Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil.

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil.

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Antimicrobial effect of photodynamic therapy on intracanal biofilm: A systematic review of in vitro studies.

BACKGROUND: Antimicrobial photodynamic therapy (A-PDT), is one of the adjunctive therapies developed to improve the effectiveness of root canal disinfection.. The aim of this study was to analyze the antimicrobial effect of PDT on intracanal biofilm. METHODS: Two reviewers conducted a literature search in PubMed, MEDLINE, Lilacs, SciELO, EMBASE and Google Scholar using the following search strategy: photochemotherapy "[Mesh] OR (photodynamic therapy) AND" dental plaque "[Mesh] OR (dental biofilm) AND (root canal). The following data were collected: publication year, author's name, study site, type of study, participant number, type of photosensitizer, type of laser, method of data collection, application time and results. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: After selection based on title, abstract and full text, 27 studies were included in this systematic review. PDT reduced bacterial viability in most studies when combined with conventional endodontic techniques. CONCLUSION: PDT reduced bacterial counts in most studies, especially when used as an adjunct to the conventional endodontic technique to treat refractory infection. However, PDT effects on in vitro bacterial biofilm were not accurately quantified because of the numerous biases in the studies reviewed.

Relação entre o estrogênio e as disfunções temporomandibulares: uma revisão de literatura / Relationship between estrogen and temporomandibular disorders: a review of literature

Objetivo: realizar uma revisão da literatura a fim de traçar um panorama atual sobre o papel do estrogênio nas disfunções temporomandibulares. Metodologia: foram realizadas buscas nas plataformas digitais Pub- Med, SciELO e Google Acadêmico, durante os meses de setembro de 2018 a maio de 2019, sem filtros para determinar período de tempo, sendo excluídos aqueles trabalhos em que não foi possível identificar relação com o tema. Resultados: na análise dos estudos encontrados, foi observada a relação entre o estrogênio e a prevalência de disfunções temporomandibulares em mulheres. O estrogênio atua central e perifericamente no sistema nervoso central, influenciando no processamento dos receptores pró e antinoceptivos da articulação temporomandibular. Considerações finais: a modulação estrogênica da dor é um mecanismo complexo. Diversos estudos associam o hormônio estrogênio às disfunções temporomandibulares. Embora não haja um consenso entre os autores do papel exato deste hormônio, há evidências comprovadas de que as mulheres possuem uma susceptibilidade a dores em geral, com prevalência tanto em frequência quanto em intensidade.(AU)

Objective: to carry out an integrative review of the literature in order to outline the role of estrogen in temporomandibular disorders. Methodology: the study searched studies in the digital platforms PubMed, SciELO and Google Acadêmico, from September 2018 to May 2019, without filters to determine the time period, excluding those works in which it was not possible to identify relation with the theme. Results: among the analysis of the studies found, the relationship between estrogen and the prevalence of temporomandibular disorders in women was observed. Estrogen acts centrally and peripherally in the central nervous system, influencing the processing of the pro and antinoceptive receptors of the temporomandibular joint. Final considerations: estrogenic modulation of pain is a complex mechanism. Several studies associate the estrogen hormone with temporomandibular disorders. Although there is no consensus among authors of the exact role of this hormone, there is proven evidence that women have a susceptibility to pain in general, with prevalence both in frequency and intensity.(AU)

Vigilância em saúde bucal na perspectiva do georreferenciamento: análise da distribuição de cárie dentária em escolares de uma Unidade de Saúde / Oral health surveillance from the perspective of geo-referencing: analysis of dental caries distribution in schoolchildren of a primary health unit

