Estudo da rugosidade e da morfologia superficial do esmalte de dentes decíduos submetidos a diferentes métodos profiláticos / Study of the superficial roughness of the enamel of deciduous teeth submitted to different prophylactic methods

O controle da doença cárie é um dos maiores desafios na Odontologia. O controle do biofilme, de forma mecânica pelo paciente ou pelo profissional, ainda é o melhor método preventivo Este trabalho tem como objetivo a realização de um estudo in vitro da rugosidade do esmalte de dentes decíduos submetidos a quatro métodos profiláticos diferentes. Selecionamos 32 faces proximais de dentes decíduos hígidos, que foram divididos em 4 grupos. No primeiro grupo utilizamos para o polimento mistura de pedra-pomes (SSWHITE)® e água destilada e realizamos polimento utilizando taça de borracha em caneta de baixa rotação; no segundo, pasta profilática Clinpro Prophy Paste (3M)®também com taça de borracha em caneta de baixa rotação; no terceiro jato de bicarbonato de sódio (Polident) e no quarto jato de glicina Clinpro Prophy Powder(3M). Todos os procedimentos foram realizados pelo mesmo operador, que foi calibrado na busca de reprodução de situação clínica. Em cada espécime os procedimentos foram realizados durante 10 segundos com os produtos e equipamentos determinados. Após os procedimentos profiláticos os dentes foram lavados e armazenados em água destilada até o momento das leituras. As leituras para mensuração da rugosidade superficial em micrometros foram realizadas antes e após os procedimentos profiláticos por meio do Perfilômetro Óptico Wyko NT1100 INPE. Todos os grupos provocaram um aumento do valor de Rugosidade aritmética Ra, que é a rugosidade provocada por picos e vale do esmalte de dentes decíduos, sendo que o grupo 4 do (bicarbonato) que apresentou melhores resultados por apresentar menor variação em analise estatísticas, através da ferramenta teste t-Student mostrou que não houve variação de Ra inicial entre os 4 grupos

Caries disease control is one of the greatest challenges in dentistry. The biofilm control mechanically by the patient or by the professional is still the best preventive method. This work aims to perform an in vitro study of the enamel roughness of deciduous teeth submitted to four different prophylactic methods. We selected 32 faces close to healthy deciduous teeth, which were divided into 4 groups. In the first group we used a mixture of pumice (SSWHITE) ® and distilled water polishing with rubber cup in a low rotation pen; in the second group we used Clinpro Prophy Paste (3M) ® prophylactic paste also with rubber cup in low rotation pen, in the third group the polishing with sodium bicarbonate jet (Polident) and in the fourth group with glycine jet Clinpro Prophy Powder (3M ). All procedures were performed by the same operator properly calibrated for 10 seconds with parameters controlled after the prophylactic procedures the teeth were washed and stored in distilled water until readings. The readings for measuring surface roughness in micrometers will be performed before and after the prophylactic procedures using the Wyko NT1100 INPE apparatus obtaining the Ra value. All the prophylactic methods caused an increase in the Ra value, with the bicarbonate group 4 having the best results in statistical analysis the tStudent test tool and there was no initial Ra variation among the 4 groups

Pigmentações extrínsecas negras do esmalte em Odontopediatria / Pigmentos negros extrínsecos del esmalte en Odontopediatría / Extrinsic dark-pigmentation of the tooth enamel in pediatric dentistry

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente(AU)

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient(AU)

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente(AU)

Dissemination of periodontal pathogens in the bloodstream after periodontal procedures: a systematic review.

