Dental students’ reports of occupational exposures to potentially infectious biological material in a Brazilian School of Dentistry / Estudantes de odontologia e o relato das exposições ocupacionais a material biológico potencialmente contaminado em uma Faculdade de Odontologia no Brasil

Abstract Introduction Occupational exposures to contaminated biological material in dental teaching settings can place students at higher risk of bloodborne infections. Methods This cross sectional study was conducted using a self-administered questionnaire culturally adapted to Portuguese language, Brazil. In total, 173 undergraduate dental students agreed to participate in the study, answered the questionnaire, and filled in the details about their own occupational exposures. The association of these factors was analyzed by the chi-square test or Fisher's exact test using Stata® software. Results High prevalence of occupational exposures (40%) was observed among the participants, and 52% of the accidents were not reported to the clinical instructor. The most frequent type of accident was related to “puncture/cut/abrasion” (56%). Significant correlation was observed between number of exposures and academic year (p=0.002), age (p=0.012), gender (p=0.010), and between number of injuries in the last 6 months and academic year (p=0.003). No significant correlation was observed between number of exposures and dominant hand, use of protective eyewear or Hepatitis B vaccination status (p>0.05). Conclusion Additional teaching strategies need to be developed to motivate adherence to occupational post-exposure protocols regarding biological material, improving the notification of the occupational exposures that occur among dental students.

Resumo Introdução A exposição ocupacional a material biológico contaminado em ambientes de ensino de odontologia pode colocar os estudantes em maior risco de infecções transmissíveis pelo sangue. Métodos Tratou-se de um estudo transversal de avaliação, com questionário auto administrado e culturalmente adaptado para o português do Brasil. Ao total, 173 estudantes de odontologia concordaram em participar e forneceram detalhes sobre suas exposições ocupacionais. A associação de fatores foi analisada por meio do teste do qui-quadrado e/ou teste exato de Fisher, com auxílio do programa Stata®. Resultados Entre os participantes, houve alta prevalência a exposições ocupacionais (40%), e 52% dos acidentes não foram comunicados ao instrutor. O mais frequente ferimento foi do tipo “punção/ corte/ abrasão” (56%). Houve associação significativa entre “número de exposições” e “série” (p=0,002), “idade” (p=0,012) e “sexo” (p=0,010), e entre outras duas variáveis: “número de lesões nos últimos seis meses” e “série” (p=0,003). Não houve associação significativa entre o “número de exposições” e “mão dominante”, “uso de óculos de proteção” ou “estado vacinal contra o vírus da Hepatite B” (p>0,05). Conclusão Estratégias de ensino adicionais precisam ser implementadas para motivar a adesão aos protocolos pós-exposição ocupacional a material biológico, favorecendo a notificação dos casos entre acadêmicos de odontologia.

Reliability of marginal microleakage assessment by visual and digital methods.

OBJECTIVE: The aim of this study was to investigate the reliability of visual and digital methods to assess marginal microleakage in vitro. MATERIALS AND METHODS: Typical Class V preparations were made in bovine teeth and filled with composite resin. After dye penetration (0.5% basic fuchsin), teeth were sectioned and the 53 obtained fragments were assessed according to visual (stereomicroscope) and digital methods (Image Tool Software(®)-ITS) (University of Texas Health Science Center-San Antonio Dental School, USA). Two calibrated examiners (A and B) evaluated dye penetration, by means of a stereomicroscope with ×20 magnification (scores), and by the ITS (millimeters). The intra- and inter-examiner agreement was estimated according to Kappa statistics (κ), and intraclass correlation coefficient (ρ). RESULTS: In relation to the visual method, the intra-examiner agreement was almost perfect (κA = 0.87) and substantial (κB = 0.76), respectively to the examiner A and B. The inter-examiner agreement showed an almost perfect reliability (κ = 0.84). For the digital method, the intra-examiner agreement was almost perfect for both examiners and equal to ρ = 0.99, and so was the inter-examiner agreement value. CONCLUSION: Visual (stereomicroscope) and digital methods (ITS) showed high levels of intra- and inter-examiner reproducibility when marginal microleakage was assessed.

[Mortality of the elderly in a municipality of southeastern Brazil from 2006 to 2011]. / Mortalidade de idosos em município do Sudeste brasileiro de 2006 a 2011.

This paper addressed the mortality rate for elderly people in Araraquara in the state of São Paulo between 2006 and 2011. An epidemiological descriptive study was conducted using data from the National Mortality Information System and the Data Analysis State System Foundation. The ratio between mortality rates by point (R) and by 95% confidence interval (IC95%) were estimated. More than 60% of elderly people had low education, and 76% of them died in hospital. For the period from 2006 to 2008 a statistically significant difference was observed between males and females, the most common causes of death being circulatory disease R = 1.41 (IC95%:1.24-1.58), respiratory problems R = 1.49 (IC95%:1.22-1.76), and cancer R = 1.79 (IC95%: 1.40-2.18). For the period from 2009 to 2011, circulatory diseases accounted for R=1.18 (IC95%:1.03-1.33)], and the differences were significant for respiratory disease R = 1.33 (IC95%:1.11-1.55) and cancer R = 1.94 (IC95%:1.53-2.35). The fourth and fifth more frequent causes of death among the elderly population were diabetes mellitus and external causes, respectively. The pattern of mortality found emphasizes the importance of actions aimed at reducing the major causes of death such as increasing the coverage of the influenza vaccine and control of hypertension and diabetes mellitus.

