Factors associated with the performance and achieving goals of specialized periodontal procedures in Brazilian dental specialties centers.

BACKGROUND: The Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO. METHODOLOGY: Analytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05). RESULTS: A third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160-3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002-1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103-1.201; p < 0,001). CONCLUSION: Although most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis.

OBJECTIVES: This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. METHODOLOGY: A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. RESULTS: CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. CONCLUSIONS: CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Masticatory function and mortality among older adults living in long-term care facilities in Brazil.

OBJECTIVE: To investigate the association between mortality and masticatory function in older adults living in long-term care facilities (LTCFs), controlling for demographic and health covariates. BACKGROUND: Poor oral health has been associated with mortality; however, no previous study investigated whether objective and self-reported poor masticatory function is a predictor of early mortality in LTCFs. MATERIALS AND METHODS: Baseline characteristics of 295 participants were collected, including age, sex, polypharmacy, mobility, activities of daily living, frailty, nutritional status, and objective (masticatory performance - chewing gum) and self-reported masticatory function. The participants were followed-up with for 4 years to record the mortality data. Cox regression models were run to analyse the data (α = .05). RESULTS: During the 4-year follow-up, 124 (42.0%) participants died. Older adults with poor masticatory performance (hazard ratio [HR] = 1.59, 95% confidence interval [95% CI] = 1.07-2.36) and those who self-reported masticatory dysfunction (HR = 1.48, 95% CI = 1.01-2.16) were at higher risk of early death than those with good mastication. However, in a multivariate model including both objective and self-reported masticatory function, only the objective measurement remained associated with early death (HR = 1.52, 95% CI = 1.02-2.27). CONCLUSION: Poor masticatory performance seems to be associated with early death in older adults living in LTCFs, but they may have shared risk factors accumulated throughout life that were not covered by the study period.

In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets.

OBJECTIVE: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. MATERIAL AND METHODS: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). RESULTS: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. CONCLUSION: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

Accuracy of Remote Examination for Detecting Potentially Malignant Oral Lesions: A Systematic Review and Meta-Analysis.

Objective: We aimed to investigate the accuracy of remote examination by photographs compared to in-person clinical examination for detecting potentially malignant oral lesions (PMOLs). Methods: The Reporting Guide and Guidelines for Writing Systematic Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analysis [PRISMA]) guided the reporting of findings. The search was conducted by two independent reviewers in six databases with no language restriction until November 2022. The Population, Test-Index, Reference Standard, Outcome and Study Design (PIROS) strategy guided the eligibility criteria, and studies with adult patients (P) examined remotely (I) and in-person (R) to verify the detection of PMOLs (O) were considered. The methodological quality was assessed by QUADAS-2, and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: A total of 769 files were identified. After removing duplicates and reading titles and abstracts, 16 were read in full, from which 6 articles then comprised the qualitative synthesis. The oral clinical examination was the reference standard in four studies. Five studies presented high risk of bias in at least one assessment domain. A high probability of detection of PMOL by remote examination (97.37%) was observed for the three studies included in the meta-analysis, which presented high heterogeneity among them. The certainty of evidence for the outcome was considered very low. Conclusions: Remote tools for detecting PMOLs may be feasible and assertive, but new studies are required to incorporate them into clinical practice. Clinical Relevance: Remote examination for the detection of PMOLs has the potential to favoring the early diagnosis of malignant lesions.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Long-term care facilities' response to the COVID-19 pandemic: An international, cross-sectional survey.

AIMS: To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions. DESIGN: Cross-sectional survey. METHODS: Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines. RESULTS: The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work-life imbalance. CONCLUSIONS: Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks. IMPACT: This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

Racial inequality in complete dental prosthesis delivered: can public services reduce inequities?