Objetivo: O estudo buscou realizar um mapeamento ge-orreferenciado dos usuários escolares de uma Unidade de Saúde de Porto Alegre em relação à cárie dentária. Materiais e métodos: A pesquisa foi desenvolvida em uma Unidade de Saúde do Grupo Hospitalar Conceição. A população do estudo foi composta por 103 alunos, entre 6 e 17 anos, de 2 escolas de ensino fundamental. Os dados sobre a ne-cessidade de tratamento restaurador, vinculados à cárie dentária, foram obtidos dos prontuários dos pacientes cadastrados no Coinma, examinados pela equipe de saúde através do PSE, nos anos de 2016 e 2017, totalizando 103 prontuários. Para o georreferenciamento, foi utilizada a ferramenta online Google Maps®, onde foram adicionados marcadores na cor vermelha para alunos com necessidade de tratamento e verde para alunos sem necessidade de tratamento. Resultados: Da população do estudo, 30% apresentava alguma necessidade de tratamento. Os meni-nos apresentavam mais necessidades quando comparados às meninas, com ênfase na faixa etária entre 8­9 anos. Quanto à análise geovisual, foi possível identificar um aumento na concentração dos casos de estudantes com necessidades de intervenção em saúde bucal na área ROSA, onde moravam 53 (51,4%) dos alunos, sendo que 19 (35,84%) deles apresentavam necessidades, seguidos pelas áreas AZUL, onde 25 (24,3%) dos alunos avaliados, 5 (20%) apresentavam necessidades; AMARELA, com 14 (13,6%) alunos avaliados, 2 (14%) apresentavam neces-sidades; VERDE, com 11 (10,7) alunos avaliados, 5 (45,5%) apresentavam necessidade de tratamento. Conclusão: O georreferenciamento é um instrumento importante para a análise da distribuição espacial da cárie dentária. O presente estudo pode contribuir para a elaboração de políticas de saúde voltadas para a vigilância em saúde de abrangência local.

Objective: The study aimed to perform a georeferenced mapping of school users of a health unit in Porto Alegre in relation to dental caries. Materials and methods: This study was carried out in a he-alth unit of the Hospitalar Conceição Group. The school consisted of 103 students, aged 6 to 17, from 2 elementary schools. Data on the accessibility of restorative treatment linked to the disease were included in the medical records of patients registered with Coinma and compared by the health team through the PES in 2016 and 2017, totaling 103 records. For the georeferencing, the Google Maps® online tool was used, where red markers were added for students who needed treatment and green for students with no need of treatment. Results: Of the study population, 30% had some need of treatment. The boys had more needs when compared to the girls, with emphasis on the group aged between 8-9 years. Concerning to the geo-visual analysis, it was possible to identify an increase in the concentration of students with oral health intervention needs in the PINK area, where 53 (51.4%) students lived, and 19 (35.84%) needed treatment. Besides, in the BLUE areas, out of 25 (24.3%) of students, 5 (20%) showed needs; In the YELLOW area, out of 14 (13.6%) students evaluated, 2 (14%) showed treatment needs; In the GREEN area, out of 11 (10.7) students evaluated, 5 (45.5%) presented a need for treatment. Conclusion: Georeferencing is an important tool for the analysis of the spatial distribution of dental caries. The present study may contribute to the elaboration of health policies focused on local health surveillance.

Impacto do uso de probióticos sobre o biofilme bucal / Impact of the use of probiotics on oral biofilme

Objetivo: o objetivo desse estudo foi realizar uma revisão integrativa sobre o impacto do uso de probióticos sobre o biofilme bucal. Revisão de literatura: a busca foi feita nas bases de dados Scielo, Science Direct, PubMed e LILACS, utilizando-se como descritores os termos probióticos, biofilme, cárie e periodontite, nos idiomas português e inglês. Foram selecionados os estudos que delimitavam o assunto em relação ao biofilme bucal. Foram encontrados 1689 artigos e selecionados 48. Os resultados demonstraram empregabilidade otimista dos probióticos, visto que apenas 2 artigos selecionados não obtiveram resultados positivos. Dentre as bactérias probióticas, a Lactobacillus salivarius e a Lactobacillus casei foram as mais utilizadas. Sugerem-se produtos viscosos como meio de utilização, por sua boa substantividade. Considerações finais: Recomenda-se que sejam realizados mais estudos com metodologias comparáveis, para melhor compreensão do efeito dos probióticos no biofilme bucal e para que sejam padronizadas doses, modo de administração, tempo da duração do seu efeito, bem como as cepas e as espécies bacterianas mais eficazes para cada objetivo. Principalmente, compreender melhor o seu mecanismo de ação para que assim possa ser protocolada uma técnica eficiente, fundamentada e segura para sua aplicação.

