Effectiveness of experimental dentifrices based on essential oils on biofilm on complete dentures: an in vitro study.

Specific products containing natural resources can contribute to the innovation of complete denture hygiene. OBJECTIVE: To conduct an in vitro evaluation of experimental dentifrices containing essential oils of Bowdichia virgilioides Kunth (BvK), Copaifera officinalis (Co), Eucalyptus citriodora (Ec), Melaleuca alternifolia (Ma) and Pinus strobus (Ps) at 1%. METHODOLOGY: The variables evaluated were organoleptic and physicochemical characteristics, abrasiveness (mechanical brushing machine) simulating 2.5 years, and microbial load (Colony Forming Units - CFU/mL), metabolic activity (XTT assay) and cell viability (Live/Dead® BacLight™ kit) of the multispecies biofilm (Streptococcus mutans: Sm, Staphylococcus aureus: Sa, Candida albicans: Ca and Candida glabrata: Cg). Specimens of heat-polymerized acrylic resins (n=256) (n=96 specimens for abrasiveness, n=72 for microbial load count, n=72 for biofilm metabolic activity, n=16 for cell viability and total biofilm quantification) with formed biofilm were divided into eight groups for manual brushing (20 seconds) with a dental brush and distilled water (NC: negative control), Trihydral (PC: positive control), placebo (Pl), BvK, Co, Ec, Ma or Ps. After brushing, the specimens were washed with PBS and immersed in Letheen Broth medium, and the suspension was sown in solid specific medium. The organoleptic characteristics were presented by descriptive analysis. The values of density, pH, consistency and viscosity were presented in a table. The data were analyzed with the Wald test in a generalized linear model, followed by the Kruskal-Wallis test, Dunn's test (mass change) and the Bonferroni test (UFC and XTT). The Wald test in Generalized Estimating Equations and the Bonferroni test were used to analyze cell viability. RESULTS: All dentifrices showed stable organoleptic characteristics and adequate physicochemical properties. CN, Ec, Ps, Pl and PC showed low abrasiveness. There was a significant difference between the groups (p<0.001) for microbial load, metabolic activity and biofilm viability. CONCLUSIONS: It was concluded that the BvK, Ec and Ps dentifrices are useful for cleaning complete dentures, as they have antimicrobial activity against biofilm. The dentifrices containing Bowdichia virgilioides Kunth showed medium abrasiveness and should be used with caution.

A system for automatic classification of endodontic treatment quality in CBCT.

OBJECTIVES: An evaluation of the effectiveness of a new computational system proposed for automatic classification, developed based on a Siamese network combined with Convolutional Neural Networks (CNNs), is presented. It aims to identify endodontic technical errors using Cone Beam Computed Tomography (CBCT). The study also aims to compare the performance of the automatic classification system with that of dentists. METHODS: One thousand endodontically treated maxillary molars sagittal and coronal reconstructions were evaluated for the quality of the endodontic treatment and the presence of periapical hypodensities by three board-certified dentists and by an oral and maxillofacial radiologist. The proposed classification system was based on a Siamese network combined with EfficientNet B1 or EfficientNet B7 networks. Accuracy, sensivity, precision, specificity, and F1-score values were calculated for automated artificial systems and dentists. Chi-square tests were performed. RESULTS: The performances were obtained for EfficienteNet B1, EfficientNet B7 and dentists. Regarding accuracy, sensivity and specificity, the best results were obtained with EfficientNet B1. Concerning precision and F1-score, the best results were obtained with EfficientNet B7. The presence of periapical hypodensity lesions was associated with endodontic technical errors. In contrast, the absence of endodontic technical errors was associated with the absence of hypodensity. CONCLUSIONS: Quality evaluation of the endodontic treatment performed by dentists and by Siamese Network combined with EfficientNet B7 or EfficientNet B1 networks was comparable with a slight superiority for the Siamese Network. CLINICAL RELEVANCE: CNNs have the potential to be used as a support and standardization tool in assessing endodontic treatment quality in clinical practice.