Mortalidade de idosos em município do Sudeste brasileiro de 2006 a 2011 / Mortality of the elderly in a municipality of southeastern Brazil from 2006 to 2011

O objetivo foi descrever a mortalidade entre idosos em Araraquara (SP), no período de 2006 a 2011. Estudo epidemiológico descritivo, tendo como fontes de dados o Sistema de Informações sobre Mortalidade e a Fundação Sistema Estadual de Análise de Dados. Foi calculada razão entre coeficientes de mortalidade por ponto (R) e por intervalo de 95% de confiança (IC95%). Observou-se mais de 60% dos idosos com nível baixo de escolaridade, sendo que 76% faleceram em hospitais. Entre 2006 e 2008, as diferenças foram estatisticamente significantes entre homens e mulheres, predominando as doenças circulatórias com R = 1,41 (IC95%:1,24-1,58), respiratórias com R = 1,49 (IC95%:1,22-1,76) e neoplasias com R = 1,79 (IC95%: 1,40-2,18). Entre 2009 e 2011, obteve-se, para as causas circulatórias R = 1,18 (IC95%:1,03-1,33), sendo significativas as diferenças para as respiratórias com R = 1,33 (IC95%:1,11-1,55) e câncer sendo R = 1,94 (IC95%:1,53-2,35). O diabetes mellitus e as causas externas apareceram, respectivamente, como quarta e quinta causas de mortes mais frequentes na população idosa. O padrão de mortalidade encontrado ressalta a importância de ações voltadas à redução das principais causas de morte, como o incremento da cobertura da vacina contra a influenza e o controle da hipertensão arterial e do diabetes mellitus.

This paper addressed the mortality rate for elderly people in Araraquara in the state of São Paulo between 2006 and 2011. An epidemiological descriptive study was conducted using data from the National Mortality Information System and the Data Analysis State System Foundation. The ratio between mortality rates by point (R) and by 95% confidence interval (IC95%) were estimated. More than 60% of elderly people had low education, and 76% of them died in hospital. For the period from 2006 to 2008 a statistically significant difference was observed between males and females, the most common causes of death being circulatory disease R = 1.41 (IC95%:1.24-1.58), respiratory problems R = 1.49 (IC95%:1.22-1.76), and cancer R = 1.79 (IC95%: 1.40-2.18). For the period from 2009 to 2011, circulatory diseases accounted for R=1.18 (IC95%:1.03-1.33)], and the differences were significant for respiratory disease R = 1.33 (IC95%:1.11-1.55) and cancer R = 1.94 (IC95%:1.53-2.35). The fourth and fifth more frequent causes of death among the elderly population were diabetes mellitus and external causes, respectively. The pattern of mortality found emphasizes the importance of actions aimed at reducing the major causes of death such as increasing the coverage of the influenza vaccine and control of hypertension and diabetes mellitus.

CIE L*a*b*: comparison of digital images obtained photographically by manual and automatic modes

The aim of this study was to analyze the color alterations performed by the CIE L*a*b* system in the digital imaging of shade guide tabs, which were obtained photographically according to the automatic and manual modes. This study also sought to examine the observers' agreement in quantifying the coordinates. Four Vita Lumin Vaccum shade guide tabs were used: A3.5, B1, B3 and C4. An EOS Canon digital camera was used to record the digital images of the shade tabs, and the images were processed using Adobe Photoshop software. A total of 80 observations (five replicates of each shade according to two observers in two modes, specifically, automatic and manual) were obtained, leading to color values of L*, a* and b*. The color difference (ΔE) between the modes was calculated and classified as either clinically acceptable or unacceptable. The results indicated that there was agreement between the two observers in obtaining the L*, a* and b* values related to all guides. However, the B1, B3, and C4 shade tabs had ΔE values classified as clinically acceptable (ΔE = 0.44, ΔE = 2.04 and ΔE = 2.69, respectively). The A3.5 shade tab had a ΔE value classified as clinically unacceptable (ΔE = 4.17), as it presented higher values for luminosity in the automatic mode (L* = 54.0) than in the manual mode (L* = 50.6). It was concluded that the B1, B3 and C4 shade tabs can be used at any of the modes in digital camera (manual or automatic), which was a different finding from that observed for the A3.5 shade tab.

CIE L*a*b*: comparison of digital images obtained photographically by manual and automatic modes.

