CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sagittal split osteotomy.

BACKGROUND: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. MATERIAL AND METHODS: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). RESULTS: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. CONCLUSION: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO.

Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions.

Postoperative pain and inflammation after oral surgery is mostly managed using non-steroidal anti-inflammatory drugs (NSAIDs). However, opioids combined with NSAIDs may improve pain management in patients, especially after traumatic oral surgery. Few studies have compared NSAIDs with and without opioid use after oral and maxillofacial surgery. This randomized, double-blind, cross-over study compared the clinical efficacy of either diclofenac (50mg) and codeine (50mg) or diclofenac alone (50mg) for the management of postoperative pain after invasive third molar surgery. Volunteers (n=46) who were scheduled to undergo the removal of symmetrically positioned lower third molars in two separate appointments were included. They reported significantly less postoperative pain at various time points within 24h after surgery and also consumed significantly less rescue medication (paracetamol (acetaminophen)) throughout the study when they took diclofenac combined with codeine than when they took only diclofenac. In conclusion, oral diclofenac with codeine was more effective for managing postoperative pain than diclofenac without codeine. It was expected that patients taking two pain medications after surgery would generally have less pain than when taking only one of the two medications. The prospective cross-over design of the present work makes this study distinct from many others.

Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study.

BACKGROUND: Using a double-blinded randomized crossover design, this study aimed to evaluate acute postoperative pain management, swelling and trismus in 46 volunteers undergoing extractions of the two lower third molars, in similar positions, at two different appointments who consumed a tablet of either NE (naproxen 500 mg + esomepraz ole 20 mg) or only naproxen (500 mg) every 12 hours for 4 days. MATERIAL AND METHODS: Parameters were analyzed: self-reported pain intensity using a visual analog scale (VAS) pre- and postoperative mouth opening; incidence, type and severity of adverse reactions; total quantity consumed of rescue medication; and pre- and postoperative swelling. RESULTS: Female volunteers reported significantly more postoperative pain at 1, 1.5, 2, 3 and 4hrs after surgery while also taking their first rescue medication at a time significantly earlier when consuming NE when compared to naproxen (3.7hrs and 6.7hrs). Conversely, no differences were found between each drug group in males. CONCLUSIONS: In conclusion, throughout the entire study, pain was mild after using either drug in both men and women with pain scores on average well below 40mm (VAS), although in women naproxen improved acute postoperative pain management when compared to NE.

Efficacy and Safety of 2% and 4% Articaine for Lower Third Molar Surgery.

This double-blind crossover randomized clinical trial compared the efficacy of 2 concentrations of articaine, 2% (A2) and 4% (A4), with 1:200,000 epinephrine, for lower third molar removal. During 2 separate appointments with either A2 or A4, both similarly positioned lower third molars in 46 volunteers were extracted. The following were evaluated: onset and duration of anesthetic action on soft tissues, intraoperative bleeding, hemodynamic parameters, postoperative analgesia, and mouth opening and wound healing during the 7th postoperative day, along with the incidence, type, and severity of adverse reactions. Nearly identical volumes of both anesthetic solutions were used for each appointment: 3.4 ± 0.9 mL ≈ 68 mg of articaine (A2) and 3.3 ± 0.8 mL ≈ 132 mg of articaine (A4). Statistical analysis indicated no differences in onset or duration of anesthetic action on soft tissues or duration of postoperative analgesia evoked by A2 and A4 anesthetic solutions (P > 0.05). The surgeon's rating of intraoperative bleeding was considered minimal throughout all surgery with both anesthetic solutions. While transient changes in blood pressure, heart rate, and oxygen saturation were observed, these factors were clinically insignificant and were uninfluenced by articaine concentration (P > 0.05). No systemic or local adverse reactions were observed in the preoperative and postoperative periods due to A2 or A4, but 1 case of bilateral paresthesia was observed. There were no significant differences between preoperative and postoperative (7th day) values of mouth opening and wound healing whether volunteers received A2 or A4 (P > 0.05). In conclusion, both A2 and A4, administered in equal volumes, were effective and safe during lower third molar surgery, and no significant differences were found between their efficacy and safety (ClinicalTrials.gov NCT02457325).

