Effect of glucosamine sulphate on the temporomandibular joint of ovariectomised rats.

Glycosamine is an amino-monosaccharide present in connective and cartilage tissues that contribute to the maintenance, resistance, flexibility, and elasticity of these tissues. This study aimed to determine the in vivo effects of glucosamine sulphate (GS) on the temporomandibular joint (TMJ) of ovariectomised rats (OVX).Thirty-two rats were distributed into four groups as follows: G1, sham-OVX+saline solution; G2, sham-OVX+glucosamine sulphate (80mg/kg) - oral administration; G3, OVX+saline solution; G4, OVX+glucosamine sulphate (80mg/kg) - oral administration. Animals were treated for seven days. The TMJ was removed and stained with toluidine blue. The thickness of the cartilage layers and cytokines IL-1ß, IL-6, and TNF-α levels were determined by histomorphometry and immunoassay, respectively. The administration of GS to OVX females did not change the thickness of condylar cartilage when compared with the other groups (p>0.05). There was an increase in the total cartilage thickness in sham-OVX females. IL-1ß and TNF-α levels were significantly lower in sham-OVX females than in OVX females, indicating that ovariectomy acts as potent cytokine inducer. IL-6 levels were significantly higher in sham-OVX females. GS did not affect cytokine production in OVX females (p>0.05). In conclusion, the administration of GS did not affect cytokine levels, but did induce an increase in the total thickness of the TMJ condylar cartilage in sham-OVX rats.

A new model of classification of third molars development and its correlation with chronological age in a Brazilian subpopulation.

The present study correlated the mineralization of third molars to chronological age using a modified classification based on Demirjian's stages in a Brazilian subpopulation and compared with the original classification. A total of 1082 patients with age ranging from 6 to 26 years were included in the sample, with at least one third molar on panoramic radiographs. The third molars were classified according to the original Demirjian classification (8 stages) and a new model based on the Demirjian method, where the original stages were grouped into four stages: AB-enamel mineralization; CD-crown dentin mineralization; EFG-root formation; and H-complete development. Statistical analyses were performed by Kruskal-Wallis/Dunn tests (α = 0.05) and the multinomial logistic regression model. Data were analyzed according to percentiles for the probability of an individual being over 18 years old. The mean ages of the stages in both classifications did not present a significant difference between superior and inferior arches (p < 0.05). The differences in mean ages between all the stages of mineralization were statistically significant (p < 0.001) only for the 4-stage classification. Males attained root formation and complete formation earlier than females (p < 0.05) in the 4-stage classification. The modified classification system showed dependence between chronological age and mineralization stages of third molars, simplifying the age estimation process. At stage H, females present a 95.7% chance of being over 18, while for males, this probability is 89.6%. This modified classification system simplifies the dental age estimation process based on third molars and can be used as a reference for future studies.

Evaluation of the screw tent-pole technique for the repair of anterior maxilla width defects: a prospective, randomized, split-mouth study.

The aim of this prospective study was to compare horizontal bone augmentation in the anterior maxilla associated with two types of tenting screw used in the screw tent-pole technique. Ten patients with a premaxilla width deficiency underwent grafting with protein-free xenograft bone. A split-mouth design was used, with sides allocated randomly to receive standard and wide-head tenting screws. Implants were installed after 9 months. Patients underwent clinical, cone beam computed tomography (CBCT), and histomorphometric evaluations. The buccal aspect of the ridge was classified as flat or concave in shape. Clinical measurements showed width augmentation of 1.05mm, 2.45mm, and 2.70mm for standard screws and 1.50mm, 3.10mm, and 3.45mm for wide-head screws, at the ridge, 5mm, and 10mm, respectively. CBCT showed width augmentation of 0.74mm, 3.88mm, and 4.72mm for standard screws and 0.91mm, 4.05mm, and 4.37mm for wide-head screws, at the crest, 5mm, and 10mm, respectively. Histomorphometric analysis showed 30.99% ± 26.43% vital bone tissue, 11.32% ± 9.68% graft residue, and 57.66% ± 21.85% connective tissue for standard screws and 32.64% ± 20.28%, 9.73% ± 5.82%, and 57.61% ± 20.15%, respectively, for wide-head screws. Flat alveolar ridges showed the lowest percentage of vital bone. New bone formation seems to be optimized on concave ridges. There was no statistically significant difference in bone gain results between standard and wide-head tenting screws.