BACKGROUND: To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude, duration, prevalence and nature of bacteremia caused by periodontal procedures. STUDY DESIGN: Systematic Review. TYPES OF STUDIES REVIEWED: MEDLINE, EMBASE and LILACS databases were searched in duplicate through August, 2013 without language restriction. Observational studies were included if blood samples were collected before, during or after periodontal procedures of patients with periodontitis. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS). RESULTS: Search strategy identified 509 potentially eligible articles and nine were included. Only four studies demonstrated high methodological quality, whereas five were of medium or low methodological quality. The study characteristics were considered too heterogeneous to conduct a meta-analysis. Among 219 analyzed patients, 106 (49.4%) had positive bacteremia. More frequent bacteria were S. viridans, A. actinomycetemcomitans P. gingivalis, M. micros and species Streptococcus and Actinomyces, although identification methods of microbiologic assays were different among studies. CLINICAL IMPLICATIONS: Although half of the patients presented positive bacteremia after periodontal procedures, accurate results regarding the magnitude, duration and nature of bacteremia could not be confidentially assessed.

Detection of specific periodontal microorganisms from bacteraemia samples after periodontal therapy using molecular-based diagnostics.

AIM: The aim of this study was to assess the presence of subgingival pathogens in peripheral blood samples from periodontitis patients before and after scaling and root planing (Sc/RP) using nested polymerase chain reaction (nested PCR). MATERIALS AND METHODS: Peripheral blood samples were obtained from 42 patients with severe generalized chronic or aggressive periodontitis. In each patient, four samples of peripheral blood were drawn at different times: immediately before the Sc/RP procedure; immediately after Sc/RP; 15 and 30 min. post-Sc/RP. Blood samples were analysed for bacteraemia with anaerobic culturing and nested PCR, using universal bacterial primers that target the 16S-rRNA gene of most bacteria, subsequently re-amplified with specific primers to Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Eikenella corrodens, Campylobacter rectus and Prevotella intermedia, using a modified phenol-chloroform method for DNA extraction. RESULTS: Presence of specific periodontal pathogens in peripheral blood after treatment was detected in 54.8% of the patients, in 47.6% with anaerobic culturing and in 19% with nested PCR. In 16.6%, the periodontal pathogens were detected before Sc/RP. P. gingivalis and A. actynomicetemcomitans were the pathogens most frequently detected in the bloodstream before and after Sc/RP. CONCLUSIONS: Nested PCR demonstrated the presence of DNA from periodontal pathogens in blood samples in severe periodontitis patients before, during and after periodontal therapy. The use of these molecular-based techniques may improve the accuracy from the results obtained by haemoculture.

Treatment of chronic periodontitis and its impact on mastication.

BACKGROUND: The aim of the present study is to assess the impact of conventional periodontal treatment of chronic periodontitis on the perception of mastication. METHODS: The patients (n = 28; age range: 23 to 56 years, mean age: 37.9 years) were evaluated on two occasions (before and after treatment) with a 45-day interval using the Oral Impact on Daily Performance questionnaire. An electromyography system was used for the determination of activity in muscles of mastication and bite force. Masticatory performance was assessed using a test material. The median particle size of the masticated material was determined using a sieve method and the Rosin-Rammler equation. The clinical criteria were the number of teeth and probing depth, both determined by a single calibrated observer masked to the treatment phase. The data were analyzed in the pretreatment and post-treatment periods using Wilcoxon test; Spearman correlation coefficient; and two multiple linear regression models (backward stepwise procedure). RESULTS: There was a significant negative correlation between the number of teeth (number of mastication units) and difficulty eating (P <0.05) before and after treatment. Probing depth had a positive relationship with the total Oral Impact on Daily Performance score before treatment (P <0.01). CONCLUSIONS: The subjective perception of the impact of oral health on mastication diminished after periodontal treatment. The number of teeth had considerable importance in the perception of impact on mastication in the sample studied.

Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial.

OBJECTIVES: Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12% chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group). METHODS: This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12% CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period. RESULTS: Intergroup comparisons showed statistically higher (p<0.05) stain intensity and extent index as well as calculus formation over the study in test surfaces as compared to control surfaces. Thus, 26.19% of test surfaces presented calculus, whereas calculus was observed in 4.52% in control surfaces. CONCLUSIONS: The presence of plaque increased 0.12% CHX side effects. These results strengthen the necessity of biofilm disruption prior to the start of CHX mouthrinses in order to reduce side effects.

