Relationship Between Celiac Disease and Dental Caries in Children and Adolescents: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To assess the relationship between celiac disease and the prevalence of dental caries in children and adolescents and also evaluate if dental enamel defects in celiac children predispose to dental caries. Material and Methods: Searches were performed in the following databases: PubMed, Scopus, Cochrane Library, Latin American and Caribbean Literature on Health Sciences, and OpenGrey. The risk of bias was assessed using the Newcastle-Ottawa Scale. DMFT/dmft and DMFS/dmfs data of observational studies that compared the prevalence of caries between children and adolescents with celiac disease and healthy individuals. Meta-analysis was performed using a random effects model. Heterogeneity between studies was estimated using Cochran's Q test, and inconsistency was measured using I2 statistics. Results: Of the 121 studies retrieved, 17 were selected, and 12 were included in the meta-analysis. The prevalence of caries in the primary dentition (dmft) did not differ between celiac patients and controls [SMD = -0.35; 95% CI (-0.83; 0.13); p = 0,15; I2 = 89%]. There was also no difference in the prevalence of caries in permanent teeth (DMFT) between groups [SMD = -0.44; 95% CI (-1.02; 0.14); p = 0.14; I2 = 95%]. Conclusion: Celiac disease is not a determinant factor in the development of dental caries in children and adolescents compared to the control group.

External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis.

BACKGROUND: Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost-benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control. METHODS: The protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger's tests. RESULTS: The search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity. CONCLUSION: More than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health.

Fluoride Binding to Streptococcus mutans Pellets Rich in Extracellular Polysaccharides.

Extracellular polysaccharides (EPS), mainly the insoluble ones, increase the cariogenicity of dental biofilm, but whether they interfere with the binding and retention of fluoride is unknown. EPS-rich (EPS+) and EPS-poor (EPS-) pellets of Streptococcus mutans were formed and treated with increasing fluoride concentrations (0, 0.1, 1, or 10 mM). A concentration-dependent fluoride binding was observed in both EPS- and EPS+ pellets, but the presence of EPS did not affect the retention of fluoride in the pellets. In conclusion, the data suggest that a matrix of dental biofilm rich in EPS does not affect fluoride retention in the biofilm.

Influence of dental erosion on shear bond strength of ceramic brackets bonded with two different adhesive systems: an in vitro study

This study aimed to analyze the shear bond strength (SBS) of ceramic orthodontic brackets bonded with two different adhesive systems to intact and eroded teeth. Ceramic brackets were bonded to 72 bovine central incisors divided into four groups, defined by two study factors: enamel condition (control group, kept in artificial saliva; and experimental group, eroded by using immersion cycles in Coke™ for 90 seconds, every six hours for five days), and adhesive system type (Transbond™ XT or Transbond™ Plus Color Change). Polycrystalline ceramic brackets were adhesively fixed on all specimens using the same light curing protocol. SBS was tested using 0.5 mm/min and the failure mode was classified. SBS data was analyzed using two-way ANOVA followed by Tukey test. The adhesive remnant index (ARI) scores were analyzed using Kruskal-Wallis test with Dunn's post-hoc pairwise comparison (α=0.05). Percentages of ARI scores between the groups were compared by Fisher's exact test. Spearman's correlation coefficient was applied to investigate the correlation between ARI scores and SBS values. Only the adhesive system factor had significant effect on SBS (p=0.014), Transbond™ Plus Color Change showing higher values. No significance was found for enamel condition (p=0.665) or the interaction between adhesive system and enamel condition (p=0.055). ARI scores frequencies differed between groups (p<0.001). The median ARI scores were statistically different for most comparisons among the groups. However, no significant correlation was found between ARI scores and SBS. In conclusion, the type of adhesive system affected the SBS of ceramic brackets to dental enamel, but the enamel condition, intact or eroded, had no significant effect. There was no correlation between ARI scores and SBS values, although eroded enamel tended to retain more adhesive after bracket removal.

Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

Cinnamaldehyde is a biologically active compound for the disinfection of removable denture: blinded randomized crossover clinical study.

BACKGROUND: Fungal infections associated with the use of dentures, like denture stomatitis, are difficult to prevent and treat. This in situ study aimed to investigate the efficacy of cinnamaldehyde for the disinfection of complete removable dentures, and the effect on the physical and mechanical properties (Vickers microhardness, color, and surface roughness) of the acrylic resin. METHODS: Acrylic resin disks were inserted into the dentures of a probabilistic sample of 33 complete denture users, that used cinnamaldehyde (27 µg/mL) and 0.5% sodium hypochlorite solutions in a 20 min/7-days protocol of dentures immersion in each solution, with a wash-out period of 7 days, to constitute a crossover-study. The disks were analyzed before and after the immersion, for the presence of microorganisms (CFU/mL) and by scanning electron microscope (SEM). Also, the surface roughness (Ra) and Vickers microhardness were measured, and color parameters were analyzed using the National Bureau of Standards (NBS) method. Data was analyzed by Wilcoxon and Friedman (microbiological evaluation), paired t-test (color and roughness) and independent t-test (Vickers hardness) (α = 0.05). RESULTS: A significant reduction (P < 0.05) in the number of microorganisms was observed for each species (total microorganisms, Streptococcus mutans, and Candida spp.), with no significant differences (P > 0.05) between hypochlorite and cinnamaldehyde. There was an increase in the roughness and a decrease in the hardness of the test specimens, with no difference between the two disinfectant substances (P > 0.05). Both hypochlorite and cinnamaldehyde also caused changes in color, considered as "perceptible" by the NBS classification, but with no significant difference between disinfectant substances (P < 0.05), and under the clinically acceptable limit (ΔE ≤ 3.7). CONCLUSION: The 27 µg/mL cinnamaldehyde solution was effective against all evaluated microorganisms and caused minor alterations in hardness, surface roughness, and color parameters, with no clinical relevance.

Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis. / Prevalência de fluorose dental em regiões abastecidas com água sem suplementação de flúor no território brasileiro: uma revisão sistemática e metanálise.

This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a "literatura cinzenta". As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.

Prevalência de fluorose dental em regiões abastecidas com água sem suplementação de flúor no território brasileiro: uma revisão sistemática e metanálise / Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis

Resumo Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a "literatura cinzenta". As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.

Abstract This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

Fluoride Binding to Dental Biofilm Bacteria: Synergistic Effect with Calcium Questioned.

It has been suggested that fluoride binding to dental biofilm is enhanced when more bacterial calcium binding sites are available. However, this was only observed at high calcium and fluoride concentrations (i.e., when CaF2 precipitation may have occurred). We assessed fluoride binding to Streptococcus mutans pellets treated with calcium and fluoride at concentrations allowing CaF2 precipitation or not. Increasing calcium concentration resulted in a linear increase (p < 0.01) in fluoride concentration only in the pellets in which CaF2 precipitated. The results suggest that CaF2 precipitation, rather than bacterially bound fluoride, is responsible for the increase in fluoride binding to dental biofilm with the increase in calcium availability.

Fluoride Penetration and Clearance Are Higher in Exopolysaccharide-Containing Bacterial Pellets.

Extracellular polysaccharides (EPS) could increase the penetration of fluoride through dental biofilm, reducing its cariogenicity. We measured the concentration of fluoride in EPS-containing (EPS+) or not-containing (EPS-) Streptococcus mutans bacterial pellets resembling test biofilms, before and up to 60 min after a 0.05% NaF rinse in situ. Fluoride penetration and clearance were higher in EPS+ bacterial pellets. The data suggest that EPS enhances fluoride penetration, but also accelerates fluoride clearance from dental biofilms.