Objectives: to carry out an integrative review on the impact of the use of probiotics on oral biofilm. Materials and method: the search was done in the databases SciELO, Science Direct, PubMed and LILACS, using the terms probiotics, biofilm, caries and periodontitis, in Portuguese and English. The studies selected were those that delimited the subject in relation to the oral biofilm. Results: a total of 1.689 articles were found and 48 were selected. The results demonstrated optimum employability of probiotics, since only two of the selected articles did not obtain positive results. Among the probiotic bacteria, Lactobacillus salivarius and Lactobacillus casei were the most used. Viscous products are suggested as a means of use because of their good substantivity. Final considerations: it is recommended that further studies be conducted with comparable methodologies to better understand the effect of probiotics on oral biofilm and to standardize doses, mode of administration, duration of their effect, as well as the most effective strains and bacterial species for each objective. Mainly, it is necessary a better understanding of the mechanism of action, so that an efficient, reasoned and safe technique can be defined for its application.(AU)

Effectiveness of the Distance Learning Strategy Applied to Orthodontics Education: A Systematic Literature Review.

Introduction: Tele-education refers to the use of interactive distance learning technologies. The objective of this systematic review was to evaluate the impact of tele-education in the field of orthodontics.Methods: This systematic review has been registered in PROSPERO and followed PRISMA guidelines. Two independent researchers reviewed the literature available in the databases of PubMed/MEDLINE, Bireme, the Cochrane Library, EMBASE, TRIP, SCIELO, LILAS, SCIENCEDIRECT, and Google Scholar using the following descriptors: "Education, Distance" OR "e-learning" AND "Orthodontics," including only interventional studies. The descriptive synthesis was conducted according to the Center for Reviews and Dissemination. The analysis of the biases was conducted using the MINORS protocol, and the analysis of the interventions using Kirkpatrick's method was evaluated.Results: Of the 15 remaining articles for complete reading, 4 were excluded for not meeting the inclusion criteria, leaving 11 articles for evaluation in the systematic review. Eight articles emphasized the evaluation of the distance education materials available, achieving a high percentage of acceptability among students, two cited only satisfaction, and one article evaluated the practical performance of the students.Conclusion: The results showed that orthodontic distance learning is an effective but complementary element, with no significant differences, to the traditional method of teaching.

Performance of primary healthcare dentists in a distance learning course in pediatric dentistry.

OBJECTIVE: Children are an important portion of the population of the territories covered by Primary Health Care (PHC), with needs and characteristics that can be managed at this level of care. Therefore, it is essential that professionals working in PHC be capable of providing child care. The aim of this study was to evaluate the performance of dentists working in primary healthcare (PHC) in a pediatric dentistry distance learning (DL) course, and to investigate the relationship between the grades earned on questionnaires applied after each course module and features of their personal and professional profile. METHOD: The study used a convenience sample of 201 dentists working in PHC, who enrolled in a DL course offered by a telehealth center in the state of Rio Grande do Sul, Brazil. The course consisted of video classes on restorative dentistry, endodontics, dental trauma, and clinical management in pediatric dentistry. After completing each module, each participant was asked to answer a questionnaire to assess their acquisition of immediate knowledge. Student's t-test and the ANOVA test were used to assess the relationship between the mean grade earned and the variables of sex, age, type of training institution, time since graduation, and years working in PHC. RESULTS: A significant relationship was observed between type of training institution (public) and the grade earned on the restorative dentistry questionnaire, and also between time since graduation and the grade earned on the dental trauma questionnaire (p < 0.05). No relationship was observed between the personal/professional variables and the grades earned on the endodontics and clinical management questionnaires. Grades were significantly lower on the endodontics questionnaire (p < 0.05). DISCUSSION: The large number of dentists enrolled in this DL course is a demonstration that there is great interest in pediatric dentistry contents. Improvement of DL courses may lead to the enhancement of professionals and their skills, and to a significant improvement in the quality of care provided to children in public health networks. CONCLUSION: It was concluded that training in a public institution and a longer time since graduation positively influenced the grades earned on the restorative dentistry and dental trauma questionnaires, respectively.