Staining and calculus formation after 0.12 percent chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial

OBJECTIVES: Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12 percent chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group). METHODS: This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12 percent CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period. RESULTS: Intergroup comparisons showed statistically higher (p<0.05) stain intensity and extent index as well as calculus formation over the study in test surfaces as compared to control surfaces. Thus, 26.19 percent of test surfaces presented calculus, whereas calculus was observed in 4.52 percent in control surfaces. CONCLUSIONS: The presence of plaque increased 0.12 percent CHX side effects. These results strengthen the necessity of biofilm disruption prior to the start of CHX mouthrinses in order to reduce side effects.

Effect of prophylactic treatments on the superficial roughness of dental tissues and of two esthetic restorative materials.

Dental prophylaxis is a common way to remove dental plaque and stain, both undesirable factors in most dentistry procedures. However, besides cleaning the tooth surface, prophylactic techniques may increase the surface roughness of restorations and dental tissues, which, in turn, may result in plaque accumulation, superficial staining and superficial degradation. This study evaluated the effect of three prophylactic techniques--sodium bicarbonate jet, pumice paste and whiting paste--on the superficial roughness of two restorative materials--a composite resin and a compomer--and on the superficial roughness of two dental surfaces--enamel and cementum/dentin--through rugosimetric and scanning electron microscopy (SEM) analysis. Statistical analysis of the rugosimetric data showed that the use of pumice paste on enamel produced a significantly smoother surface than the natural surface. However, comparing the effect of the three techniques, prophylaxis with the pumice paste produced a rougher surface than did the other techniques as regards enamel and cementum/dentin probably due to its abrasiveness. On composite resin, the pumice paste only produced a rougher surface than did the whiting paste. On compomer, all of the applied treatments produced similar results. Based on rugosimetric and SEM analysis, we could conclude that the prophylactic treatments employed did not improve roughness of the studied surfaces. As to the effects of the techniques, they were different depending on the surfaces on which the prophylactic treatments were applied.

Estudo sobre a ocorrência de traumatismos decorrentes do uso de fio dental em crianças de cinco a 12 anos / Study about the occurrence of gingival traumas due to the usage of dental floss with children agedfive to 12 years old

Verificou-se a existência de associaçäo entre faixa etária e habilidade no uso do fio dental em crianças de cinco a 12 anos. Foram observadas quatro variáveis do uso do fio, capacidade, ocorrência de traumatismo e índice de gengivite. Após análise estatística, observou-se que tanto a freqüência quanto a capacidade motora no uso do fio estäo associadas positivamente com a faixa etária. A ocorrência de traumatismos também está associada, porém com menos intensidade. Näo há evidências de que índices de gengivites mais altos estejam associados com traumatismos mais graves

Estudo "in vivo" da concentraçäo de flúor em saliva após utilizaçäo de fio e fita dental fluoretados / In vivo study of fluoride concentration in saliva after utilization of dental floss and dental tape with fluoride

Os autores verificaram "in vivo" a concentraçäo de fluoreto nos fluídos orais de 10 voluntários, após o uso de fio e fita dental com flúor durante um minuto em cada arco dental. O grupo que usou fio fluoretado mostrou logo após o uso do produto, um incremento médio estatisticamente significativo de 0,0025 ppm, D.P.=0,0014 (12,82 por cento), enquanto o grupo que usou a fita fluoretada teve um incremento médio estatisticamente significativo de 0,0045 ppm, D.P.=0,0026 (22,61 por cento). Cinco minutos após o uso do início do experimento da ordem de -7,69 por cento e -10,10 por cento, respectivamente. Ao final, verificou-se que houve uma eliminaçäo total do fluoreto na saliva, obtendo-se valores -3,6 por cento, e -7,0 por cento, respectivamente, menores que os iniciais

Bacteremias posteriores a la profilaxis dental en pacientes pediátricos / Bacteremias following dental prophylaxis in pediatric patients

En este trabajo se trata de demostrar, mediante una investigación a nivel hospitalario, la entrada de microorganismos que normalmente habitan en la flora bucal, al torrente circulatorio (bacteremias transitorias), a consecuencia de una manipulación dental, pero que pueden llegar a causar inflamación del endocardio