Single-session Endodontic Treatment is a Reality in Low-income Areas in Brazil?

AIM: The present study aimed to investigate the total number of visits required to conclude root canal treatments (RCTs) as well as the motivations associated to the choice of dentists practicing in low-income areas of Brazil. MATERIALS AND METHODS: A total of 3,103 questionnaires were electronically and individually delivered to professionals of Salvador, Sergipe, and Alagoas (Brazil). The questionnaire encompassed sociodemographic data and questions regarding the number of sessions required to conclude RCT. Also, postoperative pain, professional qualification, the use of technological resources, and time for one-visit treatment were evaluated. Data were analyzed using Chi-square and Poisson regression analyses (p < 0.05). RESULTS: A total of 326 responses were obtained with higher prevalence of specialists in the field of endodontics (36.8%). Dentists reported greater preference for rotary instrumentation (Alagoas 54.6%, Aracaju 62.1%, and Salvador 83.5%), and most of the participants reported multiple visits to treat root canals with the necrotic pulp tissue associated or not to periapical radiolucency, excluding Salvador (53.8%). Dentists who graduated in public dental schools were less likely to perform RCT of necrotic teeth with periapical lesion in one clinical appointment (p = 0.034). The single-session therapy was positively associated to continuing education attendance (p = 0.004) and to the occurrence of clinical complications (p < 0.001). Dentists who graduated in lato sensu programs were more likely to conclude RCT in less than 60 minutes (p < 0.001), although the occurrence of postoperative pain was more likely observed upon this scenario (p < 0.001). CONCLUSION: Despite the social inequalities in the analyzed area, professionals have been seeking for knowledge by means of continuing education programs and the implementation of technological resources in their clinical routine, although this fact has poorly influenced the acceleration of RCT. Clinical significances: The total number of visits to conclude endodontic treatment may be influenced by both professional and biological parameters such as the attendance to postgraduation programs and the use of technology as well as to the biological condition of the pulp and the occurrence of postoperative complications.

Clinical and Molecular Microbiological Evaluation of Regenerative Endodontic Procedures in Immature Permanent Teeth.

INTRODUCTION: This study evaluated the bacterial levels after regenerative endodontic procedures and their correlation with the treatment outcome using molecular microbiology methods. METHODS: Root canal samples of 15 necrotic immature teeth were analyzed by quantitative polymerase chain reaction. Bacteria were counted before treatment (S1), after irrigation with 6% sodium hypochlorite (S2), and after intracanal dressing (S3) using either triple antibiotic paste (n = 7) or calcium hydroxide with chlorhexidine (n = 8). The Wilcoxon test for related samples and the Mann-Whitney test were used for statistical analysis (P < .05). After a follow-up period of 12-48 months, clinical and radiographic findings were correlated with microbiological data using a linear regression model (P < .05). RESULTS: All S1 and S2 samples were positive for bacteria, but the number of positive S3 samples decreased to 53.3% (P = .001). Overall, there was a significant reduction of bacterial levels after each treatment step (S1-S2, P = .001; S2-S3, P = .02). In the triple antibiotic paste and chlorhexidine groups, 57.1% and 50% of S3 samples were positive with median numbers of 6.97 × 103 and 3.59 × 104 bacterial cells, respectively. No significant differences were found between the groups. Periapical healing occurred in all cases despite the presence of low levels of residual bacteria. However, the latter had a negative impact on the thickness of dentinal walls (R2 = 0.0043). CONCLUSIONS: Although the bacterial levels were drastically reduced after the regenerative endodontic procedures, the residual bacteria influenced the thickness of the dentinal walls.

Domestic violence against children detected and managed in the routine of dentistry - A systematic review.