Impacts of Orthognathic Surgery on Patient Satisfaction, Overall Quality of Life, and Oral Health-Related Quality of Life: A Systematic Literature Review.

Several treatments have been suggested to correct dentofacial abnormalities, including orthognathic surgery. The aim of the present systematic review was to assess the impact of orthognathic surgery on patient satisfaction, overall quality of life, quality of life related to oral health-and to orthognathic surgery in particular-among adult patients. Two investigators independently reviewed the available literature in the databases PubMed/MEDLINE, LILACS, SciELO, EMBASE, Trip, and Google Scholar (gray literature) based on the keywords "orthognathic surgery" and "quality of life." An analysis of bias was performed based on the MINORS (methodological index for nonrandomized studies). A total of 245 relevant studies were retrieved from the databases, and 6 additional studies were located after a manual search of the references. Following selection based on titles, abstracts, and full-text analysis, 30 studies were included in the present systematic review. To evaluate quality of life before and after orthognathic surgery, 12 studies applied the surgery-related Orthognathic Quality of Life Questionnaire (OQLQ), 12 used the Oral Health Impact Profile (OHIP-14), and 4 used the Short Form Health Survey (SF-36). Orthognathic surgery results in improvements in quality of life both physically and psychosocially after surgery and is associated with high rates of patient satisfaction.

Avaliação da efetividade de tratamentos conservadores para disfunções temporomandibulares miogênicas: revisão integrativa da literatura / Evaluation of the effectiveness of conservative treatments for miogenic temporomandibular dysfunctions: integrating review of the literature

Objetivo: revisão integrativa sobre os principais métodos de tratamento conservador para disfunção temporomandibular, sendo eles: placa oclusal, aconselhamento e farmacoterapia. Materiais e método: a busca foi feita nas bases de dados PubMed, SciELO, Lilacs e Google Acadêmico, utilizando os seguintes descritores: "counseling and temporomandibular joint"; "counseling and facial pain"; "counseling and temporomandibular joint dysfunction syndrome"; "counseling and temporomandibular joint and drug therapy"; e "counseling and drug therapy and facial pain". Resultados: no total, foram encontrados 314 estudos nesta pesquisa, porém, somente 8 foram incluídos no estudo. Esses comprovam a eficácia desses métodos de tratamento, fazendo com que o paciente obtenha diminuição da sintomatologia dolorosa, melhora das funções mastigatórias, além de proporcionar um alívio na tensão muscular, devido ao relaxamento das estruturas relacionadas. A placa oclusal tende a diminuir as forças oclusais aplicadas, redistribuindo a carga mastigatória sobre as superfícies oclusais. Alguns fármacos (anti-inflamatórios, antidepressivos e relaxantes musculares) são capazes de minimizar a sintomatologia dolorosa, proporcionando uma melhora na qualidade do sono e a redução de episódios de dor intensa. Por sua vez, o aconselhamento orienta os pacientes para que possam evitar atitudes que piorem sua doença, educando-os e conscientizando-os sobre seus hábitos parafuncionais, além de reduzir os fatores causadores de sintomatologia dolorosa. Conclusão: conseguimos observar que esses tratamentos apresentam índices de sucesso relevantes, quando se referem à diminuição dos sintomas, especialmente o aconselhamento, que ainda é uma terapia conservadora pouco explorada. Faz-se necessária a realização de mais estudos neste campo, para que sejam obtidos resultados cada vez mais concretos e conclusivos. (AU)

