis could contribute to their persistence in root canal systems previously treated with calcium hydroxide.

Bacterial pathogens related to chronic suppurative otitis media in individuals with cleft palate: bacteriological culture and polymerase chain reaction.

OBJECTIVE: To characterize the microbial etiology of chronic suppurative otitis media comparing the methods of classical bacteriological culture and polymerase chain reaction. DESIGN/SETTING/PATIENTS: Bacteriological analysis by classical culture and by molecular polymerase chain reaction of 35 effusion otitis samples from patients with cleft lip and palate attending the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru, Brazil. INTERVENTIONS: Collection of clinical samples of otitis by effusion through the external auditory tube. MAIN OUTCOME MEASURE: Otolaryngologic diagnosis of chronic suppurative otitis media. RESULTS: Positive cultures were obtained from 83% of patients. Among the 31 bacterial lineages the following were isolated. In order of decreasing frequency: Pseudomonas aeruginosa (54.9%), Staphylococcus aureus (25.9%), and Enterococcus faecalis (19.2%). No anaerobes were isolated by culture. The polymerase chain reaction was positive for one or more bacteria investigated in 97.1% of samples. Anaerobe lineages were detected by the polymerase chain reaction method, such as Fusobacterium nucleatum , Bacteroides fragilis , and Peptostreptococcus anaerobius . CONCLUSIONS: Patients with cleft lip and palate with chronic suppurative otitis media presented high frequency of bacterial infection in the middle ear. The classical bacteriological culture did not detect strict anaerobes, whose presence was identified by the polymerase chain reaction method.

Comparison of the Physicochemical Properties, Antimicrobial Action, and Cytotoxicity of Ambroxol Hydrochloride, N-acetylcysteine, and Calcium Hydroxide Pastes.

OBJECTIVE: To evaluate the solubility, pH, antimicrobial action, and cytotoxicity of ambroxol hydrochloride (AMB), N-acetylcysteine (NAC), and calcium hydroxide (CH) pastes for use as intracanal medications. METHODS: Solubility was determined by micro-CT, based on the paste volume remaining after immersion in water for 7 days. pH was measured by immersing acrylic tubes containing the pastes in ultrapure water and then measuring pH after 3 hours, 3 days, and 7 days. Antimicrobial action against Enterococcus faecalis was assessed based on the percentage of living cells, using the live/dead staining method under confocal microscopy. Cytotoxicity was assessed based on the cell viability of L929 fibroblast-like cells after 6, 24, and 48 hours. Cytotoxicity data were compared using the ANOVA and Tukey tests, and the antimicrobial data were compared using the Kruskal-Wallis and Dunn tests. The significance level used was 5% (α=0.05). RESULTS: The solubility values for all the study groups were significantly different (P<0.05), where the highest values were for NAC, followed by AMB, and then CH. Likewise, the pH levels were all significantly different (P<0.05), where NAC and AMB levels were acidic, and CH levels were alkaline. The antimicrobial action of AMB was significantly higher than that of CH (P<0.05), and that of NAC was also higher than that of CH, albeit not significantly. AMB and NAC were more cytotoxic than CH, and higher dilutions of CH promoted higher cell viability levels than lower dilutions of the same paste (P<0.05). CONCLUSION: The NAC and AMB pastes were more soluble and cytotoxic than the CH paste and had acidic pH levels. The AMB paste displayed the highest antimicrobial action against Enterococcus faecalis biofilm.

A new technique for tongue brushing and halitosis reduction: the X technique.