Knowledge, Attitudes, and Practices on New Treatment Modalities for Temporomandibular Dysfunctions and Orofacial Pain / Conocimientos, Actitudes y Prácticas sobre Nuevas Nodalidades de Tratamiento de las Disfunciones Tempomanibulares y el Dolor Orofacial

The present study proposed to describe, through a literature review, the use of new therapeutic management which allows for offering a better quality of life to individuals affected by these pathologies. A bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 1987 to 2023 were collected. In the first stage, the list of retrieved articles was examined by reading the titles and abstracts. In the second stage, the studies were selected by reading the full contents. Two authors (JDMM and DAQ) performed stages 1 and 2. Experimental, clinical, case-control, randomized controlled, and laboratory cohort studies, case reports, systematic reviews, and literature reviews, which were developed in living individuals, were included. Therefore, articles that did not deal with the subject in question, letters to the editor, opinion articles, duplicated literature in databases, and literature that did not address the variables under study, we re excluded. Contemporary dentistry uses alternative treatments capable of improving the patient's condition since a cure is not always possible. Therefore, the possibility of improving the quality of life becomes an important point to be reached. Evidence-based healthcare has made great advances in recent decades, especially in the areas of orofacial pain, TMD, and occlusion, especially related to orthodontic, prosthetic, and restorative care.

En el presente estudio se propuso describir, a través de una revisión bibliográfica, el uso de nuevos manejos terapéuticos que permitan brindar una mejor calidad de vida a los individuos afectados por estas patologías. Se realizó una búsqueda bibliográfica en las principales bases de datos de salud PUBMED (www.pubmed.gov) y Scholar Google (www.scholar.google.com.br), en las que se recopilaron estudios publicados entre 1987 y 2023. En la primera etapa, se examinó la lista de artículos recuperados mediante la lectura de los títulos y resúmenes. En la segunda etapa, los estudios fueron seleccionados mediante la lectura del contenido completo. Dos autores (JDMM y DAQ) realizaron las etapas 1 y 2. Se incluyeron estudios de cohortes experimentales, clínicos, de casos y controles, controlados aleatorios y de laboratorio, informes de casos, revisiones sistemáticas y revisiones de la literatura, que se desarrollaron en individuos vivos. Por lo tanto, se excluyeron artículos que no trataran el tema en cuestión, cartas al editor, artículos de opinión, literatura duplicada en bases de datos y literatura que no abordara las variables en estudio. La odontología contemporánea utiliza tratamientos alternativos capaces de mejorar el estado del paciente, ya que no siempre es posible la curación. Por lo tanto, la posibilidad de mejorar la calidad de vida se convierte en un objetivo importante. La atención médica basada en la evidencia ha logrado grandes avances en las últimas décadas, especialmente en las áreas de dolor orofacial, TMD y oclusión, especialmente en relación con la atención de ortodoncia, prótesis y restauración.

Comparative analysis of Candida spp. isolated from complete denture wearers with and without an HIV diagnosis.

STATEMENT OF PROBLEM: Denture-related stomatitis (DRS), an inflammation frequently present in human immunodeficiency virus-positive (HIV+) individuals, can be attributable to colonization by Candida spp., which is considered a main factor. The virulence factors of these species are often modulated by the systemic condition of their hosts. PURPOSE: The purpose of this clinical study was to evaluate the incidence, virulence, and morphology of Candida spp. isolated from biofilms of complete denture wearers with DRS, with and without an HIV diagnosis. In addition, the interaction of the systemic condition with the ability of Candida spp. to colonize was evaluated. MATERIAL AND METHODS: Fifty-five complete denture wearers diagnosed with DRS were divided into 2 groups: experimental (HIV+) and control (human immunodeficiency virus-noninfected participants [HIV-]). Biofilm was collected by a standardized method of ultrasonification of prostheses. The incidence was evaluated by a chromogenic method and polymerase chain reaction (PCR). The virulence factors were assessed by using the capacity for biofilm formation by counting colony-forming units (CFUs/mL), biofilm metabolism by tetrazolium salt metabolization, and proteinase and phospholipase production by using a fluorimetric kit. Morphology was verified by using the hyphae-inducing test, and participants' health data were collected with a form. Data were analyzed by using the Student t, Mann-Whitney U, Spearman, and Fisher tests (α=.05). RESULTS: The results of incidence were related to 55 participants (22 experimental and 33 control); in total, 63 Candida spp. samples were isolated, showing 28 Candida albicans and 36 nonalbicans strains. No significant difference was found between groups in baseline CFU/mL counts, biofilm formation capacity, cell metabolism, and phospholipase production. Proteinase production was higher for C. albicans in the control (P=.031) and for nonalbicans in the experimental (P=.016) groups. Relative to health data, the experimental group showed a moderate negative correlation between the CFU count/mL at baseline for nonalbicans and DRS classification (P=.020). CONCLUSIONS: C. albicans was the most prevalent species. No difference was found in the Candida spp. of complete denture wearers with DRS, with and without an HIV diagnosis, with regard to virulence factors (except for proteinase production) and morphology.