Seven-year clinical performance of resin composite versus resin-modified glass ionomer restorations in noncarious cervical lesions.

PURPOSE: The purpose of this study was to comparatively assess the seven-year clinical performance of a one-bottle etch-and-rinse adhesive with resin composite (RC) and resin-modified glass ionomer (RMGI) restorations in noncarious cervical lesions. METHODS AND MATERIALS: One operator placed 70 restorations (35 restorations in each group) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by two independent examiners, using modified US Public Health Service criteria at baseline and 6, 12, 24, 60, and 84 months. The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests. A difference was significant if p<0.05. RESULTS: Twenty patients were available for recall after seven years (66.6%), and 25 RC and 26 RMGI restorations out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (κ≥0.85). Alfa and bravo scores were classified as clinically acceptable. The McNemar test detected significant differences within RC restorations between baseline and seven-year evaluations for anatomic form, marginal integrity, and retention (p<0.05). For RMGI restorations, a significant difference was identified for marginal integrity (p<0.05). As to material comparison, the Fisher exact showed a better retention performance for RMGI restorations than for RC restorations (p<0.05). Twelve composite restorations were dislodged (52.0% retention) and three ionomer restorations were lost (88.5% retention). The cumulative success rate for RC and RMGI was 30% and 58.1%, respectively. CONCLUSIONS: After seven years of service, the clinical performance of RMGI restorations was superior to that of the adhesive system/resin composite restorations in this study.

Determination of a pressure pain threshold cut-off value for the diagnosis of temporomandibular joint arthralgia.

Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty-nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1.07 kgf cm(-2) ) than the others. Asymptomatic disc displacement group (mean of 1.64 kgf cm(-2) ) has shown significant lower PPT than the control (mean of 2.35 kgf cm(-2) ). 89.66% of specificity and 70% of sensitivity were obtained when 1.36 kgf cm(-2) was applied to the TMJ (ROC area = 0.90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1.36 kgf cm(-2) can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain.

Histochemistry profile of the biceps brachii muscle fibres of capuchin monkeys (Cebus apella, Linnaeus, 1758).

A general analysis of the behaviour of "Cebus" shows that when this primate moves position to feed or perform another activity, it presents different ways of locomotion. This information shows that the brachial biceps muscle of this animal is frequently used in their locomotion activities, but it should also be remembered that this muscle is also used for other development activities like hiding, searching for objects, searching out in the woods, and digging in the soil. Considering the above, it was decided to research the histoenzimologic characteristics of the brachial biceps muscle to observe whether it is better adpted to postural or phasic function. To that end, samples were taken from the superficial and deep regions, the inserts proximal (medial and lateral) and distal brachial biceps six capuchin monkeys male and adult, which were subjected to the reactions of m-ATPase, NADH-Tr. Based on the results of these reactions fibres were classified as in Fast Twitch Glycolitic (FG), Fast Twitch Oxidative Glycolitic (FOG) and Slow Twitc (SO). In general, the results, considering the muscle as a whole, show a trend of frequency FOG> FG> SO. The data on the frequency were studied on three superficial regions FOG=FG>SO; the deep regions of the inserts proximal FOG=FG=SO and inserting the distal FOG>FG=SO. In conclusion, the biceps brachii of the capuchin monkey is well adapted for both postural and phasic activities.

How to assess tonsilloliths and styloid chain ossifications on cone beam computed tomography images.

OBJECTIVE: The aim of this study was to establish an anatomical guideline in cone beam computed tomography (CBCT) images to discriminate soft-tissue calcifications, specifically, tonsilloliths, and styloid chain ossification (SCO) in the multiplanar reconstruction screen of the i-CAT Vision. MATERIALS AND METHODS: We analyzed 100 pairs of CBCT images and panoramic digital radiographies regarding the presence or absence of tonsilloliths and SCO. The intraobserver agreement varied from excellent to good. The statistical analyses included Mann-Whitney test, chi-square test, Spearman test, Student's t-test, and Wilcoxon test. The analyses were repeated without the guideline to verify its effectiveness. RESULTS: A total of 25 tonsilloliths were found in panoramic images while CBCT images revealed 60. Panoramic and CBCT images showed 42% and 63% of patients positive to SCO, respectively. We found a statistically significant difference when comparing the presence of tonsilloliths and SCO between panoramic and CBCT images (Wilcoxon test P < 0.05). The analyses without the guideline showed that the observer tended to diagnoses more false-positive SCO. CONCLUSION: Based on the results, we can suggest that CBCT images are more suitable to differentiate tonsilloliths and SCO than panoramic images. The guideline was more important to diagnosis SCO than tonsilloliths. SCO was misclassified in 34% without the guideline.

Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation.

The aim of this research was to test the hypothesis that treatment with intra-oral appliances with different occlusal designs was beneficial in the management of pain of masticatory muscles compared with a control group. A total of 51 patients were analysed according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to obtain the diagnosis of masticatory myofascial pain (MMP). The sample was then randomly divided into three groups: group I (n = 21) wore a full coverage acrylic stabilisation occlusal splint; group II (n = 16) wore an anterior device nociceptive trigeminal inhibitory (NTI) system; and group III (n = 14) only received counselling for behavioural changes and self-care (the control group). The first two groups also received counselling. Follow-ups were performed after 2 and 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale (VAS) and pressure pain threshold (PPT) of the masticatory muscles. Possible adverse effects were also recorded, such as discomfort while using the appliance and occlusal changes. The results were analysed with Kruskal-Wallis, anova, Tukey's and Friedman tests, with a significance level of 5%. Group I showed improvement in the reported pain at the first follow-up (2 weeks), whereas for groups II and III, this progress was detected only after 6 weeks and 3 months, respectively. The PPT values did not change significantly. It was concluded that behavioural changes are effective in the management of pain in MMP patients. However, the simultaneous use of occlusal devices appears to produce an earlier improvement.

Is podoplanin expression associated with the proliferative activity of ameloblastomas?

OBJECTIVES: The aim of this study was to investigate the relationship between podoplanin expression and proliferative activity of ameloblastomas and remnants of the odontogenic epithelium from dental follicles (DF) of unerupted teeth. SUBJECTS AND METHODS: Thirty-three paraffin-embedded ameloblastomas and thirty-two DF obtained of unerupted teeth were analyzed by immunohistochemistry using anti-human podoplanin and anti-Ki-67 antibodies. Podoplanin expression in odontogenic epithelial cells was evaluated using a scoring method, and the Ki-67 labeling index was determined by the percentage of positive odontogenic cells. RESULTS: All ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands. Membranous expression of podoplanin in ameloblastomas was stronger than in the remnants of odontogenic epithelium (P = 0.001). Statistically significant difference was observed between the cytoplasmic and membranous expression of podoplanin in the remnants of odontogenic epithelium (P = 0.001). The index of epithelial odontogenic proliferative activity, verified by Ki-67 expression, was higher in ameloblastomas vs remnants of odontogenic epithelium (P < 0.001). No statistically significant correlation was identified between podoplanin and the cellular odontogenic proliferative activity in meloblastomas and DF (P > 0.05). CONCLUSIONS: These results provide evidence that there is no connection between podoplanin immunostaining and odontogenic cellular proliferative activity and suggest a role for membranous podoplanin expression in the local invasion of ameloblastomas.

The relationship between tooth wear in the primary and permanent dentitions.

OBJECTIVE: To evaluate the relationship between tooth wear in primary and permanent dentition in 7 to 10-year-old school children, in 2007. METHODS: An epidemiological cross-sectional survey was conducted by trained, calibrated examiners, using the dental wear index (DWI). The cluster sample consisted of 764 children (382 boys, 382 girls) attending 4 public schools selected in different regions of the city. The DWI was proposed to evaluate primary and permanent teeth, coded as letters and numbers, respectively. Data were collected via clinical examinations performed outdoors under natural light, following the WHO recommendations and using a dental mirror and probe. Proportions and confidence intervals were used to describe the prevalence of dental wear. The Mann-Whitney and the Odds Ratio (OR) tests were used to compare the tooth wear prevalence between primary and permanent teeth according to surface (p < 0.05). RESULTS: The 7 to 10-year-old school children presented 16% tooth wear. The tooth wear was mostly seen on the occlusal/incisal surfaces (47%), involving enamel or enamel-dentine. Tooth wear in primary teeth was found in canines and molars (93%) and in permanent teeth in molars (34%). There was significant difference between primary and permanent teeth (p < 0.001) and dental wear in primary teeth was greater in boys than in girls (p = 0.02) but not in permanent teeth. CONCLUSION: The results suggest that 7 to 10-year-old children with tooth wear in primary teeth had more chances of developing tooth wear in permanent dentition. However, the findings of this study are not conclusive as the associations described are not causal.