[The association between normative and subjective oral health conditions and dissatisfaction with dental services among adult Brazilians]. / Associação das condições normativas e subjetivas de saúde bucal com a insatisfação com os serviços odontológicos entre adultos brasileiros.

The prevalence of dissatisfaction with dental services and its association with normative and subjective oral health conditions among adult Brazilians was evaluated. This cross-sectional study used data from the last Brazilian National Oral Health Survey (SBBrasil), conducted in 2010. It was considered a representative sample of the adult Brazilian population. Data were analyzed by descriptive, univariate and multiple statistics (OR / 95% CI), with correction by the design effect. Among the 4539 adults included in the study, 614 (13.4%) reported dissatisfaction with dental services. Dissatisfaction was higher among adults who had any decayed teeth (1.61 / 1.06; 2.44), adults who were dissatisfied with their teeth and mouth (2.36 / 1.39; 4.02) and adults who had reported toothache in the previous six months (1.99 / 1.29, 3.07). The conclusion drawn was that the prevalence of dissatisfaction with dental services among Brazilian adults was low and associated to normative and subjective oral health conditions.

Avaliou-se a prevalência da insatisfação com os serviços odontológicos e sua associação com condições normativas e subjetivas de saúde bucal entre adultos brasileiros. Trata-se de um estudo transversal que utilizou dados do inquérito nacional de saúde bucal (SB Brasil) realizado em 2010. Considerou-se uma amostra representativa da população adulta brasileira. Foram conduzidas análises descritivas, bivariadas e múltiplas (OR/IC 95%) com correção pelo efeito desenho. Dentre os 4.539 adultos incluídos, 614 (13,4%) relataram a insatisfação com os serviços odontológicos utilizados. A insatisfação foi maior entre aqueles que apresentavam algum dente cariado (1,61/1,06 ; 2,44), que estavam insatisfeitos com seus dentes e boca (2,36/1,39 ; 4,02) e que haviam relatado dor de dente nos últimos 6 meses (1,99/1,29 ; 3,07). Conclui-se que a prevalência da insatisfação com os serviços odontológicos entre adultos brasileiros foi baixa e esteve associada a condições normativas e subjetivas de saúde bucal.

Associação das condições normativas e subjetivas de saúde bucal com a insatisfação com os serviços odontológicos entre adultos brasileiros / The association between normative and subjective oral health conditions and dissatisfaction with dental services among adult Brazilians

Resumo Avaliou-se a prevalência da insatisfação com os serviços odontológicos e sua associação com condições normativas e subjetivas de saúde bucal entre adultos brasileiros. Trata-se de um estudo transversal que utilizou dados do inquérito nacional de saúde bucal (SB Brasil) realizado em 2010. Considerou-se uma amostra representativa da população adulta brasileira. Foram conduzidas análises descritivas, bivariadas e múltiplas (OR/IC 95%) com correção pelo efeito desenho. Dentre os 4.539 adultos incluídos, 614 (13,4%) relataram a insatisfação com os serviços odontológicos utilizados. A insatisfação foi maior entre aqueles que apresentavam algum dente cariado (1,61/1,06 ; 2,44), que estavam insatisfeitos com seus dentes e boca (2,36/1,39 ; 4,02) e que haviam relatado dor de dente nos últimos 6 meses (1,99/1,29 ; 3,07). Conclui-se que a prevalência da insatisfação com os serviços odontológicos entre adultos brasileiros foi baixa e esteve associada a condições normativas e subjetivas de saúde bucal.

Abstract The prevalence of dissatisfaction with dental services and its association with normative and subjective oral health conditions among adult Brazilians was evaluated. This cross-sectional study used data from the last Brazilian National Oral Health Survey (SBBrasil), conducted in 2010. It was considered a representative sample of the adult Brazilian population. Data were analyzed by descriptive, univariate and multiple statistics (OR / 95% CI), with correction by the design effect. Among the 4539 adults included in the study, 614 (13.4%) reported dissatisfaction with dental services. Dissatisfaction was higher among adults who had any decayed teeth (1.61 / 1.06; 2.44), adults who were dissatisfied with their teeth and mouth (2.36 / 1.39; 4.02) and adults who had reported toothache in the previous six months (1.99 / 1.29, 3.07). The conclusion drawn was that the prevalence of dissatisfaction with dental services among Brazilian adults was low and associated to normative and subjective oral health conditions.