The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. OBJECTIVE: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. MATERIAL AND METHODS: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. RESULTS: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. CONCLUSION: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

Effect of Casearia sylvestris on the obliteration of dentinal tubules and the control of dental sensitivity / Efecto de Casearia sylvestris sobre la obliteración de los túbulos dentinarios y el control de la sensibilidad dental

The present study evaluated the efficacy of the mineralizing action of Casearia sylvestris ethanolic extract on bovine dentin blocks in its pure form and in dental paste, through scanning electron microscopy. The dentin blocks were immersed in artificial saliva and incubat ed at 37°C for 7 days. Subsequently, six groups were treated with different test substances and analysed qualitatively and quantitatively at 30 and 60 days. The tests used were Kruskal - Wallis and Dunn's. Shapiro - Wilk and ANOVA. The qualitative analysis at 30 days showed a difference between the groups treated with ethanolic extract and toothpaste. Quantitatively, at 30 days, treatment with ethanolic extract of Casearia showed a greater number of open dentinal tubules. At 60 days, the difference persisted on ly for the blocks treated with toothpaste. The results obtained indicated that there is a positive relationship between the use of Casearia sylvestris and obliteration of dentinal tubules

El presente estudio evaluó la eficacia de la acción mineralizante del extracto etanólico de Casearia sylvestris sobre bloques de dentina bovina en su forma pura y en pasta dental, mediante microscopía electrónica de barrido. Los bloques de dentina se sumergieron en saliva artificial y se incubaron a 37°C durante 7 días. Posteriormente, se trataron seis grupos con diferentes sustancias de ensayo y se analizaron cualitativa y cuantitativamente a los 30 y 60 días. Las p ruebas utilizadas fueron Kruskal - Wallis y Dunn's. Shapiro - Wilk y ANOVA. El análisis cualitativo a los 30 días mostró una diferencia entre los grupos tratados con extracto etanólico y pasta dentífrica. Cuantitativamente, a los 30 días, el tratamiento con ex tracto etanólico de Casearia mostró un mayor número de túbulos dentinarios abiertos. A los 60 días, la diferencia persistió sólo para los bloques tratados con pasta dentífrica. Los resultados obtenidos indicaron que existe una relación positiva entre el us o de Casearia sylvestris y la obliteración de los túbulos dentinarios

Effect of the Association of Nonsteroidal Anti-inflammatory and Antibiotic Drugs on Antibiofilm Activity and pH of Calcium Hydroxide Pastes.

INTRODUCTION: The objective of the present study was to evaluate the in vitro antibiofilm activity and pH of calcium hydroxide associated with different nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: The groups analyzed were as follows: group 1, calcium hydroxide paste with propylene glycol; group 2, calcium hydroxide paste with propylene glycol + 5% diclofenac sodium; group 3, calcium hydroxide paste with propylene glycol + 5% ibuprofen; group 4, calcium hydroxide paste with propylene glycol + 5% ciprofloxacin; and group 6, positive control (without medication). For analysis of the pH, the pastes were inserted into tubes and immersed in flasks containing ultrapure water. At the time intervals of 3, 24, 72, and 168 hours, the pH was measured with a calibrated pH meter. For microbial analysis, biofilm was induced in 30 bovine dentin blocks for 21 days. Subsequently, the pastes were placed on the blocks with biofilm for 7 days. Afterward, the pastes were removed by irrigation with sterile water, and the specimens were analyzed with a laser scanning confocal microscope with the 50 µL Live/Dead BacLight Bacterial Viability solution L7012 Kit (Molecular Probes, Inc, Eugene, OR). Data were subjected to statistical analysis at a significance level of 5%. RESULTS: The highest pH values were found for calcium hydroxide associated with ciprofloxacin in all periods analyzed. With the exception of pure calcium hydroxide paste, the other groups showed statistically significant differences (P < .05) in comparison with the positive control. CONCLUSIONS: The association of NSAIDs or antibiotic did not interfere with the pH of calcium hydroxide paste and increased the antimicrobial action of calcium hydroxide paste against Enterococcus faecalis biofilm formation.

Effect of Using Different Vehicles on the Physicochemical, Antimicrobial, and Biological Properties of White Mineral Trioxide Aggregate.