Objective: integrative review on the main methods of conservative treatment for Temporomandibular Dysfunction, being occlusal plaque, counseling and pharmacotherapy. Materials and method: the search was done in the databases PubMed, SciELO, Lilacs and Google Scholar using the descriptors: "counseling" and "temporomandibular joint", "counseling" and "facial pain", "counseling" and "temporomandibular joint dysfunction syndrome", "counseling" and "temporomandibular joint" and "drug therapy" and "counseling" and "drug therapy" and "facial pain". Results: in total were found 314 studies in this work, but only 8 were included. These tests prove the efficacy of these treatment methods, causing to the patient a decrease in painful symptoms, an increase in masticatory functions, and also providing a relief in muscle tension due to the relaxation of related structures. The occlusal plaque tends to decrease the forces applied in the occlusion, preventing the muscles from exerting excessive force. Some drugs (anti-inflammatories, antidepressants and muscle relaxants) are able to minimize the painful symptomatology, providing an improvement in the quality of sleep and reduction of episodes of intense pain. In turn, counseling guides patients to avoid attitudes that worsen their illness, educating them and making them aware of their parafunctional habits, as well as reducing the factors that cause painful symptoms. Conclusion: we could observe that these treatments present relevant success indexes when it refers to the decrease of the symptoms, especially the counseling, which is still a little explored conservative therapy. It is still necessary to carry out further studies in this field in order to obtain increasingly concrete and conclusive results. (AU)

Dendritic cells and their relation to apical peridontitis.

The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.

Aplicativos móveis para ensino e assistência odontológica: uma revisão integrativa / Mobile applications for dental education and assistance: an integrative review

Este estudo teve como objetivo identificar o estado da arte atual e as tendências de pesquisas que utilizam aplicativos móveis na Odontologia por meio de uma revisão integrativa. Realizaram-se buscas nas bases de dados SciELO, LILACS e PubMed, utilizando os termos "mobile application", "Dentistry" e "informatics", e no Google Acadêmico, para abarcar a literatura cinza, com os mesmos termos na língua portuguesa, sem período de tempo determinado. Os títulos e resumos de todos os artigos encontrados foram lidos por dois pesquisadores de forma independente. Foram incluídas pesquisas oriundas de dados primários e que estivessem relacionados apenas à saúde bucal, cujo meio de informação fosse smartphones, nas línguas inglesa, portuguesa e espanhola. Além disso, os artigos publicados em periódicos científicos foram analisados em relação aos itens atribuídos no checklist do STROBE Statement. Foram encontrados 911 estudos. Após a leitura de todos os títulos e resumos, foram excluídos 897, totalizando 14 estudos para leitura na íntegra. Nove artigos foram incluídos no estudo, classificados em estudos com foco profissional (6) e estudos com foco acadêmico (3). Os dados descritos nos estudos deixam claro a crescente adoção do uso dos aplicativos como recursos educacionais e assistenciais. A criação de aplicativos móveis direcionados à Odontologia é apropriada, tanto no ensino, como uma nova possibilidade de construir conhecimento, quanto para o uso profissional, já que é inegável a disseminação global do uso de dispositivos móveis (AU).

This study aimed to identify the current state of the art and trends of research using mobile applications in Dentistry through an integrative review. SciELO, LILACS and PubMed databases, using the terms "mobile application", "Dentistry" and "informatics", and in Google Scholar, to cover the gray literature, with the same terms in the Portuguese language, without time limitation were searched. The titles and abstracts of all articles found were read independently by two researchers. Studies based on primary data that were related only to oral health, whose medium of information was smartphones, in the English, Portuguese and Spanish languages were included. Also, articles published in scientific journals were analyzed in relation to the items assigned in the STROBE Statement checklist. There were 911 studies. After reading all the titles and abstracts, 897 were excluded, totaling 14 studies for reading in full. Nine articles were included in the study, classified in studies with a professional focus (6) and studies with an academic focus (3). The data described in the studies have shown the increasing adoption the applications use as educational and assistance resources. The creation of mobile applications directed to Dentistry is appropriate, both in teaching, as a new possibility to build knowledge, and for professional use, since the global dissemination of the use of mobile devices is undeniable (AU).

Dendritic cells and their relation to apical peridontitis

Abstract: The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.