Automatic Classification System for Periapical Lesions in Cone-Beam Computed Tomography.

Imaging examinations are of remarkable importance for diagnostic support in Dentistry. Imaging techniques allow analysis of dental and maxillofacial tissues (e.g., bone, dentine, and enamel) that are inaccessible through clinical examination, which aids in the diagnosis of diseases as well as treatment planning. The analysis of imaging exams is not trivial; so, it is usually performed by oral and maxillofacial radiologists. The increasing demand for imaging examinations motivates the development of an automatic classification system for diagnostic support, as proposed in this paper, in which we aim to classify teeth as healthy or with endodontic lesion. The classification system was developed based on a Siamese Network combined with the use of convolutional neural networks with transfer learning for VGG-16 and DenseNet-121 networks. For this purpose, a database with 1000 sagittal and coronal sections of cone-beam CT scans was used. The results in terms of accuracy, recall, precision, specificity, and F1-score show that the proposed system has a satisfactory classification performance. The innovative automatic classification system led to an accuracy of about 70%. The work is pioneer since, to the authors knowledge, no other previous work has used a Siamese Network for the purpose of classifying teeth as healthy or with endodontic lesion, based on cone-beam computed tomography images.

Metal Alloys in Dentistry: An Outdated Material or Required for Oral Rehabilitation?

ABSTRACT: The present study aims to describe through a literature review, the main types of noble and non-noble alloys in dentistry looking to identify the adhesion mechanisms, compositions and mechanical properties, and its applicability as a rehabilitation resource nowadays. A bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 1971 to 2021 were collected. Laboratory studies, case reports, systematic and literature reviews, which were developed in living individuals. Articles that did not deal with metal alloys and its use in dentistry were excluded. Through the review, it was possible to ver ify that all works presented the metal alloys and their main properties, indicating that they are divided into three main types: hi gh noble alloys, noble alloys and base metal alloys differing in their levels of constituent noble metals. Several alloys and meta ls are available for the dental market each presenting advantages and disadvantages, mainly based on its specific composition.Continuous research and development are resulting in the production of new technologies and products, giving dental surgeons even more options in the design and manufacture of restorations using metal alloys and understanding that these resources will still be viable alternatives in oral rehabilitations. However, further studies on metal alloys are needed to better understand this subject.

RESUMEN: El presente trabajo tuvo como objetivo describir a través de una revisión de la literatura, los principales tipos de aleaciones nobles y no nobles utilizados en odontología buscando identificar los mecanismos de adhesión, composiciones y propiedades mecánicas, así como reflejar su aplicabilidad como recurso rehabilitador en la actualidad. Realizamos una búsqueda bibliográfica em las principales bases de datos de salud PUBMED (www.pubmed.gov) y Scholar Google (www.scholar.google.com.br), en la que se recopilaron estudios publicados desde 1971 hasta 2021. Estudios de laboratorio, informes de casos, revisiones sistemáticas y bibliográficas, que se desarrollaron en individuos vivos. Sin embargo, se excluyeron los artículos que no trataban sobre aleaciones metálicas y su uso en odontología. Se pudo observar que todos los trabajos presentaban las aleaciones metálicas y sus principales propiedades indicando que se estas dividen en tres tipos principales: aleaciones altamente nobles, aleaciones nobles y aleaciones de metales base que difierenen sus niveles de metales nobles constituyentes. Hay varias aleaciones y metales disponibles para el mercado dental, cada uno presenta ventajas y desventajas, principalmente en función de su composición específica. La investigación y el desarrollo continuo están dando como resultado la producción de nuevas tecnologías y productos, brindando a los cirujanos dentistas aún más opciones en el diseño y fabricación de las restauraciones, utilizando aleaciones metálicas y, permite concluir que estos recursos seguirán siendo alternativas viables en los tratamientos de rehabilitación. Sin embargo, se necesitan más estudios sobre el tema abordado en el trabajo, para una comprensión más profunda del tema.

Effectiveness of Oil-Based Denture Dentifrices-Organoleptic Characteristics, Physicochemical Properties and Antimicrobial Action.