The effect of omega-3 in temporomandibular joint synovial tissues of rats with induced arthritis: pilot study.

This study evaluated the effect of systemic administration of omega-3 on the expression of interleukins IL-1ß and IL-10 and tumour necrosis factor alpha (TNF-α) and on the thickness of cartilage in the temporomandibular joint (TMJ) inflammatory model induced by complete Freund's adjuvant (CFA). Thirty-two adult rats were divided equally into four groups: control, CFA (induced arthritis), and induced arthritis animals treated with dexamethasone or omega-3. The TMJs were then removed and assigned to histomorphometric analysis or immunoassay. The Kruskal-Wallis test with Dunn post hoc test was applied to the data; the significance level was set at 5%. IL-1ß levels (median; interquartile range) were higher (P<0.0001) in the CFA group (46.4 ng/ml; 39.4-53.3) than in the control group (1.81 ng/ml; 1.5-5.4), but there were no differences between the control, omega-3, and dexamethasone groups. TNF-α levels were also higher (P<0.0001) in the CFA group (122.7 ng/ml; 92.9-284.7) than in the control group (29.1 ng/ml; 23.7-31.3). IL-10 levels were lowest (P<0.0001) in the CFA group (73.5 ng/ml; 52.8-90.5), and no differences were found amongst the other groups. In conclusion, omega-3 successfully reduced the damage in the TMJ of induced arthritis rats. Further investigations are warranted to confirm whether the administration of omega-3 has a comparable effect to glucocorticoids in rheumatoid arthritis patients.

Assessment of the bioavailability of an antibiotic prophylactic protocol in patients undergoing third molar surgery.

The aim of this prospective study was to determine the antibiotic bioavailability of a prophylactic protocol in patients undergoing third molar surgery. Samples from 25 patients were analysed (average age 21 ± 3.89 years, range 18-33 years; 14 female). The patients received single-dose prophylaxis of 2 g amoxicillin orally 1 hour prior to third molar surgery. Venous blood (1.5 ml) and blood from the third molar socket (1.50 ml) were obtained. The amoxicillin plasma concentration was determined in both samples by high performance liquid chromatography with a diode-array detector (HPLC/DAD). Their associations with demographic variables (age, height, weight, body mass index (BMI), sex) and antibiotic exposure time were analyzed using linear regression models. The mean amoxicillin plasma level detected in the venous blood was 1.21 ± 1.17 µg/ml (range 0.49-6.34 µg/ml) and in the third molar socket was 4.14 ± 2.24 µg/ml (range 0.86-7.46 µg/ml) (P < 0.001). No relationship was observed between the bioavailability of the drug and the patient biometric indices evaluated. The prophylactic administration of 2 g amoxicillin in third molar surgery showed greater bioavailability in the molar socket than the concentrations established as necessary to inhibit the growth of microorganisms that cause oral infections. The results show the need to review the current infection control protocols in oral surgery in light of the overestimated doses observed.

Evaluation of volume of the sphenoid sinus according to sex, facial type, skeletal class, and presence of a septum: a cone-beam computed tomographic study.

We have used cone-beam computed tomographic (CT) images to retrospectivelyevaluate the influence of sex, skeletal class, facial type, and the presence of septa on the volume of the sphenoid sinus in 172 images from 85 men (mean (SD) age 28 (2) years) and 87 women (mean (SD) age 30 (1) years). Skeletal class and facial type were calculated for each patient from multiplanar reconstructions using NemoCeph® software. Volumetric analysis of the sphenoid sinus was made with the help of the ITK-SNAP® 3.4.0 segmentation software, while the presence or absence of septa in the sphenoid sinus was evaluated with the Carestream 3D Imaging® software 3.4.3. We analysed the results using two-way ANOVA, Student's independent sample t test, and Fisher's exact test, as appropriate, and probabilities of <0.05 were accepted as significant. Sex (p=0.0946), facial type (p=0.790), and skeletal class (p=0.120) had no significant influence on the volume of the sphenoid sinus, and nor did the volumes of the right and left sphenoid sinuses (p=0.0923), or the presence of a septum within the sinus (p=0.330) in its volume.

Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction.

Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO2)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO2. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P<0.0001). More undesirable effects were observed with midazolam (P<0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine.

