Saúde bucal e condições sistêmicas em idosos da Baixada Fluminense: coorte retrospectivo / Oral health and systemic conditions in elderly people from Baixada Fluminense: retrospective cohort

O equilíbrio sistêmico e a saúde bucal são condições clínicas que estabelecem entre si uma relação multidimensional capaz de exercer grande impacto sobre o bem-estar cotidiano do indivíduo. As disfunções metabólicas associadas ao estado nutricional e a perda da capacidade muscular geram uma maior necessidade de cuidados em pessoas idosas. Sob o ponto de vista odontológico a presença de dentes naturais bem como o grau de doença periodontal, estão associados a competência mastigatória e, desta forma, são fatores determinantes na saúde da população acima dos 60 anos de idade. O presente estudo teve como objetivo avaliar, através da análise retrospectiva dos últimos 05 anos, a relação entre a saúde bucal e as condições sistêmicas de indivíduos acima de 60 anos residentes na Baixada Fluminense (Rio de Janeiro/Brasil) com evidente crescimento demográfico populacional. Para isso foram analisados 11.390 prontuários de pacientes usuários da Clínica Odontológica da Universidade Iguaçu/RJ sendo selecionados 1.125 que atendiam aos critérios de inclusão. Os resultados destacam a presença de doença periodontal em cerca de 56% dos indivíduos diabéticos, além de 43% com quadro hipertensivo no momento do atendimento apontando para uma importante relação entre a atenção com a saúde bucal da população assistida nessa região e suas condições sistêmicas.

Systemic balance and oral health are clinical conditions that establish a multidimensional relationship capable of having a great impact on the individual's daily well-being. Metabolic dysfunctions associated with nutritional status and loss of muscle capacity generate a greater need for care in the elderly. From the dental point of view, the presence of natural teeth, as well as the degree of periodontal disease, are associated with masticatory competence and, thus, are determining factors in the health of the population over 60 years of age. The present study aimed to describe descriptively, through the retrospective analysis of the last 05 years, the relationship between oral health and the systemic conditions of individuals over 60 years old living in the Baixada Fluminense (Rio de Janeiro / Brazil) with evident population demographic growth. For that purpose, 11,390 medical records of patients who were users of the Clínica Odontológica of Universidade Iguaçu / RJ were analyzed, 1,125 who met the inclusion criteria were selected. The results highlight the presence of periodontal disease in about 56% of diabetic individuals, in addition to 43% with the hypertensive condition at the time of care, pointing to an important relationship between the attention to the oral health of the assisted population in this region and their systemic conditions.

Comparação do alargamento apical do canal radicular através dos sistemas de instrumentação SAF e Reciproc / Comparison of apical enlargement of the root canal through SAF and Reciproc instrumentation systems

Objetivo: Comparar o aumento percentual da área da secção reta transversal de canais radiculares, no nível de 3 mm aquém do ápice radicular, após instrumentação com dois sistemas de instrumento único. Métodos: Dezenove primeiros molares inferiores extraídos tiveram as raízes mesiais seccionadas no nível de 3 mm aquém do ápice radicular, sendo os 2 milímetros finais de cada raiz removidos e descartados, para proceder a mensuração da área pré-operatória, através de estereomicroscopia. As raízes foram instrumentadas com os sistemas SAF e Reciproc R25.08 e procedeu-se nova mensuração para comparação do aumento percentual da área. O aumento percentual da área da secção reta transversal foi comparado e analisado estatisticamente pelo teste t de Student. O nível de significância foi estabelecido em 5% (p < 0,05). Resultados: O aumento percentual da área dos canais foi significativamente maior para o grupo Reciproc (p = 0,001) em comparação com o grupo SAF. Os canais instrumentados com o sistema SAF tiveram sua área aumentada em média 53,5%, enquanto que nos instrumentados com o sistema Reciproc a média foi 154,5%. Conclusão: O sistema Reciproc proporcionou um aumento percentual da área da secção reta transversal dos canais radiculares, no nível dos 3 mm apicais, 3 vezes maior que o sistema SAF.