Denture dentifrices must be effective and not deleterious to prosthetic devices. This study formulated and evaluated dentifrices based on oils of Copaifera officinalis, Eucalyptus citriodora, Melaleuca alternifolia, Pinus strobus, and Ricinus communis. Organoleptic characteristics (appearance, color, odor, taste), physicochemical properties (pH, density, consistency, rheological, abrasiveness, weight loss, and surface roughness) and antimicrobial (Hole-Plate Diffusion-HPD)/anti-biofilm (Colony Forming Units-CFU) action against Staphylococcus aureus, Streptococcus mutans, and Candida albicans were evaluated. Formulations were compared with water (negative control) and a commercial dentifrice (positive control). The data were analyzed by Kruskal-Wallis and Dunn tests (α = 0.05). The organoleptic and physicochemical properties were adequate. All dentifrices promoted weight losses, with high values for C. officinalis and R. communis, and an increase in surface roughness, without differing from each other. For antimicrobial action, C. officinalis and E. citriodora dentifrices were similar to positive control showing effectiveness against S. mutans and C. albicans and no dentifrice was effective against S. aureus; regarding the anti-biofilm action, the dentifrices were not effective, showing higher CFU counts than positive control for all microorganisms. The dentifrices presented satisfactory properties; and, although they showed antimicrobial action when evaluated by HPD, they showed no effective anti-biofilm action on multispecies biofilm.

Estudo da espessura labial com finalidade pericial ­ comparação entre autoavaliação e avaliação técnica / Study of lip thickness for expert purposes-comparison between self-assessment and technical assessment

O exame da espessura labial pode se apresentar como uma útil ferramenta orientadora da identificação humana. Neste sentido, este estudo teve como objetivo a avaliação de 200 imagens dos lábios superior e inferior de estudantes da área de saúde da Universidade Federal de Pernambuco, por 02 examinadores, a fim de verificar a concordância entre a avaliação técnica, realizada por eles, e a autoavaliação, realizada pelos examinados, quanto à espessura dos lábios. Para isso, cada examinado inicialmente, após recebimento de instruções e assinatura do TCLE, olhando para um espelho, classificou, sem experiência prévia, seus lábios em finos, médios, grossos ou mistos, segundo sua autoavaliação, o que consideramos como avaliação empírica. Em seguida, o vermelhão dos lábios foi fotografado, associado a uma régua ABFO nº2, e mensurado pelos dois examinadores. Os resultados demonstraram que a concordância inter-examinadores técnicos, quanto a indicação do tipo de lábios foi alta, se apresentando com um percentual de 98,5%. Em relação à concordância entre a avaliação técnica com a avaliação empírica, foram obtidos valores baixos, ou seja, apresentaram uma concordância pequena, com percentual de 35%. Segundo a avaliação técnica, os lábios grossos se apresentaram com maior porcentagem, 49,5%, contra 54% da autoavaliação. Na autoavaliação, o tipo mais destacado foi lábios médios (54%). Pode-se concluir que a concordância entre a avaliação técnica e a autoavaliação realizada por pessoa sem experiência (avaliação empírica), neste estudo, quanto ao exame dos tipos de lábio, foi pouco exitosa, em face da pequena coincidência observada, destacando a importância de se considerar seriamente o fato de que tais divergências podem ser altas também em situações onde informações são obtidas a partir de pessoas comuns.

Disfunção temporomandibular e ansiedade em graduandos de odontologia / Disfunción temporomandibular y ansiedade en los estudiantes de odontologia / Temporomandibular dysfunction and anxiety among dental students

Introdução: A disfunção temporomandibular apresenta etiologia multifatorial, enquadrando-se nesses fatores etiológicos condições psicológicas como a ansiedade. Objetivo: Identificar a prevalência da disfunção temporomandibular, ansiedade e seus respectivos graus nos graduandos. Métodos: Trata-se de um estudo do tipo transversal, observacional, com abordagem indutiva, adotando como estratégia de coleta de dados o Índice Anamnésico de Fonseca e o Inventário de Ansiedade Traço-Estado em uma amostra de 185 estudantes de Odontologia da Universidade Federal de Campina Grande, Patos, Brasil. Os dados foram trabalhados pela estatística descritiva e submetidos ao teste estatístico Qui-quadrado e Exato de Fisher considerado significativo ao nível de 5 porcento. Resultados: Os resultados indicam que a maioria da amostra é composta pelo sexo feminino (67 porcento) com idade média de 21,4 anos. Além disso, 79 porcento dos alunos apresentou algum grau da disfunção, tendo a maior parte (72 porcento) se encaixado no grau leve. A ansiedade estado e a ansiedade traço foram mais prevalentes no grau moderado com 79 porcento e 72 porcento, respectivamente. Não foi identificada associação estatística significativa entre a presença e ausência de Disfunção Temporomandibular e ansiedade, seja ela traço ou estado, na amostra estudada com p= 0,484 e p= 0,297, respectivamente. Conclusão: Conclui-se que houve uma alta prevalência de Disfunção Temporomandibular e ansiedade nos graduandos de Odontologia, destacando-se, assim, a importância da busca detalhada desses sinais e sintomas durante o exame clínico(AU)