Effect of 5,000 ppm Fluoride Dentifrice or 1,100 ppm Fluoride Dentifrice Combined with Acidulated Phosphate Fluoride on Caries Lesion Inhibition and Repair.

High fluoride dentifrice (FD; 5,000 ppm F) has been recommended to arrest root dentine lesions and to control enamel caries in high-risk patients. Also, standard FD (1,100 ppm F) in combination with professional fluoride application has been recommended to control dentine caries, but the effect of this combination on enamel has been considered modest. Considering the lack of evaluation comparing the use of 5,000 ppm FD (5,000-FD) versus acidulated phosphate fluoride (APF) application combined with 1,100 ppm FD (1,100-FD) on the inhibition and repair of caries lesions in both enamel and dentine, we conducted this in situ, double-blind, crossover study of 3 phases of 14 days. In each phase, 18 volunteers wore palatal appliances containing enamel and root dentine specimens, either sound or carious, to evaluate the effect of the treatments on the inhibition or repair of caries lesions, respectively. The treatments were non-FD (negative control), 5,000-FD, or 1 APF gel application on dental specimens combined with 1,100-FD used twice per day (APF + 1,100-FD). The reduction of demineralization and enhancement of remineralization were assessed by surface and cross-sectional hardness. Fluoride concentration was determined on dental specimens and on the formed biofilm. For enamel, APF + 1,100-FD and 5,000-FD did not differ regarding the inhibition of demineralization and repair of caries lesions. However, for dentine the difference between these treatments was inconclusive because while APF + 1,100-FD was more effective than 5,000-FD in caries lesion reduction and repair, 5,000-FD was more effective than APF + 1,100-FD in the reduction of surface demineralization. Therefore, the findings show that the combination of APF + 1,100-FD is as effective as 5,000-FD in enamel inhibition of demineralization and enhancement of remineralization.

Calcium Prerinse before Fluoride Rinse Reduces Enamel Demineralization: An in situ Caries Study.

A calcium (Ca) prerinse before a fluoride (F) rinse has been shown to increase oral F levels. We tested the anticaries effect of this combination in a dose-response in situ caries model. In a double-blind, crossover experiment, 10 volunteers carried enamel slabs in palatal appliances for 14 days, during which they rinsed twice/day with one of four rinse combinations: (1) a placebo prerinse (150 mM sodium lactate) followed by a distilled water rinse (negative control); (2) a placebo prerinse followed by a 250 ppm F rinse; (3) a placebo prerinse followed by a 1,000 ppm F rinse, or (4) a Ca prerinse (150 mM Ca, as calcium lactate) followed by a 250 ppm F rinse. Sucrose solution was dripped onto the slabs 8×/day to simulate a high cariogenic challenge. The percent surface hardness loss (%SHL) was significantly lower in the Ca prerinse used with the 250 ppm F rinse group (%SHL = 38.0 ± 21.0) when compared with the F rinse alone (%SHL = 59.5 ± 24.1) and similar to the 1,000 ppm F rinse group (%SHL = 42.0 ± 18.3). Compared with the 250 ppm F rinse, the Ca prerinse increased biofilm fluid F only twice (nonsignificant). However, it greatly increased F in biofilm solids (∼22×). The Ca prerinse had little effect on loosely or firmly bound enamel F. The results showed an increased level of protection against demineralization by the use of a Ca prerinse, which seems to be caused by the enhancement of F concentration in the biofilm.

Frequency of Fluoride Dentifrice Use and Caries Lesions Inhibition and Repair.