The aim of this study was to analyze the color alterations performed by the CIE L*a*b* system in the digital imaging of shade guide tabs, which were obtained photographically according to the automatic and manual modes. This study also sought to examine the observers' agreement in quantifying the coordinates. Four Vita Lumin Vaccum shade guide tabs were used: A3.5, B1, B3 and C4. An EOS Canon digital camera was used to record the digital images of the shade tabs, and the images were processed using Adobe Photoshop software. A total of 80 observations (five replicates of each shade according to two observers in two modes, specifically, automatic and manual) were obtained, leading to color values of L*, a* and b*. The color difference (ΔE) between the modes was calculated and classified as either clinically acceptable or unacceptable. The results indicated that there was agreement between the two observers in obtaining the L*, a* and b* values related to all guides. However, the B1, B3, and C4 shade tabs had ΔE values classified as clinically acceptable (ΔE = 0.44, ΔE = 2.04 and ΔE = 2.69, respectively). The A3.5 shade tab had a ΔE value classified as clinically unacceptable (ΔE = 4.17), as it presented higher values for luminosity in the automatic mode (L* = 54.0) than in the manual mode (L* = 50.6). It was concluded that the B1, B3 and C4 shade tabs can be used at any of the modes in digital camera (manual or automatic), which was a different finding from that observed for the A3.5 shade tab.

Mortality rate in children caused by traffic accidents according to geographical regions - Brazil, 1997 - 2005.

Fatal injuries in children caused by motor vehicle accidents represent a common situation in many countries worldwide. The present study addresses the mortality rate in children as vehicle passengers in Brazil, from 1997 to 2005. To evaluate mortality rates, the number of deaths was collected from the National Mortality Information System (SIM) and the population size was obtained using the Brazilian Bureau Census (IBGE) data available at DATASUS. Mortality rates were estimated in three-year periods and analyzed according to age groups (younger than 1 year old, 1-4 years old, 5-9 years old) and geographical regions using a 95% confidence interval. Overall results showed mortality rates of 5.68, 7.32 and 6.78 (per 1,000,000) for the 1997-1999, 2000-2002 and 2003-2005 periods, respectively for the whole country. Children younger than 1 year old had a mortality rate of 10.18 (per 1,000,000), which was higher than for the other age groups. For the period analyzed, the highest rates were observed for the Mid-West and South regions of Brazil, with rates of 13.88 and 11.47 (per 1,000,000), respectively. These results show the risk of fatal injury in children caused by motor vehicle accidents and may contribute to the establishment of educational campaigns aiming injury prevention in children as vehicle passengers.

Mortality rate in children caused by traffic accidents according to geographical regions : Brazil, 1997 - 2005 / Mortalidade de crianças por acidente de trânsito segundo região geográfica : Brasil, 1997 a 2005

Fatal injuries in children caused by motor vehicle accidents represent a common situation in many countries worldwide. The present study addresses the mortality rate in children as vehicle passengers in Brazil, from 1997 to 2005. To evaluate mortality rates, the number of deaths was collected from the National Mortality Information System (SIM) and the population size was obtained using the Brazilian Bureau Census (IBGE) data available at DATASUS. Mortality rates were estimated in three-year periods and analyzed according to age groups (younger than 1 year old, 1-4 years old, 5-9 years old) and geographical regions using a 95% confidence interval. Overall results showed mortality rates of 5.68, 7.32 and 6.78 (per 1,000,000) for the 1997-1999, 2000-2002 and 2003-2005 periods, respectively for the whole country. Children younger than 1 year old had a mortality rate of 10.18 (per 1,000,000), which was higher than for the other age groups. For the period analyzed, the highest rates were observed for the Mid-West and South regions of Brazil, with rates of 13.88 and 11.47 (per 1,000,000), respectively. These results show the risk of fatal injury in children caused by motor vehicle accidents and may contribute to the establishment of educational campaigns aiming injury prevention in children as vehicle passengers.

Lesões fatais em crianças causadas por acidentes de trânsito representam um problema em muitos países. Este estudo analisou a taxa de mortalidade em crianças passageiras de automóveis menores de 10 anos de idade no Brasil, entre 1997 e 2005. Para isso, o número de mortes foi obtido diretamente no banco de dados do Sistema de Informação sobre Mortalidade (SIM) e os dados da população são projeções intercensitárias a partir censo demográfico do Instituto Brasileiro de Geografia e Estatística (IBGE) disponíveis pelo site do DATASUS. Foram calculadas, para os triênios compreendidos no período em estudo, as taxas de mortalidade por acidente de trânsito entre crianças passageiras de automóveis segundo faixa etária (menor que 1 ano, 1 a 4 e 5 a 9) e região geográfica. Os resultados mostraram taxas de mortalidade de 5,68, 7,32 e 6,78 (por 1.000.000), respectivamente, para os períodos 1997-1999, 2000-2002 e 2003-2005 para todo o Brasil. Crianças menores de 1 ano de idade apresentam taxa de mortalidade de 10,18 (por 1,000,000), maior que as observadas para as outras faixas etárias. Para o período 1997-2005, as maiores taxas foram observadas nas regiões Centro-Oeste e Sul, representando, respectivamente, 13,88 e 11,47 (por 1.000.000). Tais resultados mostram a situação de risco da criança em relação a acidentes de trânsito como passageiras de automóveis e contribuem para a elaboração de campanhas educativas de prevenção de lesões.