The domestic violence against children (DVAC) interferes in the psychological development leading to sequels that manifest and persist up to the adulthood. The physical evidences of domestic violence are more easily observed in the orofacial complex, becoming eventually detected by dentists. The present systematic literature review aimed to investigate the perception, knowledge and attitude of dentists towards the detection and management of DVAC cases. A systematic search was performed in 6 databases: PubMed, ScienceDirect, LILACS, SciELO, GoogleScholar, and OpenGrey. Cross-sectional articles assessing the perception, knowledge, and attitude of dentists facing potential cases of DVAC were selected. No restriction of language, time, and publication status was considered. The search resulted in 1.024 articles, of which 18 fit the eligibility criteria. The knowledge for detecting cases of DVAC obtained during the undergraduation course was classified by the dentists (in 39% of the articles) as "insufficient". When suspecting of cases involving domestic violence, most of the dentists (in 77.75% of the articles) considered reporting to the competent authorities. However, the dentists are not sure about who these authorities are (in 31.25% of the articles). More attention must be given to the Forensic education in Dentistry. Specifically, proper training is necessary to support the dentists on the detection and management of pediatric patients under domestic violence. Systematic Review Registration Number: PROSPERO CRD42015026747 (http://www.crd.york.ac.uk/PROSPERO).

Repair of apical root resorption associated with periodontitis using a new intracanal medicament protocol.

Endodontic therapy is indicated for cases of traumatic tooth dislocation associated with pulp necrosis and/or inflammatory resorption. Here we describe the management of a maxillary left lateral permanent incisor that suffered lateral luxation, leading to pulp necrosis and root resorption, in a 13-year-old boy. The traumatized tooth was treated successfully by intracanal medication with calcium hydroxide, 2% chlorhexidine gel and zinc oxide for 12 months without any need to change the dressing, followed by conventional root canal filling. The postoperative course was uneventful and a stable clinical outcome was obtained with evidence of periapical lesion repair and stabilization of the resorption process.

Microbial evaluation of traumatized teeth treated with triple antibiotic paste or calcium hydroxide with 2% chlorhexidine gel in pulp revascularization.

INTRODUCTION: Revascularization outcome depends on microbial elimination because apical repair will not happen in the presence of infected tissues. This study evaluated the microbial composition of traumatized immature teeth and assessed their reduction during different stages of the revascularization procedures performed with 2 intracanal medicaments. METHODS: Fifteen patients (7-17 years old) with immature teeth were submitted to the revascularization procedures; they were divided into 2 groups according to the intracanal medicament used: TAP group (n = 7), medicated with a triple antibiotic paste, and CHP group (n = 8), dressed with calcium hydroxide + 2% chlorhexidine gel. Samples were taken before any treatment (S1), after irrigation with 6% NaOCl (S2), after irrigation with 2% chlorhexidine (S3), after intracanal dressing (S4), and after 17% EDTA irrigation (S5). Cultivable bacteria recovered from the 5 stages were counted and identified by means of polymerase chain reaction assay (16S rRNA). RESULTS: Both groups had colony-forming unit counts significantly reduced after S2 (P < .05); however, no significant difference was found between the irrigants (S2 and S3, P = .99). No difference in bacteria counts was found between the intracanal medicaments used (P = .95). The most prevalent bacteria detected were Actinomyces naeslundii (66.67%), followed by Porphyromonas endodontalis, Parvimonas micra, and Fusobacterium nucleatum, which were detected in 33.34% of the root canals. An average of 2.13 species per canal was found, and no statistical correlation was observed between bacterial species and clinical/radiographic features. CONCLUSIONS: The microbial profile of infected immature teeth is similar to that of primarily infected permanent teeth. The greatest bacterial reduction was promoted by the irrigation solutions. The revascularization protocols that used the tested intracanal medicaments were efficient in reducing viable bacteria in necrotic immature teeth.

Photosensitizer and light diffusion through dentin in photodynamic therapy.

Photodynamic therapy has been considered a potential antimicrobial modality against oral infections, including dental caries. A model to estimate the penetration of both photosensitizers and light through human dentin, a factor of interest in photodynamic therapy, is proposed. The photoacoustic spectroscopy technique was used to evaluate in vitro dentin permeability of three different photosensitizers. Using the dentin optical absorption and scattering coefficients, it was possible to propose a semi-quantitative model predicting both photosensitizer and light doses within dentin. The graphic illustrations obtained provided guidelines that may be useful in photodynamic therapy protocols used as antimicrobial tools in caries lesions.