Approach to the most prevalent oral disorders among the elderly: an integrative review focusing on primary health care / Abordagem das afecções bucais mais prevalentes em idosos: uma revisão integrativa com foco na atenção primária

Abstract Objective: an integrative review of the treatment of oral candidiasis, root caries and xerostomia among the elderly population, focusing on Primary Health Care, was carried out. Method: scientific articles were collected from the MEDLINE/PUBMED database using the keywords "Geriatric dentistry" and "Oral health", crossed with corresponding descriptors, together with specific terms for the pathologies studied, and with "the clinical trial" filter activated. The abstracts of the articles were read by three researchers. Result: oral candidiasis: six randomized clinical trials and one quasi-experimental design study, on the treatment of prosthetic stomatitis by medication and/or the disinfection of dentures by different techniques, were identified; root caries: three randomized clinical trials were included, which tested the use of mouthwash with chlorhexidine solution and oral hygiene instruction associated or otherwise with other drugs; and xerostomia: two articles were analyzed using various medications, and the functional massage of the salivary glands and associated muscles. Conclusion: The results demonstrate a variety of treatment options for the studied clinical situations, although these should be adapted to the characteristics of the services and the population, as standard treatment in Primary Health Care has not been established. Strategies based on soft technologies, such as health education, seem to provide good results. The present study provides additional knowledge for health professionals in search of more resolutive and qualified dental care for the elderly in primary health care. AU

Resumo Objetivo: revisão integrativa sobre o tratamento de candidíase bucal, cárie radicular e xerostomia com foco na Atenção Primária à Saúde, na população idosa. Método: busca de artigos na base de dados MEDLINE/PUBMED sobre as alterações citadas, com os descritores "Geriatric dentistry", "Oral health", cruzados com descritores correspondentes às três patologias, ativado o filtro "Clinical trial", como também termos específicos para as situações clínicas estudadas. Foram excluídos os estudos que não possuíam o escopo da Atenção Primária ou da odontogeriatria. Resultado: candidíase bucal: foram analisados seis ensaios-clínicos randomizados e um quase-experimento sobre o tratamento da estomatite protética por medicamentos e/ou pela desinfecção das próteses por diferentes técnicas; cárie radicular: três ensaios clínicos randomizados foram incluídos, os quais testaram o uso de bochechos com solução de clorexidina e instrução de higiene bucal associada ou não a outros fármacos; e xerostomia: foram analisados dois artigos que utilizaram diversos fármacos e a massagem funcional de glândulas salivares e músculos associados. Conclusão: Os resultados demonstram variadas opções de tratamento para as situações clinicas destacadas devendo ser adequadas as características dos serviços e da população atendida, tendo em vista que não foi estabelecido um tratamento padrão a ser utilizado na Atenção Primária à Saúde. Estratégias com foco em tecnologias leves, tais como a educação em saúde, parecem prover bons resultados. Todavia, o estudo agrega conhecimento aos profissionais de saúde na busca de um atendimento odontológico cada vez mais resolutivo e qualificado para o idoso na atenção primária à saúde. AU

Abordagem da doença periodontal e do edentulismo em idosos: uma revisão integrativa com foco na atenção primária / Approaching periodontal disease and edentulism in the elderly: a systematic review with a focus on primary health care

A adoção da Estratégia de Saúde da Família (ESF) como modelo de atenção primária à saúde (APS) no Brasil proporcionou mudanças na organização de serviços e nos processos de trabalho dos profissionais da saúde pública, dentro do Sistema Único de Saúde (SUS). No que se refere à saúde bucal, a inserção de equipes odontológicas na ESF, a partir dos anos 2000, também possibilitou, além do aumento do número de cirurgiões-dentistas na APS, alterações no modelo de atenção à saúde bucal. Com o declínio da cárie em populações mais jovens, a doença periodontal e o edentulismo têm assumido papel de destaque como os principais agravos a afetarem a população idosa. Nesse contexto, este trabalho tem por objetivo realizar uma revisão integrativa da literatura sobre o tratamento da doença periodontal e do edentulismo em idosos com foco na APS nas bases de dados do MEDLINE/ PUBMED publicados nos últimos 10 anos. Este trabalho contribui para a qualificação baseada em evidências dos profissionais da odontologia na atenção primária. A pesquisa, ao abordar tratamentos para doença periodontal e edentulismo em idosos, abrange assuntos que serão de grande importância para os serviços, nos próximos anos, considerando-se que o envelhecimento populacional e o acesso dessa população aos serviços se tornará mais frequente e regular com o aumento do número de cirurgiões- dentistas nas Estratégias de Saúde da Família capacitados para orientar suas práticas baseadas em evidências.