INTRODUCTION: This study evaluated the physicochemical, antimicrobial, and biological properties of white mineral trioxide aggregate (MTA) mixed with aqueous and propylene glycol extracts of Arctium lappa L. and Casearia sylvestris Sw. METHODS: The setting-time test was performed according to American Society for Testing and Materials 266/2008 and flowability by American National Standards Institute/American Dental Association 57/2012 standard specifications. The following parameters were assessed: volumetric change by micro-computed tomography; pH level and calcium ion release measured after 3 hours and 1, 3, 7, and 15 days; antimicrobial effect by the dentin decontamination method with intratubular Enterococcus faecalis viability, verified by using confocal laser scanning microscopy; and biocompatibility by histologic-morphometric analyses of inflammatory infiltrate at subcutaneous implant sites after 15, 30, and 60 days. In addition, rat alveolar tissues with implants were processed to measure tumor necrosis factor-alpha and interleukin-10 cytokines by enzyme-linked immunosorbent assay. RESULTS: The plant extracts associated with MTA significantly increased the final setting time; however, they did not influence volumetric change (P > .05) and maintained medium alkalinity and calcium ion release. Propylene glycol extracts showed higher flowability. Casearia sylvestris increased the cementing effect against E. faecalis after 24-hour and 168-hour periods. Histologic evaluation of inflammatory infiltrate showed no significant differences between plant extracts groups and the distilled water group for all periods. Tumor necrosis factor-alpha and interleukin-10 expression was similar among groups (P > .05). CONCLUSIONS: Casearia sylvestris extracts increased the antimicrobial effect of MTA and did not influence biocompatibility but changed some physicochemical properties.

Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication.

INTRODUCTION: The aim of the present study was to evaluate the pH, calcium release, solubility, and antimicrobial action against biofilms of calcium hydroxide + saline solution, Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil) (CH/P), Calen camphorated paramonochlorophenol (CMCP) (CH/CMPC), and calcium hydroxide + chlorhexidine (CH/CHX) pastes. METHODS: The pH of the pastes was determined with a calibrated pH meter placed in direct contact with each paste. The root canals of acrylic teeth (N = 10) were filled with the previously mentioned intracanal dressings and immersed in ultrapure water to measure hydroxyl (pH meter) and calcium ion release (atomic absorption spectrophotometer) at time intervals of 3, 7, 15, and 30 days. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by micro-computed tomographic imaging before (initial) and after 7, 15, and 30 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume scanning. For antimicrobial analysis, monospecies and dual-species biofilms were in vitro induced on dentin blocks (N = 20). Afterward, they were treated with the pastes for 7 days. Live/dead dye and a confocal microscope were used to measure the percentage of living cells. Data were statistically compared (P < .05). RESULTS: The highest OH- ion release values were found in 3 and 30 days. Ca2+ releases were greater in CH/CMCP. CH/P and CH/CMCP showed a higher percentage of volume loss values. CH/CHX presented the greatest antimicrobial action. CONCLUSIONS: CH/P and CH/CMPC showed higher solubility values in the period analyzed. Seven days of contact may be insufficient for calcium hydroxide + saline solution, CH/P, and CH/CMCP pastes to kill bacterial cells in the biofilms studied. Chlorhexidine added to CH favored greater effectiveness against the previously mentioned bacterial biofilms.

Antibióticos potencializam a ação antimicrobiana de cimentos endodônticos, em diferentes períodos, após a presa / Antibiotics increase the antimicrobial action of endodontic seal-ers, in different periods, after setting time