OBJECTIVES: To investigate the association between access and delivery of complete dental prosthesis according to the proportion of the black population in Brazilian municipalities and to oral health policies. MATERIALS AND METHODS: Ecological data from 2017 to 2021 relating to the delivery of complete dentures stratified by race was collected in all Brazilian cities. We calculated a racial inequality indicator by subtracting the percentage of the black population from the percentage of complete dental prostheses that were delivered to blacks in each municipality. Logistic and linear regression models were carried out. RESULTS: We found that 49.2% (2737) of municipalities delivered complete prostheses. The service was more frequently available in municipalities where black individuals made up 20-80% (odds ratio [OR] = 1.45, 95% confidence interval [CI] 1.15; 1.81), those with dental specialty centers (DSC) (OR = 3.04, 95%CI 2.50; 3.68), and those with more oral health teams (OHTs) (OR = 3.43, 95%CI 2.81; 4.18). Where dental prostheses were available, racial inequities favored the white population by 7.7 percentage points (p < 0.01). Increased inequality was observed in municipalities with more OHTs and/or a higher proportion of black individuals (>80%). CONCLUSIONS: Although municipalities with a DSC, and with more OHTs offer better access to complete dental prosthesis for blacks, racial inequality still impacts the delivery of the service. Primary and secondary healthcare services may even exacerbate this. CLINICAL RELEVANCE: Policymakers should monitor racial inequities in healthcare services. The currently unmet needs of black people are critical, especially in cities with more OHTs and/or increased proportions of black people.

Cost-effectiveness analysis of COVID-19 tests in the unified health system.

BACKGROUND: To evaluate the cost-effectiveness ratio and economic impact of the Rapid Antigen Test (TR-Ag) to replace RT-PCR for the detection of the new Coronavirus in the Unified Health System (SUS). METHODS: This is a cost-effectiveness analysis. Clinical protocols were used for the diagnosis of COVID-19 at the São José Municipal Hospital, located in the city of Itaberá-SP. The Incremental Cost-Effectiveness Ratio (ICER) was divided into two scenarios. In the first, the accuracy reported by the test manufacturers was included, and in the second, the cost resulting from a systematic review. Both were compared with the performance of the RT-PCR test. The increase in diagnoses was chosen as a health outcome and absenteeism was used as a criterion for assessing the economic impact. RESULTS: The analysis resulted in incremental cost-effectiveness ratios of R$ 42,136.67 and R$ 68,329.73 for every thousand tests, according to the accuracy of the manufacturers' TR-Ag tests and what is reported in the literature in relation to RT-PCR, respectively. The average value found for the RT-PCR test (R$ 202.87) represents an increase of 165.32% in cost in relation to the value found for the TR-Ag. 4,305 tests were performed between April 2020 and December 2021 at the referral hospital. Also, maintaining the use of RT-PCR as the first choice for diagnosing COVID-19 and regulating absenteeism in the economically active population could have an impact of up to R$ 1,022,779.68 on municipal management. CONCLUSION: It is concluded that the TR-Ag are configured as a cost-effective alternative for the SUS in the detection of the new Coronavirus. The strategy becomes economically favorable for the expansion of testing, combating the COVID-19 pandemic and reducing the impact on the local economy. However, studies are needed to validate the accuracy of the tests so that economic evaluations on the subject are more assertive.

Oral health surveys of Traditional Peoples and Communities in Brazil: a scoping review protocol.

OBJECTIVE: The objective of this review protocol is to map the available evidence regarding all the oral health surveys of Traditional Peoples and Communities (TPCs) in Brazil. METHODS AND ANALYSIS: The review question of the protocol is: 'What evidence is available on the oral health surveys of Traditional Peoples and Communities in Brazil?'. Observational studies that report oral health surveys of TPC in Brazil will be included. The protocol considered the Problem, Concept and Context strategy to guide data collection, as established by the Joanna Briggs Institute. The search strategy will consider Medical Subject Headings terms, synonyms and relevant free terms about epidemiological surveys in oral health and TPC in Brazil, with no limits to data, language, subject or search type, in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science and Embase. Bibliographic searches will be updated until June 2023. The selection will be carried out by two independent, blinded reviewers, following the eligibility criteria, based on the title and abstract identified in the initial search. Potentially eligible studies will be fully read to confirm eligibility and collect relevant information. The categorisation of the studies will consider the author and year of publication, the traditional group studied, the study design, geographic location, age group, sample size, data collection method and the main oral health problem evaluated and its outcome. The data obtained and extracted will be presented in table format and text and presented using the visualisation of similarities method. ETHICS AND DISSEMINATION: The present study does not need ethical approval. The protocol title was registered in the Open Science Framework (DOI 10.17605/OSF.IO/BQ5J3). A final article will be prepared presenting the results of the scoping review, and will be submitted for publication in a peer-reviewed journal. The findings of this review will be presented at national conferences and scientific meetings.