Aim: To compare the percentage increase in the cross-sectional area of root canals, at the level of 3 mm from the root apex after instrumentation with two single instrument systems. Methods: The roots of 19 extracted mandibular first molars were sectioned 3 mm short of the apex level, with the final 2 millimeters of each root removed and discarded in order to enable the preoperative area to be measured by stereomicroscopy. Subsequently, the roots were instrumented with the SAF and Reciproc 25/.08 systems, alternating the technique used per canal from root to root, and a new measurement was performed. After, the percentage increase in area was calculated considering the values of the original and the final area. The Student'st-test was applied to the results, with a level of significance set at 5%. Results: The percentage increase in area of the root canals was significantly higher for the Reciproc (p = 0.001) when compared to the SAF group. In the canals instrumented with the SAF system, the mean increase in area was 53.5%, while in those using the Reciproc system, it was 154.5%. Conclusion:The Reciproc system produced a 3-fold higher percentage increase in the cross-sectional area of the root canals at the level of 3 mm from the root apex than did the SAF system.

Mucosal Fenestration After 2% Chlorhexidine Extrusion Used in Substitution of Sodium Hypochlorite: A Case Report.

This report describes a case of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) extrusion through the apical foramen, causing acute pain, swelling and mucosal fenestration. A 62-year-old woman was referred for endodontic treatment in the first left maxillary premolar with a diagnosis of necrotic pulp. After the root canal irrigation with 2.5% NaOCl, the patient felt a burning sensation and pain. Discrete swelling and redness were noted in the patient's face at the end of the session. Antibiotic and corticosteroids were prescribed. In the next appointment, 2% CHX was used, but another episode of extrusion occurred, with a sudden acute pain and intense swelling within a few minutes after the injection. After 2 weeks, the patient exhibited a left-side facial swelling extending anterior and inferior to the left zygomatic arch and superior to the body of the mandible. Oral antibiotic and anti-inflammatory drugs were administered. After 10 days, the swelling had completely diminished, but a mucosal fenestration and tooth mobility were verified. A cone beam CT was requested and showed a periapical lesion involving both buccal and palatal roots. After a prosthetic evaluation, the tooth extraction was indicated. One week after tooth removal, the mucosa was completely healed.

Cone-beam computed tomography versus digital periapical radiography in the detection of artificially created periapical lesions: A pilot study of the diagnostic accuracy of endodontists using both techniques.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of previously trained endodontists in the detection of artificially created periapical lesions using cone-beam computed tomography (CBCT) and digital periapical radiography (DPR). MATERIALS AND METHODS: An ex vivo model using dry skulls was used, in which simulated apical lesions were created and then progressively enlarged using #1/2, #2, #4, and #6 round burs. A total of 11 teeth were included in the study, and 110 images were obtained with CBCT and with an intraoral digital periapical radiographic sensor (Instrumentarium dental, Tuusula, Finland) initially and after each bur was used. Specificity and sensitivity were calculated. All images were evaluated by 10 previously trained, certified endodontists. Agreement was calculated using the kappa coefficient. The accuracy of each method in detecting apical lesions was calculated using the chi-square test. RESULTS: The kappa coefficient between examiners showed low agreement (range, 0.17-0.64). No statistical difference was found between CBCT and DPR in teeth without apical lesions (P=.15). The accuracy for CBCT was significantly higher than for DPR in all corresponding simulated lesions (P<.001). The correct diagnostic rate for CBCT ranged between 56.9% and 73.6%. The greatest difference between CBCT and DPR was seen in the maxillary teeth (CBCT, 71.4%; DPR, 28.6%; P<.01) and multi-rooted teeth (CBCT, 83.3%; DPR, 33.3%; P<.01). CONCLUSION: CBCT allowed higher accuracy than DPR in detecting simulated lesions for all simulated lesions tested. Endodontists need to be properly trained in interpreting CBCT scans to achieve higher diagnostic accuracy.