O objetivo do presenteestudo foi avaliar a atividade antibacteriana dos cimentos endodôn-ticos MTA Fillapex, Sealapex, Sealer 26 e Endofill puros e acrescidos de amoxicilina e ci-profloxacina frente a duas linhagens ATCC de Enterococcus faecalis (ATCC 29212 e ATCC 4083). Os testes foram realizados pela técnica de difusão radial dos cimentos aplicados di-retamente no ágar e impregnados em discos de papel e pelo teste de contato direto. Para a análise estatística, utilizaram-se os testes de ANOVA e Tukey com nível de significância de 5%. Os resultados mostraram que pela técnica da difusão radial, considerando os cimentos puros, o Sealapex foi o único que apresentou halos de inibição frente às duas linhagens. Já quando da associação de amoxicilina e ciprofloxacina, o MTA Fillapex revelou os melhores halos de inibição para as duas linhagens. Todos os cimentos tiveram a ação potencializada pela adição dos antibióticos (p<0,05). Pela técnica de difusão dos cimentos impregnados em discos de papel, o cimento Sealapex puro fresco demonstrou atividade antimicrobiana em todas as variáveis de tempo. Quando acrescidos dos antibióticos, todos os cimentos ti-veram a ação antimicrobiana potencializada pelas drogas, em todas as variáveis de tempo. Esse mesmo resultado foi observado na técnica do contato direto dos cimentos com ambas as linhagens. A atividade antibacteriana, frente ao E. faecalis, dos cimentos MTA Fillapex, Endofill, Sealer e Sealapex, acrescidos dos antibióticos amoxicilina e ciprofloxacina, foi potencializada mesmo após um longo período da presa dos cimentos.

The objective of this study was to evaluate the antibacterial activity of different endodon-tic cements (MTA Fillapex, Sealapex, Sealer 26, and Endofill), both pure and mixed with 5% of amoxicillin or ciprofloxacin, against two strains of Enterococcus faecalis (ATCC 29212 and ATCC 4083). Bacterial susceptibility testing was conducted by radial diffusion methods and direct contact test after different periods. Data were subjected to ANO-VA and Tukey test with a significance level of 5%. Sealapex was the only pure sealer to promote the inhibition of bacterial growth against both strains in different experimental periods. However, all cements present an increase in antibacterial activity by the addition of antibiotics (p<0.05). MTA Fillapex and Sealapex associated with amoxicillin promoted increased values for bacterial growth against ATCC 29212 and ATCC 4083 in comparison to other groups (p<0.001), including extended periods after setting time. The association of antibiotic agents increased the antibacterial effect of the evaluated sealers against the strains of E. faecalis.

Análise do efeito do tratamento com nanopartículas de prata (AGNO3 ) revestidas com pectina sobre a angiogênese induzida pelas células do Tumor de Ehrlich em modelo da membrana corioalantoidea / Analysis of the effect of treatment of silver nanoparticles (AgNO3 ) with pectin-coated on ehrlich tumor cell-induced angiogenes in the chorioalantoid membrane model

Avaliou-se a interferência das nanopartículas de prata sobre a angiogênese relacionada ao crescimento tumoral. A pesquisa científica foi realizada através da incubação de 42 ovos embrionados de galinhas. Após 24 horas de incubação, esses mesmos ovos foram separados em seis grupos contendo sete ovos cada, para os tratamentos com: Grupo 1: Soro fisiológico; Grupo 2: Tumor de Ehrlich (TE); Grupo 3: Nanopartículas de prata; Grupo 4: Prednisolona; Grupo 5: Nanopartículas de prata e Tumor de Ehrlich; Grupo 6: Prednisolona e Tumor de Ehrlich. Após o tempo total de incubação, as membranas corioalantoideas (MCAs) foram removidas, e analisadas através do microscópio de luz e fotografadas. O grupo 1 apresentou um padrão normal de crescimento e foi utilizado como controle negativo; O grupo 2 apresentou um aumento na quantidade de vasos sanguíneos; o grupo 3 apresentou baixa interferência na angiogenese embrionária e não contribuiu para o desenvolvimento do tumor; O grupo 4 demonstrou diminuição no desenvolvimento de vasos sanguíneos; O grupo 5 indicou que as nanopartículas de prata, quando associadas ao TE, não favorece o desenvolvimento tumoral e o grupo 6 demonstrou que o fármaco prednisolona associado ao TE, se comporta como um excelente inibidor de neoangiogese tumoral. Considera-se através da técnica realizada a possibilidade de utilizar nanopartículas de prata para o tratamento de células tumorais de Ehrlich, porém devem ser realizados testes confirmatórios para estudar a relação da substância descrita às células tumorais empregadas.