Introducción: La disfunción temporomandibular presenta una causa multifactorial, incluyéndose en estos factores causales condiciones psicológicas como la ansiedad. Objetivo: Identificar la prevalencia de la disfunción temporomandibular y la ansiedad y sus respectivos niveles en estudiantes. Métodos: Se trata de un estudio del tipo transversal, observacional y con enfoque inductivo. Se adoptó como estrategia de recolección de datos el índice de anamnesis de Fonseca y el inventario de ansiedad rasgo-estado en una muestra de 185 estudiantes de Odontología de la Universidade Federal de Campina Grande. Los datos fueron trabajados por la estadística descriptiva y sometidos a la prueba estadística de chi cuadrado y exacta de Fisher, considerado significativo al nivel de 5 por ciento. Resultados: Los resultados indican que la mayoría de la muestra eran del sexo femenino (67 por ciento) con una edad promedio de 21,4 años. Además, 79 por ciento de los alumnos presentaron algún nivel de disfunción, y la mayor parte (72 por ciento) se encuadró en el nivel leve. La ansiedad estado y la ansiedad rasgo fueron más prevalentes en el nivel moderado con 79 por ciento y 72 por ciento, respectivamente. No se identificó ninguna asociación estadística significativa entre la presencia y ausencia de disfunción temporomandibular y la ansiedad, sea rasgo o estado, en la muestra investigada, con los respectivos valores de p= 0,484 y p= 0,297. Conclusiones: Hubo una alta prevalencia estadística de disfunción temporomandibular y ansiedad en los estudiantes de Odontología, así que se destaca la importancia de la búsqueda detallada de estos signos y síntomas en el examen clínico(AU)

Introduction: The etiology of temporomandibular dysfunction is multifactorial, and causal factors include psychological conditions such as anxiety. Objective: Identify the prevalence of temporomandibular dysfunction and anxiety as well as their levels among dental students from the Federal University of Campina Grande. Methods: An inductive cross-sectional observational study was conducted of a sample of 185 dental students from the Federal University of Campina Grande. Data collection was based on Fonseca's anamnesis index and the State-Trait Anxiety Inventory. Data were analyzed by descriptive statistics and subjected to the chi-square statistical test and Fisher's exact test, with a significance level of 5 percent. Results: Results show that most of the sample was female (67 percent) with a mean age of 21.4 years. On the other hand, 79 percent of the students had some degree of dysfunction, which was mild in most (72 percent). Anxiety state and anxiety trait were more prevalent on the moderate level with 79 percent and 72 percent respectively. No significant statistical association was identified in the study sample between the presence and absence of temporomandibular dysfunction and anxiety, be it trait or state, with values of p= 0.484 and p= 0.297 respectively. Conclusions: High statistical prevalence was found of temporomandibular dysfunction and anxiety among dental students, hence the importance of a detailed search for those signs and symptoms during clinical examination(AU)

Disfunção temporomandibular e ansiedade em graduandos de odontologia / Disfunción temporomandibular y ansiedade en los estudiantes de odontologia / Temporomandibular dysfunction and anxiety among dental students

Introdução: A disfunção temporomandibular apresenta etiologia multifatorial, enquadrando-se nesses fatores etiológicos condições psicológicas como a ansiedade. Objetivo: Identificar a prevalência da disfunção temporomandibular, ansiedade e seus respectivos graus nos graduandos. Métodos: Trata-se de um estudo do tipo transversal, observacional, com abordagem indutiva, adotando como estratégia de coleta de dados o Índice Anamnésico de Fonseca e o Inventário de Ansiedade Traço-Estado em uma amostra de 185 estudantes de Odontologia da Universidade Federal de Campina Grande, Patos, Brasil. Os dados foram trabalhados pela estatística descritiva e submetidos ao teste estatístico Qui-quadrado e Exato de Fisher considerado significativo ao nível de 5 porcento. Resultados: Os resultados indicam que a maioria da amostra é composta pelo sexo feminino (67 porcento) com idade média de 21,4 anos. Além disso, 79 porcento dos alunos apresentou algum grau da disfunção, tendo a maior parte (72 porcento) se encaixado no grau leve. A ansiedade estado e a ansiedade traço foram mais prevalentes no grau moderado com 79 porcento e 72 porcento, respectivamente. Não foi identificada associação estatística significativa entre a presença e ausência de Disfunção Temporomandibular e ansiedade, seja ela traço ou estado, na amostra estudada com p= 0,484 e p= 0,297, respectivamente. Conclusão: Conclui-se que houve uma alta prevalência de Disfunção Temporomandibular e ansiedade nos graduandos de Odontologia, destacando-se, assim, a importância da busca detalhada desses sinais e sintomas durante o exame clínico(AU)