Opiniões e atitudes dos médicos frente às ações promocionais da indústria farmacêutica / Doctors opinions and attitudes to pharmaceutical industry promotion mix / Opiniones y actitudes de los médicos en relación a las acciones de promoción de la industria farmacéutica

A indústria farmacêutica investe maciçamente na promoção de seus produtos, e estudos sugerem que essas ações influenciam a prescrição médica. O objetivo deste estudo foi analisar as opiniões e atitudes de médicos frente às ações promocionais dos laboratórios. A metodologia adotada foi a investigação de caráter descritivo, transversal e observacional com delineamento do tipo inquérito. Utilizou-se como instrumento de coleta de dados o questionário, que foi encaminhado aos médicos de Araraquara (SP). A análise dos dados incluiu estudo de associação por meio do teste de qui-quadrado. Os resultados indicaram que os médicos relacionam-se com os propagandistas (98por cento) por considerá-los úteis (55por cento), mas não como fonte principal de atualização (86por cento). Para 62por cento, suas prescrições não são influenciadas por tais relacionamentos, enquanto 24por cento, assim como os recém-formados (37por cento), discordam que os médicos em geral são influenciados. A maioria também discorda que sejam influenciados pelas cortesias (86por cento) ou pelas amostras grátis (70por cento), mas apenas 38por cento acreditam que os colegas não sejam influenciados pelas amostras. Quanto à ética desses recebimentos, 57por cento consideram ser apropriado quando beneficiam os pacientes, mas somente 32por cento quando para uso pessoal. Concluiu-se, com base nas evidências dos resultados, que os médicos são vulneráveis às influências do marketing, sendo necessários mecanismos e intervenções para que a prescrição de medicamentos seja pautada unicamente por critérios de eficácia, segurança, conveniência e acessibilidade ao paciente.

The pharmaceutical industry invests heavily in promoting their products, and studies suggest that these actions influence doctor?s prescribing. Therefore, this study aimed to analyze the opinions and attitudes of doctors when facing promotional activities of the laboratories. To this end, questionnaires were sent to doctors in Araraquara (SP) containing statements on the subject. Data analysis included study of the association by the chi-square. The results indicated that physicians relate to the propagandists (98percent) by considering them useful (55percent), but not as a main source update (86percent). For 62percent of them their prescriptions are not influenced by such relationships, while 24percent disagree that doctors in general are influenced as well as new graduates (37percent). The majority also disagrees that are influenced by amenities (86percent) or free samples (70percent) but only 38percent believe their colleagues are not influenced by the samples. As for the ethics of these receipts, 57percent considered to be appropriate when benefit patients, but only 32percent while for personal use. The results show that doctors are vulnerable to the influences of marketing. Therefore, mechanisms and interventions are needed for prescribing drugs solely by criteria of effectiveness, safety, convenience and accessibility to the patient.

La industria farmacéutica invierte fuertemente en la promoción de sus productos, y los estudios sugieren que esas acciones influyen en la prescripción médica. Este estudio tuvo como objetivo analizar las opiniones y actitudes de los médicos frente a las acciones promocionales de los laboratorios. Estudio de carácter descriptivo, transversal e de observación, con lineamiento de tipo inquisitorio. Con este fin, se enviaron cuestionarios a los médicos en Araraquara (SP). El análisis de datos incluyó el estudio de asociación por la chi-cuadrado. Los resultados indicaron que los médicos se relacionan con los propagandistas (98por ciento) por considerarlos útiles (55por ciento), pero no como una fuente principal de actualización (86por ciento). El 62por ciento de sus recetas no son influenciados por este tipo de relaciones, mientras que el 24por ciento, así como los nuevos graduados (37por ciento), no están de acuerdo en que los médicos en general estén influenciados. La mayoría también no está de acuerdo que sean influenciados por las cortesías (86por ciento) o por las muestras gratuitas (70por ciento), sin embargo, sólo el 38por ciento creen que sus colegas no estén influenciados por las muestras. En cuanto a la ética de estos ingresos, el 57por ciento lo considera adecuado cuando los pacientes se benefician, mientras que sólo el 32por ciento, cuando es de uso personal. Los resultados muestran que los médicos son vulnerables a las influencias de la comercialización, son necesarias mecanismos e intervenciones para que la prescripción de medicamentos sea guiada únicamente por criterios de eficacia, seguridad, comodidad y accesibilidad para el paciente.