Epithelial responses and Candida albicans pathogenicity are enhanced in the presence of oral streptococci.

Experimental models that consider host-pathogen interactions are relevant for improving knowledge about oral candidiasis. The aim of this study was to assess the epithelial immune responses, Candida penetration of cell monolayers, and virulence during mixed species culture infections. Single species cultures of Candida albicans and mixed cultures (C. albicans, Streptococcus mutans, and Streptococcus sanguinis) were used to infect monolayers of HaCaT and FaDu ATCC HTB-43 cells for 12 h. After infection, IL-18 and IL-34 gene expression was measured to assess epithelial cell immune responses, and lactate dehydrogenase (LDH) activity was measured as an indicator of cell damage. Microscopy determined C. albicans morphology and penetration of fungal cells through the keratinocyte monolayer. Monolayers devoid of infection served as controls. Data were analyzed by an ANOVA one-way test followed by Tukey's post-hoc test (α = 0.05). The results found that IL-18 and IL-34 gene expression and LDH activity were significantly (p < 0.05) upregulated for both cell lines exposed to mixed species cultures compared with C. albicans alone. Candida albicans yeast and hyphae were evident in C. albicans only infections. In contrast, monolayers infected by C. albicans, S. mutans, and S. sanguinis exhibited higher microbial invasion with several hyphal aggregates detected. The presence of streptococci in C. albicans infection enhances the virulence and pathogenicity of the fungus with associated increased immune responses and tissue damage. Extrapolation of these findings to oral infection would indicate the added potential benefit of managing bacterial components of biofilms during treatment.

In vitro and in situ caries-preventive effect of a new combined fluoride and calcium experimental nanocomposite solution.

To assess the in vitro and in situ effect of experimental combined fluoride and calcium nanocomposite solutions on dental caries prevention. Nanocompound mesoporous silica (MS) with calcium (Ca) and sodium fluoride (NaF) - (MSCaNaF); MS with NaF (MSNaF), NaF solution (positive control), and deionized water (negative control - CG) were studied. The specimens (n=130) were submitted in vitro to a multispecies biofilm in the presence of 2% sucrose. After 24 h and 48 h, the culture medium pH, the percent of surface mineral loss (%SML), and lesion depth (ΔZ) were analyzed. In the in situ study, 10 volunteers participated in four phases of 7-days each. The products were applied on the specimens (n=240) before 20% sucrose solution drips. The polysaccharides (SEPS and IEPS), %SML and roughness (Sa) were evaluated. There was an in vitro decrease in pH values in 24h and 48h, compared to baseline. The MSCaNaF and MSNaF groups obtained lower values of %SML and ΔZ (p < 0.05) than CG and NaF after 24h and were similar to NaF after 48h (p<0.05). In situ results showed similar SEPS and IEPS among all groups after 48h. An after 7-days, the nanocomposites had similar values (p>0.05), while NaF was similar to CG (p>0.05). After 48h, the MSCaNaF and MSNaF reduced the %SML (p<0.05). After 7-days, both experimental nanocomposites were similar to NaF (p>0.05). Regarding Sa, MSCaNaF was better than NaF for both periods (p<0.05). The nanocomposites controlled the in vitro and in situ enamel demineralization, mainly in the initial periods.