The interference of silver nanoparticles on angiogenesis related to tumor growth was evaluated. Scientific research was carried out by incubating 42 embryonated chicken eggs. After 24 hours of incubation, these same eggs were separated into six groups containing seven eggs each, for treatments with: Group 1: Saline; Group 2: Ehrlich's tumor (ET); Group 3: Silver nanoparticles; Group 4: Prednisolone; Group 5: Silver nanoparticles and Ehrlich's Tumor; Group 6: Prednisolone and Ehrlich's Tumor. After the total incubation time, the chorioallantoid membranes (MCAs) were removed, and analyzed using a light microscope and photographed. Group 1 showed a normal growth pattern and was used as a negative control; Group 2 showed an increase in the amount of blood vessels; group 3 showed low interference in embryonic angiogenesis and did not contribute to the development of the tumor; Group 4 demonstrated a decrease in the development of blood vessels; Group 5 indicated that silver nanoparticles, when associated with TE, do not favor tumor development and group 6 demonstrated that the drug prednisolone associated with TE, behaves as an excellent inhibitor of tumor neoangiogenesis. Through the technique performed, the possibility of using silver nanoparticles for the treatment of Ehrlich tumor cells is considered, however, confirmatory tests should be performed to study the relationship of the substance described to the tumor cells employed.

Effects of the association of antifungal drugs on the antimicrobial action of endodontic sealers.

This in vitro study aimed to determine the susceptibility of oral specimens and ATCC lineages of Candida albicans for five endodontic sealers, which were pure and associated with two antifungal drugs, and to analyze their effect on the physical properties. For this purpose, 30 lineages of C. albicans, collected from the oral cavity of patients assisted at the endodontics clinic of the Universidade Sagrado Coração, were analyzed. Yeasts susceptibility to the sealers was tested by diffusion on agar plates. Physical properties were evaluated according to the ADA specification no. 57. The pure versions of the Sealer 26, AH Plus, Endofill, Fillapex, and Sealapex demonstrated antifungal activity, with Endofill presenting the greatest inhibition zones. All cements, except for Endofill, had their antifungal actions enhanced by addition of ketoconazole and fluconazole (p < 0.05), and the AH Plus presented the best antifungal activity. The addition of antifungal drugs did not interfere with the setting time and flowability of the sealers. It was concluded that the addition of antifungals to endodontic sealers enhanced the antimicrobial action of most cements tested without altering their physical properties.

Analysis of the reaction of subcutaneous tissues in rats and the antimicrobial activity of calcium hydroxide paste used in association with different substances.

The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG),Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract from Casearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.

Avaliação in vitro da atividade antifúngica da pasta de hidróxido de cálcio associada a diferentes fármacos, frente à Candida albicans / In vitro evaluation of antifungal activity of calcium hydroxide paste mixed to different drugs, against Candida albicans

Introdução: a frequência de micoses invasivas causadas por patógenos fúngicos oportunistas tem aumentado significativamente nas últimas décadas. Entre os principais agentes etiológicos de micoses oportunistas está a Candida albicans. Essa levedura apresenta vários fatores de virulência importantes para produção de doença. Alguns estudos têm demonstrado que C. albicans coloniza canais radiculares e túbulos dentinários. O espectro de atividade antimicrobiana do curativo de hidróxido de cálcio deve incluir essa levedura. Objetivos: o objetivo da presente pesquisa foi determinar a suscetibilidade in vitro de quatro linhagens de C. albicans coletadas da cavidade oral e uma estirpe padrão ATCC 10231 a pastas de hidróxido de cálcio associadas a drogas antifúngicas, antibióticas e anti-inflamatórias. A eficiência das pastas de Ca(OH)2 associadas às drogas sobre as leveduras foram analisadas pelo método da difusão radial e, também, pela técnica do contato direto com os medicamentos. Os dados foram analisados pelo teste de Kruskal-Wallis e o pós-teste de Dunn, para indicar as diferenças entres os grupos, com um nível de significância de 5%. Resultados: todas as medicações antifúngicas potencializaram a ação das pastas de hidróxido de cálcio contra a Candida albicans. Conclusões: a associação de medicações antifúngicas às pastas de Ca(OH)2 pode ser uma alternativa como medicação intracanal. (AU)