Comparison of oral versus sublingual piroxicam during postoperative pain management after lower third molar extraction.

In this study, 53 patients received piroxicam, administered orally or sublingually, after undergoing removal of symmetrically positioned lower third molars, during two separate appointments. This study used a randomized, blind, cross-over protocol. Objective and subjective parameters were recorded for comparison of postoperative results for 7 days after surgery. Patients treated with oral or sublingual piroxicam reported low postoperative pain scores. The patients who received piroxicam orally took a similar average amount of analgesic rescue medication compared with patients who received piroxicam sublingually (p>0.05). Patients exhibited similar values for mouth opening measured just before surgery and immediately following suture removal 7 days later (p>0.05), and showed no significant differences between routes of piroxicam administration for swelling control during the second or seventh postoperative days (p>0.05). In summary, pain, trismus and swelling after lower third molar extraction, independent of surgical difficulty, could be controlled by piroxicam 20mg administered orally or sublingually and no significant differences were observed between the route of delivery used in this study.

Low-fluoride acidic dentifrice: a randomized clinical trial in a fluoridated area.

BACKGROUND: Low-fluoride dentifrices have been suggested as alternatives to reduce dental fluorosis risk, but there is no consensus regarding their clinical effectiveness, which has been suggested to be increased when their pH is acidic. AIMS: This single-blind randomized clinical trial evaluated the caries increment during the use of a low-fluoride acidic liquid dentifrice. METHODS: Four-year-old schoolchildren (n = 1,402) living in a fluoridated area (0.6-0.8 ppm F) were randomly allocated to 4 groups differing according to the type of dentifrice used over a 20-month period. Group 1 (n = 345): liquid dentifrice, 1,100 ppm F, pH 4.5. Group 2 (n = 343): liquid dentifrice, 1,100 ppm F, pH 7.0. Group 3 (n = 354): liquid dentifrice, 550 ppm F, pH 4.5. Group 4 (n = 360): toothpaste, 1,100 ppm F, pH 7.0. At baseline and after 20 months, clinical examinations were conducted (dmfs index) and caries increment was calculated. Data were analysed by GLM procedure using classrooms (cluster) as unit of analysis (p < 0.05). RESULTS: The mean ± SD (95% CI) net increments found were as follows. Group 1: 2.06 ± 2.38 (1.8-2.3); group 2: 2.08 ± 2.87 (1.7-2.4); group 3: 2.05 ± 2.79 (1.7-2.4), and group 4: 2.08 ± 2.34 (1.8-2.4). No significant differences were detected among the groups. CONCLUSION: In a population with high caries risk living in a fluoridated area, as the selected sample, and according to the present protocol, the low-fluoride acidic liquid dentifrice seems to lead to similar caries progression rates as conventional 1,100 ppm F toothpaste.

Evaluation of minimum interdental threshold ability in dentate female temporomandibular disorder patients.

