Cost-Effectiveness Analysis of Rehabilitation Interventions for Teeth With Extensive Coronary Destruction.

OBJECTIVE: To perform a cost-effectiveness analysis of rehabilitation interventions for management of posterior teeth (molar) with extensive coronary destruction. METHODOLOGY: An economic model by Markov simulated a hypothetical 10-year cohort with 1,000 patients requiring treatment for a molar tooth with pulp necrosis and extensive coronary destruction. This study adopted the perspective of a local manager from Specialized Center in Dentistry, based on the transfer from the Ministry of Health. Treatments were proposed: Tooth Extraction + Removable Partial Denture (TE+RPD); Root Canal Treatment + Intra-Radicular Restoration + Single Crown (RCT+RIR+SC); and Tooth Extraction + Dental Implant + Single Crown (TE+DI+SC). The costs were obtained from the SUS Integrated System of Procedures, Medicines and orthoses; prostheses and special materials table management (SIGTAP). Failure and survival rates were obtained from systematic reviews. The variable "years of survival" was an outcome of effectiveness. The probabilistic simulation considered the confidence interval of 95%, variation of parameters by 5% and annual discount rate of 5%. RESULTS: TE+RPD intervention presented lower cost and effectiveness. The incremental cost-effectiveness ratio (ICER) of RCT+IRR+SC and TE+DI+SC interventions compared to TE+RPD were $13.06 and $9.92 per year of survival. Compared to RCT+IRR+SC, the TE+DI+SC intervention had an ICER=$26.90 per year of survival. The acceptability curve indicates that the choice of intervention depends on the willingness to pay. CONCLUSION: The RCT+IRR+SC intervention presented a balance of cost-effectiveness. Rehabilitation with implants can be considered in view of the higher expectation of longevity and, especially, greater willingness to pay.

Biochemical and microbiological analysis of the saliva of institutionalized elderly: With edentulism, use of dentures and presence of biofilm.

BACKGROUND: To analyze biochemical and microbiological parameters of the saliva of institutionalized elders and to investigate the relation of these parameters with edentulism, use of dentures and presence of biofilm. MATERIAL AND METHODS: A cross-sectional study carried was out in seven long-term institutions. Samples (n=161) of unstimulated saliva were collected for analysis of salivary flow, quantification of total proteins and identification of microorganisms. Oral examination was carried out to verify the number of missing teeth, the use of dentures and the presence of visible biofilm on the surface of teeth and dentures. Associations were performed using chi-square or Fisher's exact test (α<0.05). Mann-Whitney Test was used to identify differences in the salivary flow and total proteins (α<0.05). RESULTS: There was no association between the type of edentulism and use of dentures with biochemical and microbiological parameters of saliva (p>0.05). Associations were observed between the presence of dentures biofilm and the colonization of Streptococcus sp. (p=0.038) and Candida sp. (p=0.03). CONCLUSIONS: The absence of teeth and use of dentures do not influence the amount of total proteins and the microorganisms count in saliva. Denture biofilms are associated with the presence of Streptococcus sp. and Candida sp. in saliva of institutionalized elders. Key words:Candida, long-stay institutions for elders, saliva, Streptococcus, Staphylococcus.

Glucose supplementation effect on the acidogenicity, viability, and extracellular matrix of Candida single- and dual-species biofilms.

AIM: Evidence of glucose supplementation effect on Candida biofilm metabolism has not been demonstrated. Therefore, the aim of the present study was to evaluate the effect of glucose concentration on Candida biofilms. METHODS: Single- and dual-species biofilms of Candida were grown on saliva-coated poly(methyl-methacrylate) disks for 72 hours. Biofilms (N = 8/group) were exposed to the following concentrations of glucose: 100 mmol/L (G100), 300 mmol/L (G300), and no glucose (G0: control). Biofilms were collected to determine the acidogenicity, viability, amount of soluble and insoluble extracellular polysaccharides (IEPS), and surface roughness. Data were analyzed using analysis of variance and Tukey's tests (α < 0.05). RESULTS: Single- and dual-species biofilms from G300 were more acidogenic at 48 and 72 hours compared to G100 and G0 (P < 0.05). The viability of the G100 and G300 groups did not differ (P > 0.05), but differed statistically from G0. The amount of IEPS in the G300 group was statistically higher than the G0 and G100 groups (P < 0.05). The G300 group also presented a higher IEPS proportion per number of viable cells compared to others. G300 presented greater surface roughness for both single- (mean roughness = 1460 µm) and dual-species (mean roughness = 1990 µm) biofilms. CONCLUSIONS: Higher glucose concentration (300 mmol/L) during biofilm development favors the growth of single- and dual-species biofilms of Candida.