Impacto da saúde bucal na qualidade de vida de pacientes maiores de 50 anos de duas instituições públicas do município de Araraquara-SP, Brasil / Oral health impact profile in the quality of life of patients over 50 years old of two public institutions of Araraquara city, SP, Brazil

Introdução: A saúde bucal pode afetar a qualidade de vida das pessoas, sendo o índice OHIP-14 (Oral Health Impact Profile) de utilidade para avaliar este impacto. Objetivo: Estudar o impacto da saúde bucal na qualidade de vida de pacientes maiores de 50 anos, verificando-se, preliminarmente, a confiabilidade do índice OHIP-14. Material e método: Estudo transversal, em que se aplicou o formulário OHIP-14 a 149 pacientes em duas instituições públicas de atendimento de rotina em Clínica Odontológica (UNESP) e médico (Municipal). Estudou-se a consistência interna do índice aplicando-se o coeficiente alpha-Cronbach. O índice OHIP-14 foi obtido pelo método aditivo, sendo os pacientes distribuídos segundo gênero, faixa etária e nível de escolaridade. O teste t-Student foi usado para comparações de interesse, adotando-se um nível de significância de 5%. Resultado: A amostra compôs-se de 149 pacientes (87% de cobertura). A consistência interna para o índice OHIP-14 foi boa (alpha-Cronbach = 0,78). A média, para o índice OHIP-14, foi de 4,98. Houve predomínio da dor física, nos aspectos "sentir-se incomodado ao comer algum alimento" e "sentir fortes dores na boca", com prevalências de 21,50 e de 11,40%, respectivamente. Houve diferença não-significativa entre o índice OHIP médio e cada uma das variáveis gênero, faixa etária e escolaridade (p > 0,05). Conclusão: O índice OHIP-14 apresentou consistência interna boa e mostrou ser baixo impacto da saúde bucal na qualidade de vida de pacientes maiores de 50 anos em atendimento odontológico e médico de rotina nas instituições estudadas (UNESP e Municipal).

Introduction: Oral health can affect quality of life, and the OHIP-14 index (Oral Health Impact Profile) is useful for evaluating this impact. Objective: to investigate the impact of oral health conditions on the quality of life ofpatients over 50 years, assessing, initially, the consistency of the short form of the Oral Health Impact Profile index (OHIP-14). Material and method: A cross-sectional study was performed among 149 patients of two public institutions for routine dental (UNESP) and medical practice (Municipal). They were interviewed using the OHIP-14 formulary, assessing its internal consistency (Cronbach´s alpha coefficient) and the OHIP-mean (additive method). The patients were distributed according to sex, age, and education level. The comparisons of interest were madeusing Student´s t test at a 5% level of significance. Result: A total of consecutive patients (n = 149) participated of this study (87% response rate). Cronbach´s alpha coefficient was 0.78, denoting a good consistency of the OHIP index. The OHIP mean was 4.98. The most prevalently affected OHIP domains were dimensions of physical pain:painful aching (11.40%) and uncomfortable eating foods (21.50%). There was non-significant difference (p > 0.05)between the mean OHIP value in relation to each of gender, age, and education level. Conclusion: The OHIP-14 is a reliable instrument of assessing oral health-related quality of life, and among patients under routine practice, it was found a low impact of oral conditions on their quality of life in the studied institutions (UNESP and Municipal).

Effect of drying on the reproducibility of DIAGNOdent to detect caries-like lesions.

The aim of this study was to verify the drying effect on the reproducibility of DIAGNOdent (Dd) devices to detect caries-like lesions. Three areas were created in each of the 34 bovine incisors: sound (S), demineralized (DE) and remineralized (RE). One examiner measured each area with two Dd devices (denominated X and Y), twice under humid, and twice under dry condition. Intra-rater agreement according each device and inter-device agreement were estimated by kappa statistics (k). Intra-rater agreement for device Y was substantial under humid (κ (DE)=0.68 and κ (RE+S)=0.68) and dry condition (k DE=0.64 and k RE+S=0.67). For device X, it was substantial under humid condition (k DE=0.57 and k RE+S=0.49), and it was almost perfect after air drying (κ (DE)=1.0 and κ (RE+S)=1.0). Inter-device agreement was slight (k =0.17) under humid condition, and it was substantial under dry condition (k =0.62). As reproducibility increased under dry condition, drying is advised to detect caries-like lesions on free smooth surfaces when different devices are used.

Influência de variações das normas estéticas na atratividade do sorriso / Influence of aesthetic norm variations on the attractiveness of a smile

Objetivo: Avaliar a influência de variações nas normas estéticas na percepção da atratividade do sorriso segundo dentistas e leigos. Métodos: Alterações digitais foram realizadas nos sorrisos de fotografias de dois indivíduos de sexos distintos. Foram criados 11 sorrisos para cada sexo: um sorriso ideal controle, sorriso ideal segundo normas consideradas e 10 sorrisos contendo variações individuais de cada uma das normas descritas a seguir: a) desvio de linha média 2mm e 3mm; b) linha do sorriso - linha do sorriso reta e linha do sorriso reversa; c) angulação incisivos laterais - 10º para mesial e 10º para distal; d) diastema: 0.5mm e 1mm e 5mm) proporção dental - proporção de Alber e proporção de Platão. As fotografias foram avaliadas por dois especialistas em Dentística e dois leigos, utilizando a escala visual analógica. Resultados: Foi observado que o sorriso ideal controle, em ambos os sexos e de acordo com ambos os grupos avaliadores, foi julgado favoravelmente; e que os sorrisos contendo variações estéticas receberam diferentes avaliações, algumas variações foram menos aceitas que outras. Nas avaliações realizadas foram encontradas concordâncias e discordâncias entre os avaliadores. Conclusão: Observou-se que a ausência de desvios favorece a percepção estética dos sorrisos, mas algumas variações estéticas são perceptivelmente aceitas em relação a outras e que para o sucesso dos tratamentos estéticos está condicionada a participação conjunta de dentistas e pacientes na fase do planejamento.