The action of anti-inflammatory agents in healthy temporomandibular joint synovial tissues is sex-dependent.

This study evaluated the effects of dexamethasone, parecoxib, and glucosamine on cartilage thickness and cytokine levels in the temporomandibular joint (TMJ). Forty-eight rats (24 female, 24 male) were assigned to four treatments administered once daily for 7 days: control (saline intramuscularly), parecoxib (0.3mg/kg intramuscularly), dexamethasone (0.1mg/kg intramuscularly), and glucosamine (80mg/kg orally). The thickness of TMJ cartilage and levels of four cytokines were measured. Median cartilage thickness was higher in males than in females in the control (253.2 vs. 240.4µm, P=0.0036), parecoxib (227.3 vs. 192.1µm, P<0.0001), and dexamethasone (227.1 vs. 170.5µm, P=0.017) groups, but was lower in males in the glucosamine group (214.5 vs. 239.6µm, P=0.0001). IL-1ß was not detected. Median IL-1α levels differed between males and females in the parecoxib group (0.08 vs. 0.04ng/ml, P=0.0055), but not in the control (0.07 vs. 0.06ng/ml), dexamethasone (0.06 vs. 0.04ng/ml), or glucosamine (0.08ng/ml vs. 0.06ng/ml) groups (all P>0.05). Only dexamethasone induced lower IL-6 levels in males than in females (median 4.6 vs. 2.1ng/ml, P=0.0044). Median TNF-α levels did not differ between males and females in the control (0.07 vs. 0.05ng/ml) or parecoxib (0.07 vs. 0.05ng/ml) groups (both P>0.05), but dexamethasone (0.09 vs. 0.05ng/ml, P=0.0002) and glucosamine (0.09 vs. 0.07ng/ml, P=0.0259) induced higher TNF-α levels in females. Thus, the effects of the three treatments on the levels of cytokines and thickness of condylar cartilage were sex-dependent.

Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction.

BACKGROUND: Anxiety symptoms are frequently observed in dental patients, whether they are undergoing simple or more invasive procedures such as surgery. This research aimed to compare the effects of Passiflora incarnata and midazolam for the control of anxiety in patients undergoing mandibular third molar extraction. MATERIAL AND METHODS: Forty volunteers underwent bilateral extraction of their mandibular third molars in a randomized, controlled, double-blind, crossover clinical trial. Passiflora incarnata (260 mg) or midazolam (15 mg) were orally administered 30 minutes before surgery. The anxiety level of participants was evaluated by questionnaires and measurement of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). RESULTS: Considering each procedure independently, there were no significant differences between the protocols in BP, HR, and SpO2. Over 70% of the volunteers responded that they felt quiet or a little anxious under both protocols. With midazolam, 20% of the participants reported amnesia (not remembering anything at all), while Passiflora showed little or no ability to interfere with memory formation. CONCLUSIONS: Passiflora incarnata showed an anxiolytic effect similar to midazolam, and was safe and effective for conscious sedation in adult patients who underwent extraction of their mandibular third molars.

Correlation between body mass index and faecal microbiota from children.

Childhood obesity is an increasing problem at the global level and considered as a risk factor for obesity development and the associated co-morbidities in adult life. In this study, the occurrence of Bacteroides fragilis group, Clostridium spp., Bifidobacterium spp. and Escherichia coli in 84 faecal samples from 30 obese, 24 overweight and 30 lean children was verified by culture technique and quantitative determination by quantitative PCR. In addition, Lactobacillus spp. and Methanobrevibacter smithii were also analysed. A correlation between the body mass index (BMI) and these bacteria was sought. Bacteroides vulgatus, Clostridium perfringens and Bifidobacterium adolescentis were most prevalent in all samples evaluated by culture-method. The B. fragilis group were found at high concentrations in obese and overweight children when compared with the lean ones (p 0.015). The obese and overweight children harboured higher numbers of Lactobacillus spp. than lean children (p 0.022). The faecal concentrations of the B. fragilis group (r = 0.24; p 0.026) and Lactobacillus spp. (r = 0.44; p 0.002) were positively correlated with BMI. Bifidobacterium spp. were found in higher numbers in the lean group than the overweight and obese ones (p 0.042). Furthermore, a negative correlation between BMI and Bifidobacterium spp. copy number (r = -0.22; p 0.039) was observed. Our findings show some difference in the intestinal microbial ecosystem of obese children compared with the lean ones and a significant association between number of Lactobacillus spp. and B. fragilis group and BMI.

Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study.

BACKGROUND AND OBJECTIVE: The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. MATERIAL AND METHODS: This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. RESULTS: There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). CONCLUSION: Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.

Dependence of cytokine levels on the sex of experimental animals: a pilot study on the effect of oestrogen in the temporomandibular joint synovial tissues.

The aim of this study was to evaluate the effects of 17ß-oestradiol (E2) on cartilage thickness and cytokine levels in the temporomandibular joint (TMJ). Thirty rats (15 female, 15 male) were orchidectomized (ORX), ovariectomized (OVX), or sham-operated. After 21 days, animals were assigned to six groups: (1) sham-ORX; (2) ORX; (3) ORX+E2; (4) sham-OVX; (5) OVX; and (6) OVX+E2. Treatments were administered daily for 21 days. The thickness of cartilage layers (fibrous, proliferative, maturation, and hypertrophic) and cytokine levels (interleukins IL-1α, IL-1ß, IL-6, and tumour necrosis factor alpha (TNF-α)) were measured by histomorphometry and ELISA, respectively. Kruskal-Wallis/Dunn's tests were used (alpha=5%). Sham-ORX showed thicker layers than ORX+E2, but not thicker than ORX. All layers, except the hypertrophic layer, were thicker in sham-OVX than OVX or OVX+E2. Although IL-1ß levels were higher in castrated animals, E2 did not affect the level of this cytokine. IL-1α levels were higher in both ORX (P=0.0010) and ORX+E2 (P=0.0053) than in sham-ORX. However, E2 decreased IL-1α levels in OVX (P=0.0129). When compared to sham-ORX/OVX, IL-6 levels were not affected by E2 in males but were reduced in OVX (P=0.0079) and increased in OVX+E2 (P=0.0434). Levels of TNF-α were reduced by E2 in both ORX+E2 and OVX+E2. E2 treatment caused gender- and layer-dependent changes in the cartilage. Castration increased all cytokine levels, except for IL-6, without respect to gender.

4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study.

AIM: To compare the anaesthetic efficacy of inferior alveolar nerve blocks (IANB) with 1.8 mL of 2% lidocaine (LI) to a buccal infiltration (BI) with 1.8 mL of 4% articaine (AR), both with 1 : 100 000 epinephrine, in patients with symptomatic irreversible pulpits in a randomized controlled trial. METHODOLOGY: Volunteers presenting at the Emergency Centre (FOP-UNICAMP) were randomly divided into two groups (30 for AR and 20 for LI). Operator and patient were not blinded. Success was recorded when complete pain-free treatment was achieved after a single injection (IANB or BI) or when one supplemental injection was needed for emergency endodontic procedures. Success rate of supplemental injection was evaluated between and within groups using Fisher's exact test and chi-square test. RESULTS: A higher success rate (P = 0.03/Fisher's exact test) was observed with AR (40%) than with LI (10%). No significant difference was found when a single injection plus one supplemental injection was compared between groups (P = 1.0; AR = 70%; LI = 80%). However, supplemental injection increased the anaesthetic success rates (AR, P = 0.04; LI, P = 0.0001) within groups. CONCLUSIONS: Single anaesthesia techniques (IANB or BI) were not able to achieve pain-free emergency endodontic treatment. Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate (consort: registration number - NCT01912755/Fapesp: #2009/10834-4).

Effect of particles of ashes produced from sugarcane burning on the respiratory system of rats.

The practice of burning sugarcane obtained by non-mechanized harvesting exposes workers and the people of neighboring towns to high concentrations of particulate matter (PM) that is harmful to health, and may trigger a series of cardiorespiratory diseases. The aim of this study was to analyze the chemical composition of the micro-particles coming from sugarcane burning residues and to verify the effects of this micro-particulate matter on lung and tracheal tissues. Micro-particulate matter (PM10) was obtained by dissolving filter paper containing burnt residues in NaCl solution. This material was instilled into the Wistar rats' nostrils. Histological analyses (hematoxylin and eosin - HE) of cardiac, lung and tracheal tissues were performed. Inflammatory mediators were measured in lung tissues by using ELISA. The chemical composition of the particulate material revealed a large quantity of the phthalic acid ester, high concentrations of phenolic compounds, anthracene and polycyclic aromatic hydrocarbons (PAH). Histological analysis showed a reduction in subjacent conjunctive tissue in the trachea, lung inflammation with inflammatory infiltrate formation and reduction of alveolar spaces and a significant increase (p<0.05) in the release of IL-1α, IL-1ß, IL-6, and INF-γ in the group treated with PM10 when compared to the control group. We concluded that the burning sugarcane residues release many particles, which have toxic chemical compounds. The micro-particulate matter can induce alterations in the respiratory system.