In vitro and in situ caries-preventive effect of a new combined fluoride and calcium experimental nanocomposite solution

Abstract To assess the in vitro and in situ effect of experimental combined fluoride and calcium nanocomposite solutions on dental caries prevention. Nanocompound mesoporous silica (MS) with calcium (Ca) and sodium fluoride (NaF) - (MSCaNaF); MS with NaF (MSNaF), NaF solution (positive control), and deionized water (negative control - CG) were studied. The specimens (n=130) were submitted in vitro to a multispecies biofilm in the presence of 2% sucrose. After 24 h and 48 h, the culture medium pH, the percent of surface mineral loss (%SML), and lesion depth (ΔZ) were analyzed. In the in situ study, 10 volunteers participated in four phases of 7-days each. The products were applied on the specimens (n=240) before 20% sucrose solution drips. The polysaccharides (SEPS and IEPS), %SML and roughness (Sa) were evaluated. There was an in vitro decrease in pH values in 24h and 48h, compared to baseline. The MSCaNaF and MSNaF groups obtained lower values of %SML and ΔZ (p < 0.05) than CG and NaF after 24h and were similar to NaF after 48h (p<0.05). In situ results showed similar SEPS and IEPS among all groups after 48h. An after 7-days, the nanocomposites had similar values (p>0.05), while NaF was similar to CG (p>0.05). After 48h, the MSCaNaF and MSNaF reduced the %SML (p<0.05). After 7-days, both experimental nanocomposites were similar to NaF (p>0.05). Regarding Sa, MSCaNaF was better than NaF for both periods (p<0.05). The nanocomposites controlled the in vitro and in situ enamel demineralization, mainly in the initial periods.

Epithelial responses and Candida albicans pathogenicity are enhanced in the presence of oral streptococci

Abstract Experimental models that consider host-pathogen interactions are relevant for improving knowledge about oral candidiasis. The aim of this study was to assess the epithelial immune responses, Candida penetration of cell monolayers, and virulence during mixed species culture infections. Single species cultures of Candida albicans and mixed cultures (C. albicans, Streptococcus mutans, and Streptococcus sanguinis) were used to infect monolayers of HaCaT and FaDu ATCC HTB-43 cells for 12 h. After infection, IL-18 and IL-34 gene expression was measured to assess epithelial cell immune responses, and lactate dehydrogenase (LDH) activity was measured as an indicator of cell damage. Microscopy determined C. albicans morphology and penetration of fungal cells through the keratinocyte monolayer. Monolayers devoid of infection served as controls. Data were analyzed by an ANOVA one-way test followed by Tukey's post-hoc test (α = 0.05). The results found that IL-18 and IL-34 gene expression and LDH activity were significantly (p < 0.05) upregulated for both cell lines exposed to mixed species cultures compared with C. albicans alone. Candida albicans yeast and hyphae were evident in C. albicans only infections. In contrast, monolayers infected by C. albicans, S. mutans, and S. sanguinis exhibited higher microbial invasion with several hyphal aggregates detected. The presence of streptococci in C. albicans infection enhances the virulence and pathogenicity of the fungus with associated increased immune responses and tissue damage. Extrapolation of these findings to oral infection would indicate the added potential benefit of managing bacterial components of biofilms during treatment.