The clinical relevance of the frequency of fluoride dentifrice (FD) use on enamel caries is based on evidence. However, the relative effect of FD on reduction of demineralization or enhancement of remineralization is unknown and the effect of frequency on root dentine caries has not been explored. The aim of this double-blind, crossover, in situ study, which was conducted in 4 phases of 14 days each, was to evaluate the relationship between the frequency of FD use and enamel and root dentine de- and remineralization. Eighteen volunteers wore palatal appliances containing enamel and root dentine slabs, either sound or carious. Biofilm accumulation on the slab surface was allowed, and 20% sucrose solution was dripped 3 or 8 times per day on the carious and sound slabs, respectively. Volunteers used FD (1,100 µg F/g) in the frequencies 0 (fluoride-placebo dentifrice), 1, 2 and 3 times per day. The demineralization and remineralization that occurred in sound or carious slabs was estimated by the percentage of surface hardness loss (%SHL) or recovery (%SHR). Loosely (CaF2) and firmly (FAp) bound fluoride concentrations were also determined. The relationship between the variables was analyzed by linear regression. The %SHL, CaF2 and FAp concentrations were a function of the frequency of FD use for enamel and dentine, but the %SHR was a function of the frequency of FD use only for enamel (p < 0.05). The results suggest that demineralization in enamel and root dentine is reduced in proportion to the frequency of FD use, but for remineralization the effect of the frequency of FD use was relevant only to enamel.

Concentração de fluoreto nos dentifrícios a base de MFP/CaCO3 mais vendidos no Brasil, ao final dos seus prazos de validade / Fluoride concentration in most sold MFP/CaCO3 -based Brazilian toothpastes at the expiration time

Dentifrício fluoretado deve conter pelo menos 1.000 ppm (mg F/kg) do seu flúor total (FT) na forma quimicamente solúvel (FST) para ter o potencial máximo de interferir com o processo de cárie. Em formulações de dentifrícios contendo cálcio no abrasivo, a concentração de FST (íon flúor + íon MFP) diminui em função do tempo de armazenamento. Os quatro dentifrícios a base de MFP/CaCO3 mais vendidos no Brasil são capazes de manter 1.000 ppm de FST nos produtos pelo prazo de um ano de fabricação, mas não é conhecido o que ocorre até o final do prazo de validade. Assim, o objetivo deste estudo foi avaliar a concentração de FST nesses dentifrícios ao final do seu prazo de validade. Após as análises iniciais realizadas em 2010, os cremes dentais (n=30) foram armazenados à temperatura laboratorial (25°C) e as concentrações de FT e FST foram novamente determinadas em 2012, próximo a data de vencimento (36 meses). As análises foram feitas utilizando protocolo validado de extração, as determinações foram feitas com eletrodo íon específico e os resultados expressos em ppm F (mg F/kg). A concentração (média±dp;n=30) de FT encontrada (1.415,2±62,8) estava de acordo com o declarado pelo fabricante (1.450 ppm F), porém a de FST foi 44% menor (814,7±74,7). Ao final do prazo de validade, os dentifrícios brasileiros mais vendidos não mantêm uma concentração de FST máxima desejável, mostrando tanto a importância do Cirurgião-Dentista na orientação do paciente como a necessidade da revisão da resolução Anvisa nº 79 que regulamenta a matéria sobre dentifrícios