Introduction: the frequency of invasive mycoses caused by opportunistic fungal pathogens has increased significantly in the last decades. Among the main etiological agents of opportunistic mycoses is Candida albicans. This yeast has several important virulence factors for producing disease. Some studies have demonstrated that C. albicans colonized root canals and dentinal tubules. The spectrum of antimicrobial activity of calcium hydroxide dressing should include this yeast. Objectives: the aim of the present study was to determine the in vitro susceptibility of four C. albicans strains collected from the oral cavity and a standard strain ATCC 10231 to calcium hydroxide paste associated with antifungal, antibiotic and anti-inflammatory drugs. The efficiency of the Ca(OH)2 paste associated with the drugs on the yeasts was analyzed by the radial diffusion method and also by the direct contact method. Data were analyzed by Kruskal Wallis test and the Dunn post-test were used to indicate the differences between the groups with a significance level of 5%. Results: all antifungal drugs increased the action of the calcium hydroxide pastes against Candida albicans. Conclusions: the association of antifungals with Ca(OH)2 may be considered for use as intracanal medicaments (AU).

A new technique for tongue brushing and halitosis reduction: the X technique

Abstract The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. Objective: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

In vitro alkaline pH resistance of Enterococcus faecalis.

Enterococcus faecalis is a bacterial species often found in root canals with failed endodontic treatment. Alkaline pastes are widely used in Endodontics because of their biocompatibility and antimicrobial activity, but this microorganism can resist alkalinity. The purpose of this study was to evaluate in vitro the alkaline pH resistance of E. faecalis for different periods up to 14 days. Samples were obtained from the oral cavity of 150 patients from the Endodontic clinic. The pH of the experimental tubes (n=84) was first adjusted with 6M NaOH to pH values of 9.5, 10.5, 11.5 and 12.5 (21 tubes per pH). Twenty clinical isolates and the ATCC 29212 strain were tested. The 5 positive controls and experimental tubes of each pH were inoculated with 10 µL of bacterial suspension and incubated at 36 °C for 24, 48 and 72 h, 7 and 14 days. For each period, the turbidity of the medium was visually compared with a 0.5 McFarland standard. The presence of the microorganism was confirmed by seeding on M-Enterococcus agar. Four tubes containing BHI broth adjusted to the tested pHs were incubated for 14 days to verify if pH changes occurred. The pH of inoculated BHI broth was also measured on day 14 to determine if the microorganism acidified the medium. The growth of all E. faecalis strains occurred at pH 9.5 to 11.5 in all periods. Although turbidity was not observed at pH 12.5, there was growth of 13 and 2 strains at 24 and 48 h, respectively, on M-Enterococcus agar. No tube showed growth at pH 12.5 after 72 h. It was concluded that E. faecalis can survive in highly alkaline pH, and some clinical isolates require 72 h at pH 12.5 to be killed.

Influence of radiopacifying agents on the solubility, pH and antimicrobial activity of portland cement.

The aim of this study was to evaluate the interference of the radiopacifiers bismuth oxide (BO), bismuth carbonate (BC), bismuth subnitrate (BS), and zirconiun oxide (ZO) on the solubility, alkalinity and antimicrobial properties of white Portland cement (WPC). The substances were incorporated to PC, at a ratio of 1:4 (v/v) and subjected to a solubility test. To evaluate the pH, the cements were inserted into retrograde cavities prepared in simulated acrylic teeth and immediately immersed in deionized water. The pH of the solution was measured at 3, 24, 72 and 168 h. The antimicrobial activity was evaluated by a radial diffusion method against the microorganisms S. aureus (ATCC 25923), P. aeruginosa (ATCC 27853), E. faecalis (ATCC 29212) and C. albicans (ATCC 10231). The zone of microbial growth inhibition was measured after 24 h. The addition of BS and BC increased the solubility of the cement. The pH values demonstrated that all materials produced alkaline levels. At 3 h, BS showed lower pH than WPC (p<0.05). At 168 h, all materials showed similar pHs (p>0.05). The materials did not present antimicrobial activity for S. aureus, P. aeruginosas and E. faecalis (p>0.05). With regards to C. albicans, all materials formed an inhibition zone, mainly the mixture of WPC with ZO (p<0.05). The type of radiopacifier incorporated into WPC interfered with its physical and antimicrobial properties. ZO was found to be a viable radiopacifier that can be used with WPC.