Resumo O objetivo deste estudo foi avaliar a resposta epithelial imune, a colonização da Candida albicans em monocamadas celulares e sua virulência em resposta a infecções de culturas de biofilme multiespécie. Culturas de biofilme monoespécie de C. albicans e culturas mistas (C. albicans, Streptococcus mutans e Streptococcus sanguinis) foram utilizadas para infectar monocamadas de células HaCaT e FaDu por 12 h. Após a infecção, a expressão dos genes IL-18 e IL-34 foi medida para avaliar as respostas imunes das células epiteliais. A atividade da lactato desidrogenase (LDH) foi medida como um indicador de dano celular. A microscopia determinou a morfologia de C. albicans e a penetração das células fúngicas através da monocamada de queratinócitos. Monocamadas em que não houve infecção serviram como controles. Os dados foram analisados por um teste ANOVA one-way seguido pelo teste post-hoc de Tukey (α = 0,05). Os resultados demonstraram que a expressão gênica de IL-18 e IL-34 e a atividade de LDH foram (p < 0,05) reguladas positivamente para ambas as linhagens de células expostas a culturas de espécies mistas em comparação com C. albicans isoladamente. Leveduras de C.albicans e hifas foram evidentes em infecções apenas por C. albicans. Entretanto, monocamadas infectadas por C. albicans, S. mutans e S. sanguinis exibiram maior invasão microbiana com vários agregados de hifas detectados. Dessa maneira, a presença de estreptococos na infecção por C. albicans aumentou a virulência e a patogenicidade do fungo com respostas imunes aumentadas associadas a danos nos tecidos. A extrapolação desses achados para a infecção oral indicaria o potencial benéfico do controle dos componentes bacterianos em biofilmes durante a terapia da candidíase

Tooth wear prevalence in individuals with Down syndrome: a systematic review.

OBJECTIVES: This systematic review investigated the prevalence of tooth wear between patients with and without Down syndrome. METHODS: Six databases (Embase, LILACS, Livivo, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey and ProQuest) were searched until March 7, 2022. Observational studies were included to assess the differences in tooth wear prevalence and/or severity in Down syndrome and non-syndromic controls. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations were followed. Three reviewers independently screened studies, extracted data, assessed the methodological quality (Joanna Briggs Institute) and graded the certainty of evidence through the Grading of Recommendations, Assessment, Development, Evaluation (GRADE) approach. Results were summarized through meta-analyses using a random-effects model. The protocol was registered at PROSPERO (CRD42021266997). RESULTS: Of the 1382 records identified, six cross-sectional studies were included. Individuals with Down syndrome had a higher prevalence and were more likely to have tooth wear than individuals without Down syndrome (44% × 15%; OR = 4.43; 95% CI 3.17-6.18; p < 0.00001; I2 = 8%). Also, the severity of tooth wear was higher in the Down syndrome group (n = 275) compared with the controls (n = 294). The certainty of evidence analysis was very low. CONCLUSIONS: Based on very low certainty of the evidence, patients with Down syndrome had a higher prevalence and likelihood and severity of tooth wear when compared to those without Down syndrome. CLINICAL RELEVANCE: Screening early tooth wear lesions should be carefully done in the Down syndrome population since its occurrence is remarkable compared to the general population.

Does the presence of oral health teams influence the incidence of ventilator-associated pneumonia and mortality of patients in intensive care units? Systematic review.

AIMS: To verify whether oral health teams influence the oral health status, ventilator-associated pneumonia incidence and mortality rate of patients in Intensive Care Units (ICU). MATERIALS AND METHODS: Bibliographic searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Academic Google, and Cochrane databases. The assessment of the methodological quality and risk of bias of the included studies and a random-effects meta-analysis to summarize relative risk data for ventilator-associated pneumonia (VAP) and mortality were performed. An analysis of the certainty of the evidence was performed for the main outcomes analyzed. RESULTS: Records of 518 studies were analyzed by reading titles and abstracts. Five studies were included according to eligibility criteria. The meta-analysis showed that ICU patients undergoing dental care by an oral health team had a lower incidence of VAP (OR = 0.33; 95% CI: 014-0.76) but did not lower mortality rates (OR = 0.46 95% CI: 0.16-1.32). The certainty of the evidence was considered very low. CONCLUSION: Dental care provided by oral health teams in a hospital environment did not influence oral health status or mortality, although it contributed to a reduction in VAP of patients admitted to the ICU.