Fluoride toothpaste should contain at least 1,000 ppm (mg F/kg) of fluoride chemically soluble to have the maximum potential to interfere with the caries process. In formulations containing calcium--based abrasives, the concentration of total soluble fluoride (TSF = fluoride ion + MFP ion) decreases according to the storage time. The four MFP/CaCO3-based toothpastes most consumed in Brazil are able to maintain 1,000 ppm of TSF throughout one year of manufacturing, but it is not known if it would be maintained up to the expiration date. Thus, this study evaluated the concentration of TSF in these toothpastes at the end of expiration date. As control, the total fluoride (TF) concentration was also determined. After the analysis of fresh samples conducted in 2010, the toothpastes tube (n=30) were stored at temperature of 25°C and the determinations of TF and TSF concentrations were again assessed in 2012, close to the expiration date of the toothpastes (3 years). The analyses were made using a validated protocol of extraction, the determinations were made with an ion specific electrode and the results were expressed in ppm F (mg F/kg). The concentration (mean±SD;n=30) of TF found (1.415.2±62.8) was according to the declared by the manufacturer (1.450 ppm), but the TSF was 44% lower (814.7±74.7). At expiration, the most sold MFP/CaCO3-based brazilian toothpastes do not maintain the maximum TSF concentration required, showing not only the relevance of the Dentist to advise the patients about this subject, but also the necessity to review the Brazilian regulation about toothpastes

Avaliação do Efeito Erosivo em Microscopia Eletrônica de Varredura e Propriedades Físico-Químicas de Bebidas Gaseificadas de Baixa Caloria / Evaluation of the Erosive Effect in Scanning Electron Microscopy and Physicochemical Properties of Low-Calorie Carbonated Beverages

Objetivo: Avaliar o pH, a quantidade de Sólidos Solúveis Totais (°Brix), condutividade elétrica e a superfície do esmalte bovino submetido à ação de bebidas gaseificadas de baixa caloria, em Microscopia Eletrônica de Varredura (MEV). Material e Métodos: Os produtos utilizados foram: Aquarius Fresh® limão, H2OH!® limão, Aquazero® limão, Viver light® limão, Coca-cola® (controle positivo) e água deionizada (controle negativo). A avaliação do pH foi realizada mediante o uso de phmetro digital, a condutividade elétrica foi determinada por meio de um condutivímetro de bancada e para a quantificação do °Brix utilizou-se um refratômetro específico de campo. Para cada análise foram feitas três aferições e calculou-se a média aritmética. A superfície adamantina foi confeccionada a partir da exodontia de incisivos hígidos de maxilares bovinos de animais destinados ao abate, obtendo-se ao final, blocos de esmalte de 3x3mm (n=12) que foram submetidos ao contato por 5 minutos com as bebidas e em seguida lavados e armazenados para posterior análise em MEV. Resultados: Os valores de pH variaram de 2,56 (controle positivo) a 6,00 (controle negativo), estando as demais bebidas abaixo do pH 3,46. Os resultados para condutividade elétrica variaram de 001mS.cm -¹ (controle negativo) a 1071 mS.cm -¹ (Coca-Cola® ). Com relação aos °Brix, todas as bebidas, com exceção da Coca-Cola® (6,5°Brix) tiveram valor 0°Brix. Observou-se que as bebidas analisadas revelaram-se potencialmente erosivas. A superfície do esmalte exposto às bebidas gaseificadas apresentou características microestruturais indicativas de erosão. Conclusão: As bebidas gaseificadas analisadas se revelaram potencialmente erosivas para a superfície adamantina exposta, por um curto período de tempo, à ação destes produtos, não apresentando potencial cariogênico.

Objective: To evaluate the pH, the amount of total soluble solids (°Brix), electrical conductivity and the surface of bovine enamel, by Scanning Electronic Microscopy (SEM), subjected to the action of low- calorie soft drinks. Materials and Methods: The products tested were: Aquarius® Fresh lemon, H2OH!® lemon, Aquazero® lemon, Viver Light®lemon, CocaCola® (positive control) and deionized water (negative control). The pH evaluation was performed by using digital pHmeter. Electrical conductivity wa s determined by a workbench conductivimeter and for quantification of °Brix was used a specific refractometer of . For each analysis were made three measurements and the arithmetic mean was calculated. The adamantine surface was made from the extraction of healthy maxillary incisors from bovine animals for slaughter, resulting in the end, in 3x3mm enamel blocks (n = 12), which were submitted to contact for 5 minutes with the drinks and then washed and stored for subsequent analysis by SEM. Results: The pH values tranged from 2.56 (positive control) to 6.00 (negative control), while the remaining beverages showed pH bellow than 3.46. The results for electrical conductivity ranged from 001 mS.cm-¹ (negative control) to 1071 mS.cm- (Coca-Cola®). Considering the TSS, all beverages had a value of 0° Brix, excepting Coca-Cola® (6.5° Brix). It was observed that the beverages analyzed proved to be potentially erosive. The enamel surface exposed to fizzy drinks had microstructural features indicative of erosion. Conclusion: Fizzy drinks analyzed have proved to be potentially erosive for the adamantine surface exposed for a short period of time to the action of those products, presenting no cariogenic potential.