Residues of calcium hydroxide-based intracanal medication associated with different vehicles: a scanning electron microscopy evaluation.

This study evaluated the presence of residues after removal of calcium hydroxide [Ca(OH)(2) ] associated with different vehicles. Thirty single-rooted teeth were instrumented to a master apical file #25 using 2.5% NaOCl as main irrigant and 17% trisodium EDTA (ethylenediaminetetraacetic acid) as final agent irrigant. Then, the root canals were dressed with Ca(OH)(2) associated with silicone oil (Group 1), 2% chlorhexidine gluconate (Group 2), or propylene glycol (Group 3). After coronal sealing, all teeth were kept in a moist environment at room temperature. After 7 days, the teeth were reopened and medicaments were removed using 5 mL of saline solution and instrumentation with master apical file followed by new irrigation with 5 mL of 2.5% NaOCl. Subsequently, teeth were split longitudinally and assessed by scanning electron microscopy. The wall cleanliness of the cervical and apical thirds of the roots were evaluated and scored by three blinded examiners. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests at 5% level of significance. All roots had residues of Ca(OH)(2) on the canal walls. All experimental groups had similar results (P > 0.05) regardless of the third evaluated. There was significant difference between the apical and cervical thirds only in Group 3 (P < 0.05). Association of different vehicles to Ca(OH)(2) does not influence the persistence of residues on the root canal walls.

In vitro susceptibility of oral Candida albicans strains to different pH levels and calcium hydroxide saturated aqueous solution.

Candida albicans is present in the oral cavity and in the whole digestive tract of humans and other animals, being frequently related to endodontic treatment failure. The present study determined the incidence of C. albicans in the oral cavity and the susceptibility of isolates to different pH values and saturated calcium hydroxide aqueous solution at pH 12.5. Sixty-five patients attending the Endodontic Clinic at the Sagrado Coração University participated in the study. The collected samples were cultivated in selective media for C. albicans and the isolates were tested in terms of resistance to both alkaline pH and saturated aqueous solution of calcium hydroxide. In relation to time variables, yeast viability was assessed by the Sabouraud's agar culture and fluorescein diacetate and ethidium bromide fluorescent staining method. Results from the different pHs and experimental times, including those from different techniques measuring fungal viability, were compared using the chi-square and Fisher's exact tests (α=0.05). The yeasts became completely inviable after 48 h of contact with the calcium hydroxide solution. On the other hand, when exposed to the alkaline culture broth, the yeasts were found to be viable at pHs 9.5 and 10.5 for up to 7 days. In conclusion, C. albicans can only be completely inhibited by direct contact with saturated calcium hydroxide aqueous solution after 48 h of exposure.

Avaliação do pH, liberação de íons cálcio e atividade antimicrobiana do cimento Portland associado a Bambusa textilis em diferentes proporções / Analysis of pH, calcium ion release and antibacterial activity of Portland cement associated to Bambusa textilis in different proportion