Minimum interdental threshold is the smallest thickness that can be detected between teeth during an occlusion and has an influence on the occlusal force and on the control of mandibular movements. The aim of this study was to assess the possible association of the signs and symptoms of temporomandibular disorders (TMD) with the ability to detect a minimum interdental threshold. Two hundred women were equally divided into four groups: asymptomatic (control), subjects with masticatory muscle pain, with articular [temporomandibular joint (TMJ)] pain and mixed (muscular and articular pain). Evaluation of the ability to detect a minimum interdental threshold was performed using aluminium foils with 0.010, 0.024, 0.030, 0.050, 0.080 and 0.094 mm of thickness in the premolar region. A total of 20 tests with each thickness for each patient were performed, starting with the thickest foil (0.094 mm) and ending with the thinnest one. The myogenic pain and articular groups presented significantly higher threshold values (0.020 and 0.022 mm, respectively), when compared to the control. Both groups reached the level of certain perceptiveness only at 0.030 mm. No significant correlation was found between minimum interdental threshold and age. These results suggest that discrimination of thicknesses can be disturbed as a consequence of TMD manifestations and not the cause of it. Clinicians should, therefore, be aware that changes on muscles and TMJ can secondarily lead to occlusion changes. The mechanisms involved in this process, however, are not well understood and warrant further investigation.

Environmental and individual factors associated with nail fluoride concentration.

Nails have been suggested as suitable biomarkers of exposure to F, with the advantage of being easily obtained. The effect of water F concentration, age, gender, nail growth rate and geographical area on the F concentration in the fingernail and toenail clippings were evaluated. Volunteers (n = 300) aged 3-7, 14-20, 30-40 and 50-60 years from five Brazilian communities (A-E) participated. Drinking water and nail samples were collected and F concentration was analyzed with the electrode. A reference mark was made on each nail and growth rates were calculated. Data were analyzed by ANOVA and linear regression (alpha = 0.05). Mean water F concentrations (+/- SE, mg/l) were 0.09 +/- 0.01, 0.15 +/- 0.01, 0.66 +/- 0.01, 0.72 +/- 0.02, and 1.68 +/- 0.08 for A-E, respectively. Mean F concentrations (+/- SE, mg/kg) ranged between 1.38 +/- 0.14 (A, 50-60 years) and 10.20 +/- 2.35 (D, 50-60 years) for fingernails, and between 0.92 +/- 0.08 (A, 14-20 years) and 7.35 +/- 0.80 (E, 50-60 years) for toenails. Among the tested factors, geographical area and water F concentration exerted the most influence on finger- and toenail F concentrations. Subjects of older age groups (30-40 and 50-60 years) from D and E showed higher nail F concentrations than the others. Females presented higher nail F concentration than males. Water F concentration, age, gender and geographical area influenced the F concentration of finger- and toenails, and hence should be taken into account when using this biomarker of exposure to predict risk for dental fluorosis.

The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients.

The purpose of this study was to evaluate the influence of stress and anxiety on the pressure pain threshold (PPT) of masticatory muscles and on the subjective pain report. Forty-five women, students, with mean age of 19.75 years, were divided into two groups: group 1:29 presenting with masticatory myofascial pain (MFP), according to the Research Diagnostic Criteria for Temporomandibular Disorders and group 2: 16 asymptomatic controls. An electronic algometer registered the pain thresholds on four different occasions throughout the academic year. To measure levels of stress, anxiety and pain, the Beck Anxiety Inventory, Lipp Stress Symptoms Inventory and Visual Analog Scale (VAS) were used. Three-way anova and Tukey's tests were used to verify differences in PPT between groups, times and sites. Levels of anxiety and VAS were compared using Mann-Whitney test, while Friedman's test was used for the within-groups comparison at different times (T1 to T4). The chi-squared and Cochran tests were performed to compare groups for the proportion of subjects with stress (alpha = 0.05). Differences in PPT recordings between time (P = 0.001) and sites (P < 0.001) were detected. Higher levels of anxiety and lower PPT figures were detected at T2 (academic examination) (P = 0.001). There was no difference between groups for anxiety and stress at any time (P > 0.05). The MFP group also has shown significant increase of VAS at the time of academic examination (P < 0.001). External stressors such as academic examinations have a potential impact on masticatory muscle tenderness, regardless of the presence of a previous condition such as masticatory myofascial pain.

Oral mucositis in acute lymphoblastic leukaemia: analysis of 169 paediatric patients.