Propriedades físico-químicas da dieta líquida gaseifcada: um estudo in vitro / Physico-chemical properties of the carbonated liquid diet: an in vitro study

O crescente consumo de bebidas açucaradas e com pH ácido tem sido considerado um fator de risco para o desenvolvimento de lesões nas superfícies dentais. Dessa forma, o objetivo deste estudo foi avaliar o pH, a condutividade elétrica e a quantidade de Sólidos Solúveis Totais (SST) de bebidas gaseificadas comercializadas na cidade de João Pessoa - PB. Constituíram a amostra os produtos Aquarius Regular®, Aquarius Fresh® limão, H2OH!® limão, H2OH!® limão e tangerina, Aquazero® limão, Água Mineral Schincariol® com gás, Água Tônica Antárctica® (controle positivo) e Água Mineral Schincariol® sem gás (controle negativo). A avaliação do pH foi realizada mediante o uso de pHgâmetro digital, modelo pH 300, da marca Analyser®. A condutividade elétrica foi determinada por um condutivímetro de bancada modelo 600 da Analyser®. Para a quantificação dos Sólidos Solúveis Totais ou °Brix, utilizou-se um refratômetro específico de campo, modelo N1, Atago®. Os valores de pH variaram de 2,85(controle positivo) a 6,41(controle negativo), estando as demais bebidas abaixo do pH 3,85. Os resultados para condutividade elétrica variaram de 81 mS.cm-1 (controle negativo) a 1.004 mS.cm-1 (H2OH!® limão e tangerina). Com relação aos SST, todas as bebidas, com exceção da Água Tônica Antárctica® (7,5 °Brix), tiveram valor 0 °Brix. Com base na metodologia adotada e nos resultados obtidos, observou-se que as bebidas analisadas neste estudo revelaram-se potencialmente erosivas.

The increasing consumption of sugar beverages and with acidic pH has been considered a factor of risk for the development of injuries in dental surfaces. Therefore, the objective of this study was to evaluate the pH, the electrical conductivity and the amount of Total Soluble Solids (SST) of carbonated beverages commercialized in the city of João Pessoa - PB. The sample was formed by the following products Aquarius Regular®, Aquarius Fresh® lemon, H2OH!® lemon, H2OH!® lemon and tangerine, Aquazero® lemon, Sparkling Mineral Water Schincariol®, Antartic Tonic Water® (positive control) and Still Mineral Water Schincariol® (negative control). The evaluation of pH was performed by the use of a digital pH meter, model pH 300, brand Analyser®. The electrical conductivity was determined by a bench conductivimeter, model 600 of the Analyzer®. For the quantification of Total Soluble Solids or °Brix was used a specific refractometer of , model N1, Atago®. The pH values varied from 2.85 (positive control) to 6.41 (negative control), and the other beverages had pH below 3.85. The results for electrical conductivity varied from 81 mS.cm-1 (negative control) to 1,004 mS.cm-1 (H2OH!® lemon and tangerine). About the SST, all the beverages, except the Antarctic Tonic Water® (7.5 °Brix) had value 0 °Brix. Based on the methodology adopted and the results obtained, it was observed that the beverages analyzed in this study proved to be potentially erosive.