Adopting the Family Health Strategy (FHS) as the primary health care (PHC) model in Brazil has brought about changes in the organization of services and in the work processes of public health professionals, within the Unified Health System (UHS). With regard to oral health, the inclusion of dental teams in the FHS, beginning in the 2000s, also made changes in the oral health care model possible, in addition to the increase in the number of dentists in the PHC system. With the decline in tooth decay in younger populations, periodontal disease and edentulism have assumed prominent roles as the main disorders affecting the elderly. In this context, this work aims to carry out an integrative review of the literature on the treatment of periodontal disease and edentulism in the elderly, focusing on PHC in the MEDLINE/PUBMED databases published in the last 10 years. This work contributes to the qualification of evidence-based dentistry professionals in primary health care. In addressing treatments for periodontal disease and edentulism in the elderly, it covers subjects which will be of great importance for the services in the coming years, considering the aging population and that this population's access to services will become more regular and frequent with the increase in the number of dentists in the Family Health Strategies able to guide evidence-based practices.

Ensino em serviço na perspectiva da Clínica Ampliada: relato de experiência / Education-service at the Expanded Clinic perspective: an experience report

A Clínica Ampliada pode ser compreendida como a relação estabelecida entre os diferentes profissionais de saúde com os usuários no intuito de produzir saúde por meio do empoderamento dos sujeitos e criação de autonomia. Neste contexto, a formação profissional em Odontologia deve primar pelo desenvolvimento das habilidades técnicas aliadas a qualidades humanistas para atuação na perspectiva da Clínica Ampliada. Considerando a discussão do processo de formação do cirurgiãodentista integrado ao serviço de saúde pública e a perspectiva de atuação na Clínica Ampliada, este trabalho teve como objetivo relatar a experiência acadêmica do estágio supervisionado, realizado um uma unidade de saúde, no município de Porto Alegre/RS. No modelo de um relato de experiência descritivo, com metodologia relacionada ao processo reflexivo crítico do aluno, o estágio ocorreu num período de 30 dias, com carga horária de 15 horas semanais, em uma unidade de saúde pertencente ao Grupo Hospitalar Conceição. Incluiu atividades de acompanhamento ambulatorial e de promoção e prevenção de saúde, realizados na unidade de saúde e sua área de atuação. Da experiência vivida, foi possível observar que os profissionais da equipe de saúde tinham como proposta para o atendimento a resolutividade clínica e a perspectiva de um plano de tratamento conjunto, de acordo com a realidade social de cada usuário, baseando-se na comunicação horizontal entre comunidade e profissionais. Assim, compreender a saúde bucal dentro da perspectiva da Clínica Ampliada requer, cada vez mais, uma análise conjunta das questões biopsicossociais dos indivíduos (AU).

The expanded clinic can be understood as the relationship established between the different health professionals with the users in order to produce health through the empowerment of the subjects and creation of autonomy. In this context, professional training in dentistry should be based on the development of technical skills combined with humanistic qualities to act in the perspective of the Expanded Clinic. Considering the debate regarding the formation of dentists integrated into the public health service and considering the prospect of performance in the expanded clinic, the purpose of this study is to report the academic experience of a supervised internship, in a health unit, in Porto Alegre/RS. The internship took place over a thirty-day period, with a workload of 15 hours per week, at the one health unit of the Grupo Hospitalar Conceição, and it was structured on a descriptive experience report method, related to the student's critical reflective process. The internship included activities of outpatient follow-up and health promotion and prevention, performed at the health unit and its operating fields. From the experience it was possible to observe that the team's proposal for the service performance it the conclusion of the treatment and the perspective of a joint treatment plan, specific to the social reality of each patient, based on the horizontal communication between the community and the professionals. Finally, understanding oral health within the perspective of the extended clinic requires a joint analysis of the bio-psycho-social issues of the persons (AU).