Introducción: La disfunción temporomandibular presenta una causa multifactorial, incluyéndose en estos factores causales condiciones psicológicas como la ansiedad. Objetivo: Identificar la prevalencia de la disfunción temporomandibular y la ansiedad y sus respectivos niveles en estudiantes. Métodos: Se trata de un estudio del tipo transversal, observacional y con enfoque inductivo. Se adoptó como estrategia de recolección de datos el índice de anamnesis de Fonseca y el inventario de ansiedad rasgo-estado en una muestra de 185 estudiantes de Odontología de la Universidade Federal de Campina Grande. Los datos fueron trabajados por la estadística descriptiva y sometidos a la prueba estadística de chi cuadrado y exacta de Fisher, considerado significativo al nivel de 5 por ciento. Resultados: Los resultados indican que la mayoría de la muestra eran del sexo femenino (67 por ciento) con una edad promedio de 21,4 años. Además, 79 por ciento de los alumnos presentaron algún nivel de disfunción, y la mayor parte (72 por ciento) se encuadró en el nivel leve. La ansiedad estado y la ansiedad rasgo fueron más prevalentes en el nivel moderado con 79 por ciento y 72 por ciento, respectivamente. No se identificó ninguna asociación estadística significativa entre la presencia y ausencia de disfunción temporomandibular y la ansiedad, sea rasgo o estado, en la muestra investigada, con los respectivos valores de p= 0,484 y p= 0,297. Conclusiones: Hubo una alta prevalencia estadística de disfunción temporomandibular y ansiedad en los estudiantes de Odontología, así que se destaca la importancia de la búsqueda detallada de estos signos y síntomas en el examen clínico(AU)

Introduction: The etiology of temporomandibular dysfunction is multifactorial, and causal factors include psychological conditions such as anxiety. Objective: Identify the prevalence of temporomandibular dysfunction and anxiety as well as their levels among dental students from the Federal University of Campina Grande. Methods: An inductive cross-sectional observational study was conducted of a sample of 185 dental students from the Federal University of Campina Grande. Data collection was based on Fonseca's anamnesis index and the State-Trait Anxiety Inventory. Data were analyzed by descriptive statistics and subjected to the chi-square statistical test and Fisher's exact test, with a significance level of 5 percent. Results: Results show that most of the sample was female (67 percent) with a mean age of 21.4 years. On the other hand, 79 percent of the students had some degree of dysfunction, which was mild in most (72 percent). Anxiety state and anxiety trait were more prevalent on the moderate level with 79 percent and 72 percent respectively. No significant statistical association was identified in the study sample between the presence and absence of temporomandibular dysfunction and anxiety, be it trait or state, with values of p= 0.484 and p= 0.297 respectively. Conclusions: High statistical prevalence was found of temporomandibular dysfunction and anxiety among dental students, hence the importance of a detailed search for those signs and symptoms during clinical examination(AU)

Interações Medicamentosas na Farmacoterapia de Idosos com Câncer atendidos em um Ambulatório de Onco-Hematologia / Drug Interactions in Elderly Cancer Patients Treated at a Hematology-Oncology Outpatient Clinic / Interacciones Farmacológicas en la Farmacoterapia de Adultos Mayores con Cáncer Atendidos en un Ambulatorio de Onco-Hematología

Introdução: Mais de 50% dos diagnósticos de câncer ocorrem na população idosa. Esse grupo etário possui outros problemas de saúde concomitantes à neoplasia que aumentam o risco de polifarmácia e interações medicamentosas. Objetivo: Identificar a frequência das interações medicamentosas potenciais e analisar os fatores associados na farmacoterapia de idosos com câncer. Método: Estudo transversal realizado em um ambulatório de onco-hematologia de um hospital de ensino. Foram entrevistados 160 idosos submetidos à terapia antineoplásica parenteral. Registraram-se informações sobre farmacoterapia, diagnóstico da neoplasia, outros problemas de saúde e funcionalidade. A funcionalidade foi determinada usando o Vulnerable Elders Survey. As informações clínicas foram coletadas em prontuário. Identificaram-se interações medicamentosas potenciais empregando o software Drug Interaction Checking. A regressão logística foi utilizada para determinar os fatores associados às interações medicamentosas potenciais. Resultados: Noventa e sete (60,6%) idosos apresentaram pelo menos uma interação medicamentosa e 42 (26,3%), interação envolvendo um medicamento antineoplásico. Ciclofosfamida e fluouracila foram os mais envolvidos em interações. O mecanismo farmacodinâmico foi responsável por 52,5% das interações. Identificou-se que 51% das interações foram classificadas como graves. A regressão logística mostrou que interações medicamentosas estiveram associadas de forma independente com número de medicamentos [OR=1,51; IC95% (1,277-1,78), p