Activity of in vitro forms of dentifrices containing the hydroalcoholic extract of the ripe fruit of Eugenia uniflora L. (Surinam cherry) on cariogenic bacteria.

The aim of this study was to evaluate the in vitro activity of dentifrices containing the hydroalcoholic extract of the ripe fruit of Eugenia uniflora L. (Surinam cherry) on Streptococcus oralis (ATCC 10557) and Lactobacillus casei (ATCC 7469). Five dentifrices were used: D1: containing hydroalcoholic extract of Eugenia uniflora L.; D2: containing fluoride and hydroalcoholic extract of Eugenia uniflora L.; D3: containing triclosan and hydroalcoholic extract of Eugenia uniflora L; D4: containing triclosan, fluoride and hydroalcoholic extract of Eugenia uniflora L.; D5: positive control (Colgate Total 12). To determine the antibacterial activity, the technique used was the minimum inhibitory concentration by the diffusion method in solid culture medium. At the concentration 0.05 g/mL, the best results were achieved with D1 (18 mm) and D4 (24 mm) on L.casei, and with D3 (19 mm) on S. oralis. The dentifrices D3 and D4 were found to have greater activity on the Streptococcus oralis, while D4 and D1 were found to have greater activity on Lactobaccilus casei. It is concluded that dentifrices with Eugenia uniflora L. have antimicrobial activity, suggesting that clinical trials should be conducted.

Atividade antifúngica de três óleos essenciais sobre cepas de candida / Antifungal activity of three essential oils on candida strains

Objetivou-se avaliar a atividade antifúngica dos óleos essenciais de Melaleuca alternifólia (melaleuca), Cymbopogon winterianus (citronela), e Rosmarinus officinalis (alecrim) sobre Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) e C. tropicalis (ATCC13803). Determinou-se a atividade antifúngica pela Concentração Inibitória Mínima (CIM) e Concentração Fungicida Mínima (CFM), obtidas através das técnicas de microdiluição e de esgotamento, respectivamente. Em microplacas de 96 poços foram inseridos 100?L de caldo Sabouraud-Dextrose duplamente concentrado, 100?L da diluição dos óleos essenciais e 10?L do inoculo fúngico (1,5x106 microrganismos/mL). Realizou-se diluição seriada dos produtos partindo-se da concentração inicial de 8% até 0,0625%. A CIM correspondeu a menor diluição na qual se verificou ausência de crescimento fúngico visível. Realizou-se a semeadura, em Ágar Sabouraud-Dextrose, de 10?L das diluições correspondentes a CIM e duas imediatamente anteriores. Os testes foram realizados em triplicata e a Nistatina (100.000UI/mL) serviu de controle. Procedeu-se análise estatística pelos testes Kruskal-Wallis e Dunn. Para R. officinalis, observou-se melhor desempenho frente C. albicans (ATCC289065) e C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/ mL. M. alternifólia e C. winterianus apresentaram melhor desempenho frente C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/mL. O óleo essencial de R. officinalis apresentou atividade antifúngica estatisticamente diferente (p<0,05), com menores valores de CIM e CFM. Não se observou diferença estatística (p>0,05) para a ação de M. alternifólia e C. winterianus. Concluiu-se que os produtos avaliados exerceram atividade antifúngica sobre Candida, destacando-se o óleo essencial de R. officinalis, com menores CIM e CFM.

The aim was to evaluate the antifungal activity of essential oils from Melaleuca alternifólia (tea tree), Cymbopogon winterianus (citronella), and Rosmarinus officinalis (rosemary) on Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) and C. tropicalis (ATCC13803). The antifungal activity was determined by Minimum Inhibitory Concentration (MIC) and Minimal Fungicidal Concentration (MFC), obtained through the microdilution and exhaustion techniques, respectively. In 96-well microplates were inserted 100?L of Sabouraud-Dextrose broth doubly concentrated, 100?L of the dilution of essential oils and 10?L of fungal inoculums (1.5x106 microorganisms/mL). The products were diluted from initial concentration of 8% until 0.0625%. The MIC corresponded to the lowest dilution at which there was no visible fungal growth. Aliquots of 10?L of dilutions corresponding to the MIC and two immediately preceding were sown on Sabouraud-Dextrose agar. The tests were performed in triplicate and nystatin (100,000UI/mL) served as control. Statistical analysis was conducted by Kruskal-Wallis and Dunn tests. For R. officinalis, better performance was observed on C. albicans (ATCC289065) and on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. M. alternifólia and C. winterianus presented better performance on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. The essential oil from R. officinalis presented antifungal activity statistically different (p<0.05), with lower MIC and MFC. No statistical difference (p>0.05) was observed for the antifungal activity of M. alternifólia and C. winterianus. It was concluded that the evaluated products exerted antifungal activity against Candida, highlighting the essential oil from R. officinalis, with lower MIC and MFC.