Anaesthetic efficacy of bupivacaine 2-hydroxypropyl-ß-cyclodextrin for dental anaesthesia after inferior alveolar nerve block in rats.

Bupivacaine is a long-acting local anaesthetic that is widely used in medicine and dentistry. The duration and intensity of its sensory blockade in animal models is increased by its inclusion in complexes with cyclodextrins. The aim of the present study was to evaluate the anaesthetic efficacy of bupivacaine 2-hydroxypropyl-ß-cyclodextrin (HPßCD) inclusion complex for dental anaesthesia after inferior alveolar nerve block in rats. Thirty rats were each given an injection close to the mandibular foramen of 0.2ml of one of the following formulations: 0.5% bupivacaine alone; 0.5% bupivacaine with 1:200,000 epinephrine; and 0.5% bupivacaine-HPßCD inclusion complex (bupivacaine-HPßCD). The other sides were used as controls, with either 0.9% saline or anaesthetic-free HPßCD solution being injected. The onset, success, and duration of pulpal anaesthesia were assessed by electrical stimulation ("pulp tester") on inferior molars. Results were analysed using ANOVA (Tukey), log rank, and chi square tests (α=5%). There were no differences among the formulations in onset of anaesthesia (p=0.59) or between the bupivacaine plus epinephrine and bupivacaine plus HPßCD in duration of anaesthesia, but bupivacaine plus epinephrine gave significantly higher values than bupivacaine alone (p=0.007). Bupivacaine plus epinephrine was a better anaesthetic than bupivacaine alone (p=0.02), while Bupi-HPßCD gave intermediate results, and therefore did not differ significantly from the other 2 groups (p=0.18 with bupivacaine alone; and p=0.44 with bupivacaine plus epinephrine). The bupivacaine-HPßCD complex showed similar anaesthetic properties to those of bupivacaine with epinephrine.

Effect of diazepam on temporomandibular joints in rats with increased occlusal vertical dimension.

Anxiolytic agents, mainly benzodiazepines, have been used to treat symptomatic disorders of the temporomandibular joint (TMJ). Our aim was to evaluate the effect of diazepam on the TMJ of rats with increased occlusal vertical dimension (iOVD). Forty male rats were randomly assigned to 4 groups: control rats were given sham iOVD plus saline solution daily for 7 days. The first experimental group was given sham iOVD plus diazepam 2.5mg/kg/intramuscularly daily for 7 days (diazepam alone group); the second had iOVD induced in molars for 7 days plus saline daily for 7 days (iOVD alone group); and the third had iOVD induced in molars for 7 days plus diazepam 2.5mg/kg/intramuscularly daily for 7 days (iOVD plus diazepam group). At the end of each experiment the animals were killed and their bilateral TMJs were removed, randomly stained with haematoxylin and eosin and sirius-red, and immunoassayed. The thickness of condylar cartilage and of fibrous, proliferating, mature, and hypertrophic layers, number of collagen fibres, and the articular area were measured. Proinflammatory cytokines (interleukin (IL)-1α, IL-1ß, IL-6, and tumour necrosis factor (TNF)-α) were also measured. ANOVA and Tukey's tests or the Kruskal-Wallis test were used to compare data among groups (α=5%). Condylar cartilage was thicker in the control group than in the other groups, the diazepam alone group being thicker than the other 2 experimental groups. There were fewer collagen fibres in the 2 groups given diazepam than in the other 2 groups, and there were no significant differences in the area of cartilage among groups. The controls had lower concentrations of all cytokines (p<0.05) than the 3 experimental groups, except for IL-6. Both iOVD groups had higher concentrations of IL-1α, IL-1ß, and IL-6 than the diazepam alone group. Diazepam alone was associated with increased concentrations of all cytokines except IL-6. We conclude that both iOVD and diazepam induced significant changes in rats' articular cartilage.