Are antibiotics necessary after lower third molar removal?

OBJECTIVE: Patients (n = 110) free of antibiotics, operated on by 3 surgeons ranging in clinical experiences, were evaluated for infection. STUDY DESIGN: In the preoperative period and during the second and seventh postoperative days, the following parameters were analyzed: pain, infection, swelling, trismus, body temperature, C-reactive protein levels (CRP), and salivary neutrophil counts (SNC). During surgery, the following parameters were analyzed: systolic, diastolic, and mean arterial pressure; oximetry; heart rate; anesthesia quality; local anesthetic amount; bleeding; surgery difficulty; and surgery duration. RESULTS: There were some differences in the surgery duration, local anesthetic amount, anesthesia quality, bleeding, pain experienced, trismus, CRP, and SNC, and no changes in hemodynamic parameters, rescue analgesic medication, wound healing, swelling, body temperature, confirmed case of dry socket, or any other type of local infection. Particularly, no systemic infections were found after lower third molar removal (LTMR). CONCLUSIONS: This study suggests that antibiotic prescriptions are unnecessary after LTMR when preoperative infections are absent.

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study.

OBJECTIVES: To analyse dental caries-related quality of life (QoL) in adolescent (15-19-year-old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, São Paulo, Brazil, in 2009. METHODS: This was a cross-sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14-item Oral Health Impact Profile (OHIP-14) was used to assess QoL. The non-parametric Mann-Whitney test, Spearman's correlation coefficient and chi-squared test were used in the statistical analysis. RESULTS: The DMFT index, Significant Caries (SiC) Index and percentage of caries-free students were similar (P > .05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP-14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP-14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP-14 were statistically significant (P < 0.05). CONCLUSIONS: Despite the similarities in means in the DMFT index, the SiC Index and the caries-free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.

Six-year evaluation of the atraumatic restorative treatment approach in permanent-tooth Class III restorations.

PURPOSE: The aim of this study was to assess the 6-year performance of the ART (atraumatic restorative treatment) approach in Class III restorations in permanent teeth. MATERIALS AND METHODS: A total of 127 ART Class III restorations, using Ketac-Molar (3M ESPE) ionomer cement, was performed in 58 adult patients by one experienced operator in 1998. After a 6 years, 34 patients and 65 restorations were evaluated according to ART criteria. Two calibrated examiners carried out the evaluation. Data were analyzed by exact 95% Confidence Interval and Survival Analysis using the Jackknife method for standard error determination. RESULTS: Among assessed restorations, 73.8% (95% CI = 61.5% to 86.2%) were in good condition and classified as successful, with a 67.6% (95% CI = 54.4% to 80.7%) cumulative survival rate. Failed restorations included 13.9% completely or partially missing restorations, 9.2% restorations that had been replaced by other treatment, 1.5% restorations with a large defect at the margin, and 1.5% restorations that presented high wear on the surface. No caries was observed even in those teeth in which restorations were absent. CONCLUSION: The 6-year success rate of the ART approach in anterior permanent teeth (Class III) was considered high.

A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal.

OBJECTIVE: This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN: Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS: In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.

Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efficacy of 4% articaine for lower third molar removal: a double-blind, randomized, crossover study.

PURPOSE: This study compared the use of 4% articaine in association with 1:100,000 (10 mug/mL; A100) or 1:200,000 (5 mug/mL; A200) epinephrine in lower third molar removal. PATIENTS AND METHODS: Fifty healthy volunteers underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia with either A100 or A200, in a double-blind, randomized, and crossed manner. Latency, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A100 and A200 presented very similar latency (1.64 +/- 0.08 and 1.58 +/- 0.08 minutes, respectively; P > .05). Identical volumes of both anesthetic solutions were used: 2.7 mL = 108 mg of articaine plus 27 mug (A100) or 13.5 mug (A200) of epinephrine. The 2 solutions provided similar duration of postoperative analgesia regardless of bone removal (around 200 minutes; P > .05). The 2 solutions also had a similar duration of anesthetic action on soft tissues (around 250 minutes; P > .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal. Transient changes in hemodynamic parameters were observed, but these were neither clinically significant nor attributable to the type of anesthetic used (P > .05). CONCLUSIONS: An epinephrine concentration of 1:100,000 or 1:200,000 in 4% articaine solution does not affect the clinical efficacy of this local anesthetic. It is possible to successfully use the 4% articaine formulation with a lower concentration of epinephrine (1:200,000 or 5 mug/mL) for lower third molar extraction with or without bone removal.

Consumption of bottled water by children in the city of Bauru, State of São paulo, Brazil -- a brief communication.