Introduction: More than 50% of all cancer diagnoses occur in the elderly population. This age group has other health problems concomitant with neoplasia, a scenario that increases the likelihood of polypharmacy and the risk of drug interactions. Purpose: To identify the frequency of and factors associated with drug interactions in the pharmacological treatment of elderly cancer patients. Method: This was a cross-sectional study conducted at the hematology-oncology outpatient clinic of a university hospital. We interviewed 160 elderly patients receiving intravenous antineoplastic therapy, collecting information about antineoplastic and other pharmacotherapy, the diagnosis of neoplasia, other health problems, and functionality. Functionality was assessed with the Vulnerable Elders Survey. Clinical data were collected from the patient charts. To identify potential drug interactions, we used drug interaction checking software. Logistic regression was used in order to identify factors associated with drug interactions. Results: Of the 160 elderly patients interviewed, 97 (60.6%) presented at least one drug interaction and 42 (26.3%) presented at least one interaction with an antineoplastic drug. Cyclophosphamide and fluorouracil were the drugs most often involved in interactions. Of the interactions, 52.5% were attributable to a pharmacodynamic mechanism of action and 51.0% were classified as severe. Logistic regression showed that drug interactions were independently associated with the number of drugs taken (OR=1.51, 95% CI: 1.277-1.78, p<0.0001) and with the number of health problems (OR=1.39, 95% CI: 1.030-1.880, p=0.031). Conclusion: The frequency of drug interactions in elderly cancer patients receiving intravenous antineoplastic therapy is high, and severe interactions account for approximately half of all such interactions. The number of health problems and the number of drugs taken appear to be positively associated with drug interactions

Introducción: Más del 50% de los diagnósticos de cáncer ocurren en la población anciana. Este grupo de edad posee otros problemas de salud concomitantes a la neoplasia que aumenta el riesgo de polifarmacia e interacciones medicamentosas. Objetivo: Identificar la frecuencia y los factores asociados con interacciones farmacológicas potenciales en la farmacoterapia de adultos mayores con cáncer. Método: Estudio transversal realizado en un ambulatorio de onco-hematología de un hospital universitario. Se entrevistó a 160 adultos mayores sometidos a la terapia antineoplásica parenteral. Se registró informaciones acerca de la farmacoterapia antineoplásica y no antineoplásica, diagnóstico de la neoplasia, otros problemas de salud y funcionalidad. La información clínica fue recolectada en los registros de los pacientes. La funcionalidad se determinó utilizando el Vulnerable Elders Survey. Se identificaron las interacciones medicamentosas potenciales empleando el programa Drug Interaction Checking y se utilizó la regresión logística para determinar los factores asociados a las interacciones farmacológicas. Resultados: Un total de 97 (60,6%) de los ancianos presentó al menos una interacción farmacológica y 42 (26,3%) presentaron interacción envolviendo un medicamento antineoplásico. Los antineoplásicos ciclofosfamida y fluouracilo fueron los más implicados en las interacciones. El mecanismo farmacodinámico fue responsable por 52,5% de las interacciones. Se identificó que 51% de las interacciones fueron clasificadas como graves. La regresión logística mostró que las interacciones medicamentosas se asociaron de forma independiente con el número de medicamentos [OR=1,51; IC95% (1,277- 1,78), p<0,0001) y el número de problemas de salud [OR=1,39; IC95% (1,030- 1,880), p=0,031]. Conclusiones: La frecuencia de interacciones farmacológicas potenciales en ancianos con cáncer sometidos a terapia antineoplásica parenteral fue elevada aunque la proporción de interacciones graves corresponde a aproximadamente la mitad del total de interacciones. El número de problemas de salud y el número de medicamentos presentaron una asociación positiva con las interacciones farmacológicas.

Factors associated with the use of potentially inappropriate medications by older adults with cancer.