Objective: The work presented here aims to evaluate how aesthetic norm variations influence the perception of attractiveness of a smile according to dentists and laymen. Methods: The smiles in photographs of a man and a woman were digitally changed. Eleven smiles were created for each one: an ideal, control smile - an ideal smile according to accepted norms - and 10 smiles containing individual variations of each of the following norms: a) 2mm and 3mm deviations from the middle line; b) the contour of the smile - contour of a straight smile and contour of a reverse smile; c) the angle of the lateral incisors - a mesial angle of 10º and a distal angle of 10º; d) 0.5mm and 1mm diastema; and e) dental proportion - Alber´s Proportion and Plato´s Proportion. The photographs were evaluated by two specialists in cosmetic dentistry and two laymen using the visual analogue scale. Results: The ideal smile for both genders was well accepted by both the specialists and the laymen. The opinions on the smiles with aesthetic variations varied, some were more positive than others, some were in agreement and some were in disagreement. Conclusion: The absence of deviations favors the perceived beauty of a smile, but some aesthetic variations seem to be better accepted than others. The success of aesthetic treatments depends on the active participation of dentists and patients in the planning stage

[Reproducibility of a scale for oral health among children and adolescents HIV+/AIDS]. / Reprodutibilidade de uma escala odontológica proposta como indicador de saúde bucal em crianças e adolescentes HIV+/SIDA.

The aim of this study was to investigate the intraobserver reproducibility of a Portuguese version scale used to evaluate aspects of oral health among children and adolescents HIV+. The scale was proposed by Balbo and a questionnaire was applied in two occasions, within a one week period, to 27 children and adolescents. The reproducibility was estimated by kappa statistics by point (k). With relation to the mother, it was reached a maximum of agreement for items related to the importance of maintaining the oral health, diary tooth brushing and the individual utilization of dental brush; breath and esthetics presented a good agreement. Regarding the children, a regular agreement was observed on the dental floss use. In contrast, the respondents had difficulties in reporting the name and address of the professionals that gave guidance in prevention activities to them. The k-values for perception, care and promotion were 0.48, 0.21 and 0.64 respectively, pointing to reproducibility levels classified as regular, fair and good. Given the different levels of reproducibility offered by the dental scale for HIV+ oral health, we suggest that it could be modified, especially in the domain of care.

Reprodutibilidade de uma escala odontológica proposta como indicador de saúde bucal em crianças e adolescentes HIV+/SIDA / Reproducibility of a scale for oral health among children and adolescents HIV+/AIDS

O objetivo deste trabalho foi estimar a reprodutibilidade de uma escala odontológica para avaliação da saúde bucal de crianças e adolescentes HIV+. A amostra, com delineamento não probabilístico, constituiu-se de 27 crianças e adolescentes HIV+. A escala foi aplicada, em duas ocasiões, com intervalo de sete dias. Estimou-se a reprodutibilidade intraexaminador pela estatística Kappa. Nas questões relativas à mãe, houve concordância máxima nos itens referentes à importância da saúde bucal, hábito de escovação diária e utilização de escova dental. A procura de atendimento odontológico motivado por estética e para manutenção de hálito puro apresentou concordância boa. Nas questões relativas à criança, observou-se concordância regular nos itens referentes ao fio dental. Com relação à organização do sistema de saúde, chama atenção a dificuldade dos respondentes em relatar o local e o profissional que realizou orientações educativas preventivas. A reprodutibilidade dos domínios percepção, cuidado e promoção foi de 0,48, 0,21 e 0,64, respectivamente. Sugere-se a necessidade de reestruturação das questões componentes dos algoritmos propostos pela escala para as dimensões de percepção e cuidado, a par da necessidade da saúde bucal ser inserida em programas de atendimento a portadores HIV+.

The aim of this study was to investigate the intraobserver reproducibility of a Portuguese version scale used to evaluate aspects of oral health among children and adolescents HIV+. The scale was proposed by Balbo and a questionnaire was applied in two occasions, within a one week period, to 27 children and adolescents. The reproducibility was estimated by kappa statistics by point (k). With relation to the mother, it was reached a maximum of agreement for items related to the importance of maintaining the oral health, diary tooth brushing and the individual utilization of dental brush; breath and esthetics presented a good agreement. Regarding the children, a regular agreement was observed on the dental floss use. In contrast, the respondents had difficulties in reporting the name and address of the professionals that gave guidance in prevention activities to them. The k-values for perception, care and promotion were 0.48, 0.21 and 0.64 respectively, pointing to reproducibility levels classified as regular, fair and good. Given the different levels of reproducibility offered by the dental scale for HIV+ oral health, we suggest that it could be modified, especially in the domain of care.