OBJECTIVES: To determine the consumption of bottled water by children in the city of Bauru, State of São Paulo, Brazil. METHODS: A stratified sample of the 17 areas established by the city plan was used to identify a total of 1,000 homes for visitation. Information was collected using a questionnaire concerning the type of water consumed and population demographics. RESULTS: Overall, around 30 percent of all residences used bottled water. Among all households where bottled water was consumed, about 26 percent had children residing. For those with children and bottled water, 81 percent reported to use bottled water for the preparation of the children's foods and beverages. CONCLUSIONS: An important percentage of children consume bottled water in the city of Bauru, State of São Paulo, Brazil. Considering previous studies showing that fluoride concentrations vary in bottled water, public health measures should be implemented in order to guarantee adequate levels of fluoride in commercialized water.

Clinical evaluation of multiple-surface ART restorations: 12 month follow-up.

PURPOSE: The purpose of this study was to evaluate the performance of multiple-surface restorations employing 2 different glass ionomer cements (GICs) and the Atraumatic Restorative Treatment (ART) approach in permanent molar teeth. METHODS: This study examined 60 restorations--36 Class I restorations involving 2 or more tooth surfaces and 24 Class II restorations--that were placed in 46 schoolchildren (9-16 years of age) by 2 dentists using the ART approach. The restorations were randomly divided into 2 groups: (a) 30 cavities were filled with high strength GIC (Ketac Molar-3M ESPE), and (b) 30 cavities were filled with resin-modified GIC (Fuji VIII-GC Corp). Two independent calibrated examiners carried out the evaluations according to ART criteria. The interexaminer kappa was 0.92. Data were submitted to chi-square, McNemar, and Fisher's tests. A difference was statistically significant if P<.05. RESULTS: In a 12-month follow-up, 59 restorations were evaluated. The success rates of the restorations were 100% and 93% for Fuji VIII and Ketac Molar, respectively. There was no statistically significant difference between GICs, cavity types, or operators. CONCLUSIONS: Based on a 12-month follow-up evaluation, the clinical performance of the multiple-surface atraumatic restorative treatment restorations of both glass ionomer cements (high-strength and resin-modified) was considered satisfactory with a high success rate.

Dor Crônica em Hanseníase – Um Problema de Saúde Pública? / Chronic Pain in Hansen's Disease - A Public Health Problem?

A hanseníase, ainda com taxa de detecção muito elevada no Brasil, caracteriza-se por alterações dos nervos periféricos e lesões de pele com distúrbio de sensibilidade, sendo a última um dos paradigmas para seu diagnóstico. Entretanto, o sintoma dor nesses pacientes tem sido relatado com crescente freqüência. A dor pode ser nociceptiva devido à inflamação dos tecidos (reação reversa e eritema nodoso leproso) e neuropática (por lesão anatômica e/ou funcional do sistema nervoso). Foram estudados 53 pacientes com queixas de dor para investigar suas características espaciais, temporais, descritivas, afetivas e avaliativas. Dentre eles, 73,6% já tinham completado o tratamento com PQT/OMS e 84,9% eram casos multibacilares. A localização espacial mais prevalente refere-se aos nervos ulnar e tibial. A dor em queimação é a descrição livre mais referida pelo pacientes (28,3%) e a adjetivação afetiva e avaliativa revela potencial de interferência na qualidade de vida. A dor nos portadores de hanseníase pode se apresentar, mesmo após a cura da doença, com características sensoriais, espaciais, temporais e afetivas bastante definidas e prejudiciais, que demandam controle e tratamento específico.

The changing pattern of analgesic and anti-inflammatory drug use in cleft lip and palate repair.

OBJECTIVE: This work aimed at performing a retrospective and comparative investigation of pharmacological therapeutic approach for pain and inflammation control for cleft lip and/or palate repair. STUDY DESIGN: Medical charts from 2000 patients who underwent surgical procedures at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Brazil, were assessed to obtain information regarding type of cleft, surgical procedure, and analgesic and anti-inflammatory drugs prescribed. The first 1000 consecutive surgeries performed in 1992 and 2002 were assessed. RESULTS: Different analgesic and anti-inflammatory agents-nonsteroidal anti-inflammatory drugs (NSAIDS), steroids, and opioids-were given to patients perioperatively and postoperatively. NSAIDS were given to almost all patients (97.03% in 1992 and 99.88% in 2002, P > .05). Steroid administration increased in 2002 (8.66% versus 17.71%, P < .05). Opioids were administered only in 2002 (50.31%, P < .05). CONCLUSION: NSAIDS, steroids, and opioids were used for pain and inflammation control in cleft lip and palate repair at HRAC-USP. A change in the pattern of analgesic and anti-inflammatory drug use was observed when comparing 1992 and 2002. More potent compounds, such as opioids, were used in 2002 in a significant percentage of all the surgical procedures.

Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: a double-blind, randomized, crossover study.

OBJECTIVE: Comparison of the clinical efficacy of 4% articaine in relation to 2% mepivacaine, both with 1:100,000 epinephrine, in the prevention of postoperative pain after lower third molar removal. STUDY DESIGN: Twenty patients underwent removal of bilateral lower third molars under local anesthesia (articaine or mepivacaine) in 2 separate appointments, in a double-blind, randomized, and crossed manner. Objective and subjective parameters were recorded for paired comparison of postoperative courses. RESULTS: Duration of analgesia provided by articaine and mepivacaine was 198.00 +/- 25.86, and 125.40 +/- 13.96 min, respectively (P = .02), whereas the duration of anesthesia was 273.80 +/- 15.94 and 216.85 +/- 20.15 min, respectively (P = .06). Both solutions exerted no important effects upon arterial pressure, heart rate, or oxygen saturation (P > .05). CONCLUSIONS: Articaine provides a longer period of analgesic effect and a tendency for a longer period of anesthesia as compared to mepivacaine. The presence of a vasoconstrictor agent in local anesthetic solutions does not seem to influence hemodynamic parameters during lower third molar removal in healthy subjects.

Neuropathic pain in leprosy patients.

The introduction of multidrug therapy by the World Health Organization has dramatically reduced the world prevalence of leprosy but the disease is still a public health problem in many countries, with a world prevalence of almost 600,000 cases in 2001. Damage to peripheral nerves is a key component of leprosy and the sensory and motor loss that follows is the basis for many of the classical features of this disease, such as skin wounds, cracks, plantar ulcers, clawed hands, drop foot, and incomplete closure of the eyelids. One of the most remarkable aspects of leprosy to lay persons and health care workers alike is that patients are reputed to feel no pain. However, neuropathic pain is arising as a major problem among leprosy patients. It can be nociceptive due to tissue inflammation, which mostly occurs during episodes of immune activation or neuropathic due to damage or dysfunction of the nervous system. This study, conducted among 358 leprosy patients, reveals a considerable prevalence of neuropathic pain and presents evidence that this common problem should be a high priority of those in charge of leprosy control programs.

Clinical evaluation of three restorative materials applied in a minimal intervention caries treatment approach.

OBJECTIVES: This paper reports on a longitudinal evaluation of three materials (glass ionomer, zinc oxide-eugenol cement, and composite) employed in a minimal restorative intervention approach of 81 high caries-active pregnant women selected for a preventive oral health program in Brazil. The aim of the study was to evaluate the clinical behavior of the glass ionomer cement, currently indicated in programs for control of carious lesions. METHODS: The patients were randomly divided into two groups. Both groups were engaged in an oral health promotion approach. In Group 1, 417 glass ionomer restorations were placed in 43 individuals, involving all types and sizes of cavities. In the second group, 213 posterior zinc oxide-eugenol (ZOE) restorations and 127 anterior composite restorations were placed in 38 patients. Minimal cavity preparations were made, in which only soft or infected dentin was removed, on the basis of clinical judgment. RESULTS: After two years, the restorations were clinically evaluated by two examiners for marginal integrity, amount of wear, presence of fracture, carious lesions, and lost restorations. Statistical analysis (chi-square test) identified statistically significant difference between glass ionomer and ZOE (90.6% vs 9.2%). Comparing glass ionomer and composite, similar survival rates were observed. The success rate observed for the glass ionomer cement ranged from 77.1 percent to 92.5 percent, depending on the type and size of cavity in which it was applied. Four teeth restored with glass ionomer cement and one tooth restored with composite showed caries signs. Regarding the ZOE restorations, caries was always associated with other causes of failure such as excessive wear, restoration loss, or marginal defects, with no possibility of separate evaluation. Despite the preventive and therapeutic measurements employed, a mean increase of 2.15 new surfaces with cavities was observed in Group 1, as well as 2.83 surfaces presenting the same status in Group 2. CONCLUSIONS: This study demonstrated that highly viscous glass ionomer cement applied in a minimal intervention approach provided high-quality preventive and restorative care after two years to a population at high risk for caries. The composite was employed in cavities exposed to lower stress, such as in the anterior teeth, and its behavior was comparable to that of the glass ionomer cement. The reinforced ZOE presented a high failure rate, thus contraindicating its use for such purpose.