OBJECTIVES: To determine the frequency and the factors associated with the use of potentially inappropriate medications (PIMs) by older adults with cancer at an onco-haematology ambulatory clinic of a teaching hospital in Brazil. MATERIAL AND METHODS: Patients aged 60years or older (n=160) subjected to parenteral antineoplastic chemotherapy from May to December 2015 and treated with one or more medications in the ambulatory clinic were interviewed. Data on medications, comorbidities, oncological diagnosis, and functional status were recorded. Functionality was determined using the Vulnerable Elders Survey (VES-13). PIMs were determined using the 2015 Beers Criteria. Logistic regression was used to determine the factors associated with the use of PIMs. RESULTS: A total of 78 (48.1%) older adults used at least one PIM. The PIMs to be avoided by older adults were proton pump inhibitors (33.3%), antiemetics (10.5%), long-acting benzodiazepines (10.5%), and antidepressants (7.6%). Multivariate analysis indicated that PIMs were associated with the use of five or more medications (odds ratio, 3.14; 95% confidence interval, 1.4-6.6), after adjusting for the number of medications, number of comorbidities, depression, and arthritis/arthrosis. CONCLUSION: The frequency of use of PIMs by older adults at the investigated ambulatory clinic was high. Polypharmacy was positively associated with the use of PIMs.

Drug utilization study of systemic antifungal agents in a Brazilian tertiary care hospital.

Background The inappropriate use of systemic antifungal agents can result in unnecessary exposure, adverse events, increased microbial resistance and increased costs. Aim This study analysed the use of systemic antifungal agents and adherence to treatment guidelines for fungal infections. Setting A Brazilian tertiary hospital. Methods This cross-sectional study investigated 183 patients who were treated with systemic antifungals. Antifungal drugs were classified according to the fourth level of the Anatomical Therapeutic Chemical classification system. The appropriateness of treatments was analysed with respect to the indication, dose and potential drug-drug interactions. Descriptive and univariate statistical analyses were performed. The main outcome measure was the frequency of adherence to treatment guidelines for fungal infections. Results The number of established treatments was 320, with 163 (50.9 %) pre-emptive, 63 (19.7 %) targeted, 56 (17.5 %) empirical and 38 (11.9 %) prophylactic treatments. The overall adherence to the treatment guidelines was 29.4 %. The proportion of appropriate treatment considering indication, dosage and drug-drug interactions was 84.1, 67.8 and 47.2 %, respectively. The most commonly prescribed systemic antifungal agents were fluconazole in 170 (53.1 %), voriconazole in 43 (13.4 %) and amphotericin B deoxycholate in 36 (11.3 %) cases. Conclusion The study showed a low proportion of appropriate antifungal drug use; the dosage and drug-drug interactions criteria were the determining factors for the high percentage of non-adherence to treatment guidelines in the hospital. The profile of antifungal agents used showed the predominance of fluconazole as well as the use of new antifungal drugs.

Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High-Complexity Hospital.

The aim of the present study was to determine the frequency of adverse drug reactions (ADRs) associated with the use of systemic antifungal drugs in patients hospitalized at a high-complexity hospital. In addition, factors associated with ADRs were investigated. This cross-sectional retrospective study involved the investigation of 183 medical records of patients receiving systemic antifungal therapy. Antifungal drugs were classified using the fourth level of the Anatomical Therapeutic Chemical System. ADR causality was classified using the Naranjo algorithm. Drug interactions were assessed using DRUG-REAX software. Data were analyzed with descriptive statistics and univariate and multivariate logistic regression. A total of 53 patients (29.0%) had at least 1 ADR involving antifungals. Ninety-six ADRs were detected. The main ADRs observed were an infusion reaction in 24 patients (25.0%), hypokalemia in 22 (22.9%), nephrotoxicity in 18 (18.7%), and hepatotoxicity in 15 (15.6%). Amphotericin B and voriconazole were associated with ADRs of major clinical impact. Eleven of the ADRs (11.4%) were related to drug interactions. The following 3 factors were contributors to the multivariate model for the occurrence of ADRs caused by antifungal drug use: neoplasm diagnosis (odds ratio [OR], 3.9; 1.9-7.9), length of hospital stay (OR, 2.2; 1.1-4.5), and the use of ≥13 drugs (OR, 3.4; 1.6-7.2). Our study revealed positive associations between the occurrence of ADRs and diagnosis of a neoplasm, the length of stay, and the use of multiple drugs concomitant with antifungals. These risk factors should be considered in antifungal stewardship, among other actions, to promote the rational use of antifungal agents.