Chemotherapy-induced oral mucositis is a frequent therapeutic challenge in cancer patients. The purpose of this retrospective study was to estimate the prevalence and risk factors of oral mucositis in 169 acute lymphoblastic leukaemia (ALL) patients treated according to different chemotherapeutic trials at the Darcy Vargas Children's Hospital from 1994 to 2005. Demographic data, clinical history, chemotherapeutic treatment and patients' follow-up were recorded. The association of oral mucositis with age, gender, leucocyte counts at diagnosis and treatment was assessed by the chi-squared test and multivariate regression analysis. Seventy-seven ALL patients (46%) developed oral mucositis during the treatment. Patient age (P = 0.33), gender (P = 0.08) and leucocyte counts at diagnosis (P = 0.34) showed no correlation with the occurrence of oral mucositis. Multivariate regression analysis showed a significant risk for oral mucositis (P = 0.009) for ALL patients treated according to the ALL-BFM-95 protocol. These results strongly suggest the greater stomatotoxic effect of the ALL-BFM-95 trial when compared with Brazilian trials. We concluded that chemotherapy-induced oral mucositis should be systematically analysed prospectively in specialized centres for ALL treatment to establish the degree of toxicity of chemotherapeutic drugs and to improve the quality of life of patients based on more effective therapeutic and prophylactic approaches for prevention of its occurrence.

Prevalence of dental wear among 12-year-old Brazilian adolescents using a modification of the tooth wear index.

OBJECTIVE: This study investigated the prevalence of dental wear in 12-year-old adolescents using a modification of the tooth wear index (TWI). The modifications were proposed in order to fit with the World Health Organization standard, thus allowing application of the index in broad epidemiological surveys. STUDY DESIGN: An epidemiological cross-sectional survey was performed by trained, calibrated examiners, using a modified version of the TWI. METHODS: Urban elementary schools were chosen because they provide a fair representation of the city's population in terms of socio-economic status. The sample included 295 adolescents, selected randomly and systematically. Dental wear was assessed by calibrated examiners (kappa>0.85), using a modified version of the TWI. This modified version includes a code for teeth restored due to wear, and another code for teeth that cannot be assessed. In addition, it does not differentiate the depth of dentine involvement. Proportions and confidence intervals were used to describe the prevalence of dental wear. Mann-Whitney test was used to detect differences in the degree of dental wear between males and females. The level of statistical significance was set at 5%. RESULTS: In total, 24,780 dental surfaces were evaluated. Among these surfaces, 73.10% did not present dental wear, 24.10% had incipient lesions, 2.46% had moderate lesions and 0.34% had been restored. No severe lesions were detected. Tooth wear was mainly seen on the occlusal/incisal surfaces (26.55%), involving enamel or enamel-dentine, but not the secondary dentine or pulp. The prevalence of dental wear was 26.90%. Considering the different teeth, wear was present in 53.22% of incisors, 50.51% of canines, 10.17% of premolars and 10.85% of molars. The prevalence of the different degrees of dental wear was similar in males and females (P>0.05). CONCLUSION: The modified TWI seems to be an effective tool for use in broad epidemiological surveys, due to easier calibration and high reproducibility rates.

Fluoride uptake by plaque from water and from dentifrice.

It has been suggested that fluoride retention in plaque is limited by available binding sites. We determined the effects of fluoridated or placebo dentifrices on plaque and salivary fluoride concentrations [F]s in communities with different water fluoride concentrations (0.04, 0.85, 3.5 ppm). After one week of dentifrice use, samples were collected 1.0 and 12 hrs after the last use of dentifrices. After the use of fluoridated dentifrice, plaque fluoride concentrations were higher at both times, except at 12 hrs in the 3.5-ppm community. Plaque concentrations at 1.0 hr after the use of fluoridated dentifrice increased almost constantly (6.5 mmol/kg), but then decreased approximately 50% at 12 hrs in each community. Unlike previous studies, the present findings suggest that the use of fluoridated dentifrice is likely to increase plaque fluoride concentrations significantly for up to 12 hrs in areas where the water contains fluoride close to 1.0 ppm. As previously reported, plaque fluoride concentrations were directly related to calcium concentrations.

The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal.

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 +/- 4.36 and 93.12 +/- 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 +/- 91.21 and 461.54 +/- 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 +/- 1.84 and 8.46 +/- 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 +/- 1.61 and 2.23 +/- 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.