Effect of drying on the reproducibility of DIAGNOdent to detect caries-like lesions

The aim of this study was to verify the drying effect on the reproducibility of DIAGNOdent (Dd) devices to detect caries-like lesions. Three areas were created in each of the 34 bovine incisors: sound (S), demineralized (DE) and remineralized (RE). One examiner measured each area with two Dd devices (denominated X and Y), twice under humid, and twice under dry condition. Intra-rater agreement according each device and inter-device agreement were estimated by kappa statistics (k). Intra-rater agreement for device Y was substantial under humid (k DE=0.68 and k RE+S=0.68) and dry condition (k DE=0.64 and k RE+S=0.67). For device X, it was substantial under humid condition (k DE=0.57 and k RE+S=0.49), and it was almost perfect after air drying (k DE=1.0 and kRE+S=1.0). Inter-device agreement was slight (k =0.17) under humid condition, and it was substantial under dry condition (k =0.62). As reproducibility increased under dry condition, drying is advised to detect caries-like lesions on free smooth surfaces when different devices are used.

Este estudo verificou o efeito da secagem sobre o resultado de reprodutibilidade de aparelhos laser DIAGNOdent (Dd) no diagnóstico de cárie artificial. Três áreas foram produzidas em cada um dos 34 incisivos bovinos: hígida (S), desmineralizada (DE) e remineralizada (RE). Um examinador mediu cada área com dois aparelhos Dd (denominados X e Y), sendo duas vezes sob a condição úmida e duas vezes sob a condição seca. A concordância intra-examinador segundo cada aparelho, e a concordância entre aparelhos foram estimadas por meio da estatística kappa (k). A reprodutibilidade intra para o aparelho Y foi substancial sob a condição úmida (kDE=0,68 e k RE+S=0,68) e seca (k DE=0,64 e k RE+S=0,67). Para o aparelho X, a concordância foi substancial sob a condição úmida (kDE=0,57 e k RE+S=0,49) e foi quase perfeita após a secagem (kDE=1,0 e k RE+S+1,0). A concordância entre aparelhos foi fraca (k=0,17) na condição úmida, porém foi substancial na condição seca (k=0,62). Como a reprodutibilidade foi melhor sob a condição seca, a secagem da superfície dentária é aconselhada para se detectar lesões de cárie incipientes em superfícies lisas livres, quando mais de um aparelho é utilizado no diagnóstico.

Comparison between inverted and unprocessed digitized radiographic imaging in periodontal bone loss measurements

The advances in digital imaging technology in dentistry have provided an alternative to film-based radiography and have given new options to detect periodontal bone loss. The purpose of this study was to compare inverted and unprocessed digitized radiographic imaging in periodontal bone loss measurements. Thirty-five film-based periapical radiographs of patients suffering from moderate to advanced untreated periodontal bone loss associated to lower premolar and molars was selected from the department files, with 40 bone loss areas. The film-based radiographs were digitized with a flatbed scanner with a transparency and radiograph adapter used for transilluminating the radiograph imaging. Digitization was performed at 600 dpi and in gray scale. The images were digitized using Image Tool software by applying image inversion, that is, transformation of radiopaque structures into radiolucent structures and vice-versa. The digital data were saved as JPEG files. The images were displayed on a 15-inch and 24-bit video monitor under reduced room lighting. One calibrated examiner performed all radiographic measurements, three times, from the cementoenamel junction to the most apical extension of the bone loss, in both types of image (inverted and unprocessed). Brightness and contrast were adjusted according to the examiner's individual demand. Intraclass correlation coefficient was used to compare the measurements from both types of images. The means of radiographic measurements, in mm, for inverted and unprocessed digitized imaging were 6.4485 and 6.3790, respectively. The intraclass correlation coefficient was significant (0.99) The inverted and unprocessed digitized radiographic images were reliable and there was no difference in the diagnostic accuracy between these images regarding periodontal bone loss measurements.

A survey of radiographic measurement estimation in assessment of dental implant length.

The aim of this study is to survey radiographic measurement estimation in the assessment of dental implant length according to dentists' confidence. A 19-point questionnaire with closed-ended questions was used by two graduate students to interview 69 dentists during a dental implant meeting. Included were 12 questions related to over- and underestimation in three radiographic modalities: panoramic (P), conventional tomography (T), and computerized tomography (CT). The database was analyzed by Epi-Info 6.04 software and the values from two radiographic modalities, P and T, were compared using a chi2 test. The results showed that 38.24% of the dentists' confidence was in the overestimation of measurements in P, 30.56% in T, and 0% in CT. On the other hand, considering the underestimated measurements, the percentages were 47.06% in P, 33.33% in T, and 1.92% in CT. The frequency of under- and overestimation were statistically significant (chi2 = 6.32; P = .0425) between P and T. CT was the radiographic modality with higher measurement precision according to dentists' confidence. In conclusion, the interviewed dentists felt that CT was the best radiographic modality when considering the measurement estimation precision in preoperative dental implant assessment.