Introdução: há uma busca incessante por agentes fitoterápicos na medicina e odontologia. Dentro da endodontia, busca-se uma substância que potencialize os efeitos biológicos e antimicrobianos do hidróxido de cálcio como curativo de demora. Não há na literatura relatos sobre a associação do cimento Portland com a Bambusa textilis, uma planta nativa da China, onde é usada na elaboração de medicamentos, pois se trata de uma fonte importante de resinas, sendo, portanto utilizadas por seu poder anti-inflamatório, anticatarral, anticonvulsivante e antitérmico. Sabendo da semelhança do cimento Portland com o MTA, e que esse ultimo apresenta bons resultados físico-químicos, surge a dúvida da possibilidade da associação, com a finalidade de melhorar as atividades antimicrobianas, e a interferência na liberação de íons cálcio e hidroxila. Objetivo: avaliar o pH, liberação de íons cálcio e atividade antimicrobiana do cimento Portland associado a Bambusa textilis em diferentes proporções. Metodologia: os cimentos experimentais foram 3 g Cimento Portland + 1,2 ml de Bambusa textilis (G1); 3 g Cimento Portland + 0,6 ml de água + 0,6 de Bambusa textilis (G2); 3 g Cimento Portland + 0,9 ml água + 0,3 ml de Bambusa textilis (G3); 3 g Cimento Portland puro (controle) + 1,2 ml água (G4); Bambusa textilis (controle): 20 microlitros por poço. Para os testes de pH e liberação de íons cálcio foram utilizados tubos de polietileno, os quais foram preenchidos com os cimentos e imersos em frascos contendo água deionizada. As mensurações foram por meio de um peagâmetro e espectrofotômetro de absorção atômica. Para a análise da atividade antimicrobiana, foi utilizada a técnica de difusão radial com cepa de Enterococcus faecalis. Os halos de inibição foram mensurados com auxílio de um paquímetro digital. A análise estatística foi realizada pelo teste ANOVA para comparação global, e teste de Tukey para comparações individuais, com significância de 5%. Resultados: os valores de pH se mostraram próximos ao neutro para todos os grupos em todos os períodos experimentais. Houve liberação de íons cálcio e ocorreu em todos os grupos e em todos os períodos experimentais. Em relação à atividade antimicrobiana, nenhuma das proporções apresentou atividade. Conclusão: a associação da Bambusa textilis ao cimento Portland manteve seu pH e liberação de íons cálcio, mas não potencializou sua atividade antimicrobiana frente ao E. faecalis. (AU)

Introduction: there is a search for phytotherapeutic agents in medicine and dentistry. Within endodontics, a substance that potentiates the biological and antimicrobial effects of calcium hydroxide as a delay dressing is sought. There are no reports in the literature about the association of Portland cement with Bambusa textilis, a plant native to China, where it is used in the manufacture of medicines, since it is an important source of resins and is therefore used for its anti-inflammatory power, anticonvulsive and antipyretic. Knowing the similarity of the Portland cement with the MTA, and that the latter presents good physicochemical results, the possibility of the association arises, with the purpose of improving the antimicrobial activities, and the interference in the release of calcium and hydroxyl ions. Aim: to analyze the pH, calcium ion release and antibacterial activity of Portland cement associated to Bambusa textilis in different proportions. Methods: the experimental cements ́ proportions were: 3 g of Portland cement + 1.2 ml of Bambusa textilis (G1); 3 g of Portland cement + 0.6 ml of water + 0.6 of Bambusa textilis (G2); 3 g of Portland cement + 0.9 ml of water + 0.3 ml of Bambusa textilis (G3); 3 g of pure Portland cement (control group) + 1.2 ml of water (G4); Bambusa textilis (control group): 20 µLper well. Polyethylene tubes filled with the cements and immersed in deionized water were employed. Calcium ion release was analyzed using an atomic absorption spectrophotometer and the change in pH was determined through a pH meter. For the analysis of antibacterial activity, a digital radial diffusion assay with a Enterococcus faecalis strain was utilized. Statistical analysis was performed using ANOVA and Tukey's tests. The level of significance was set at P = 0.05. Results: pH values were close to neutral for all of the experimental groups in all periods evaluated. Calcium ion release was observed in all experimental groups and evaluation periods. Regarding the antibacterial activity, this property could not be detected in any of the proportions used in this study. Conclusions: the association of Bambusa textilis to Portland cement, preserved its pH values and its calcium ion release property. Nevertheless, it did not improve its antibacterial activity against E. faecalis strains. (AU)