Autopercepção das condições de saúde bucal de idosos do município deAraraquara – SP / Self-perception of oral health status by elderly in Araraquara – SP city

O objetivo deste estudo foi verificar a saúde bucal e a autopercepção de 61 idosos atendidos na FOAR/UNESP, no ano de2001. Para avaliação da autopercepção utilizou-se o Geriatric Oral Health Assessment Index (GOHAI) e o questionárioproposto por Silva & Castellanos Fernandes14 (2001) (S&CF). Um examinador realizou exame clínico e adotou-se (0)para ausência e (1) para presença de problemas periodontais ou cárie radicular e, quando da presença de próteses (0)para não funcionais e (1) para funcionais. Realizou-se análise descritiva das variáveis. Testou-se a reprodutibilidadeda autopercepção pela estatística Kappa (κ). Os pacientes foram agrupados em autopercepção “ótima”, “regular” e“ruim” e a associação com doença periodontal, cárie radicular e uso de prótese foi realizada pelo teste de qui-quadradoou teste exato de Fisher, com significância de 5%. A maioria dos idosos afirmou nunca ter sofrido limitações devido aseus dentes, gengivas ou próteses, entretanto, o Índice GOHAI global foi de 27,77, característico de uma autopercepçãoruim. Observou-se que 56% dos idosos apresentaram doença periodontal, 38% cárie radicular e 92% dos idosos eramusuários de próteses não funcionais. Houve baixa concordância entre os diferentes métodos de avaliação (κ = 0,087) eassociação não-significativa entre o índice GOHAI e doença periodontal (χ2=0,856; p=0,5133), cárie radicular (χ2=0,002;p=0,9636) e o uso de próteses (Exato de Fisher: p=0,3286). As condições de saúde bucal apresentaram-se insatisfatóriase a autopercepção mostrou-se ruim, com associação não-significativa com as variáveis clínicas doença periodontal, cárieradicular e uso de prótese.

Estudo da fluorescência de diferentes cores de uma resina composta: análise digital / Fluorescence study of composite resin different shades: digital assessment

O objetivo deste estudo foi avaliar a fluorescência de diferentes cores de uma resina composta e da estrutura dentária por meio de imagens de fluorescência conjugada ao processamento digital. A amostra foi constituída por 192 imagens, sendo 176 de corpos-de-prova de resina composta e 16 da estrutura dentária. Os corpos-de-prova foram confeccionados em matriz circular metálica, contendo orifíco central de 10mm de diâmetro e 1mm de espessura, sendo confeccionado 1 corpo-de-prova para cada uma das 11 cores avaliadas da resina composta Helio Fill (Vigodent). A análise digital da fluorescência foi realizada com auxílio de câmera CCD conectada ao computador, sendo a fluorescência analisada sob iluminação com LED UV. Foram coletadas 16 imagens pela câmera para cada corpo-de-prova e estrutura dentária e estas foram processadas matematicamente, quantificando a intensidade de fluorescência na escala de cinza. Foi aplicada análise de variância a um critério fixo e realizado teste de Tukey para os contrastes. Verificou-se que a tonalidade A1 apresentou maior média de intensidade de fluorescência e a tonalidade C3 apresentou a menor entre as resinas compostas. O comportamento foi semelhante para cores B1 e B2, bem como para A4 e C2. Porém, a intensidade média da estrutura dentária apresentou valor médio inferior a todas as cores avaliadas. Conclui-se que todas as cores analisadas sob iluminação UV possuem fluorescência superior à da estrutura dentária.

Comparison between inverted and unprocessed digitized radiographic imaging in periodontal bone loss measurements.

The advances in digital imaging technology in dentistry have provided an alternative to film-based radiography and have given new options to detect periodontal bone loss. The purpose of this study was to compare inverted and unprocessed digitized radiographic imaging in periodontal bone loss measurements. Thirty-five film-based periapical radiographs of patients suffering from moderate to advanced untreated periodontal bone loss associated to lower premolar and molars was selected from the department files, with 40 bone loss areas. The film-based radiographs were digitized with a flatbed scanner with a transparency and radiograph adapter used for transilluminating the radiograph imaging. Digitization was performed at 600 dpi and in gray scale. The images were digitized using Image Tool software by applying image inversion, that is, transformation of radiopaque structures into radiolucent structures and vice-versa. The digital data were saved as JPEG files. The images were displayed on a 15-inch and 24-bit video monitor under reduced room lighting. One calibrated examiner performed all radiographic measurements, three times, from the cementoenamel junction to the most apical extension of the bone loss, in both types of image (inverted and unprocessed). Brightness and contrast were adjusted according to the examiner's individual demand. Intraclass correlation coefficient was used to compare the measurements from both types of images. The means of radiographic measurements, in mm, for inverted and unprocessed digitized imaging were 6.4485 and 6.3790, respectively. The intraclass correlation coefficient was significant (0.99) The inverted and unprocessed digitized radiographic images were reliable and there was no difference in the diagnostic accuracy between these images regarding periodontal bone loss measurements.