Oral health-related quality of life of older adults living in long-term care facilities and its association with dental prosthesis use and condition / Qualidade de vida relacionada à saúde bucal de idosos residentes em instituições de longa permanência: associação com o uso e condição da prótese

OBJECTIVE: This cross-sectional study aimed to evaluate the association of oral health-related quality of life with prosthetic rehabilitation status and dental prosthesis condition in residents of Brazilian long-term care facilities. METHODS: The oral health-related quality of life of older adults (n = 194; mean [standard deviation] age = 78.93 [9.10]) was assessed by the Geriatric Oral Health Assessment Index and the Oral Health Impact Profile questionnaires. Prosthetic rehabilitation status was recorded according to the absence of teeth and use of dental prostheses. Dental prosthesis condition was considered good or poor based on stability, retention, occlusion, vertical dimension, and defects. Poisson regression models were plotted to analyze the data (α = 0.05). RESULTS: Lower Geriatric Oral Health Assessment Index scores were associated with edentulism with denture use only on one jaw (B = -0.05) and poor dental prosthesis stability (B = -0.04). Similarly, edentulous participants with denture only on one jaw (B = 0.59) and those wearing dental prostheses with poor stability (B = 0.36) are more likely to achieve higher Oral Health Impact Profile scores. Also, lower Oral Health Impact Profile scores were associated with denture defects (B = -0.34). CONCLUSION: In summary, the oral health-related quality of life of older adults living in long-term care facilities is negatively impacted by edentulism with denture only on one jaw and use of dental prostheses with poor stability. Therefore, long-term care facilities should provide oral health training to caregivers, include dental professionals in the staff, and articulate demands with oral health teams in the primary care system. (AU)

OBJETIVO: Este estudo transversal objetivou avaliar a associação da qualidade de vida relacionada à saúde bucal com o status de reabilitação protética e a condição da prótese em residentes de instituições de longa permanência no Brasil. METODOLOGIA: A qualidade de vida relacionada à saúde bucal dos idosos (n = 194; média [desvio padrão] idade = 78,93 [9,10]) foi avaliada pelos questionários Geriatric Oral Health Assessment Index e Oral Health Impact Profile. O status de reabilitação protética foi registrado de acordo com a ausência de dentes e uso de próteses dentárias. A condição da prótese foi considerada boa ou ruim com base na estabilidade, retenção, oclusão, dimensão vertical e defeitos. Modelos de regressão de Poisson foram plotados para analisar os dados (α = 0,05). RESULTADOS: Como resultado, menores escores no Geriatric Oral Health Assessment Index foram associados ao edentulismo com o uso de dentadura em apenas uma arcada (B = -0,05) e ao uso de próteses com estabilidade ruim (B = -0,04). De forma similar, participantes edêntulos que usavam dentadura em apenas uma arcada (B = 0,59) e aqueles que portavam prótese com estabilidade ruim (B = 0,36) são mais propensos a ter maiores escores no Oral Health Impact Profile. Além disso, menores escores no Oral Health Impact Profile foram associados a defeitos na prótese (B = -0,34). CONCLUSÃO: Sumarizando, a qualidade de vida relacionada à saúde bucal de idosos residentes em instituições de longa permanência é negativamente impactada pelo edentulismo com o uso de dentadura em apenas uma arcada e uso de prótese com estabilidade ruim. Assim, instituições de longa permanência devem promover capacitação em saúde bucal aos cuidadores, incluir dentistas no quadro de funcionários e articular com as equipes de saúde bucal da Atenção Primária à Saúde. (AU)

In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets

ABSTRACT Objective: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. Material and Methods: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). Results: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. Conclusion: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

RESUMO Objetivo: Avaliar in-vitro o efeito de uma aplicação única de cremes dentais de CPP-ACP e diferentes soluções fluoretadas na prevenção da cárie dentária ao redor de braquetes ortodônticos Material e Métodos: O conjunto dentes/braquetes (n=65) foi imerso em saliva artificial (1h em 37°C) randomizado e submetido a tratamento único (100µL; 1 min) de emulsão de fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) e CPP-ACP associado ao flúor (CPP-ACPF); soluções de tetrafluoreto de titânio (TiF4) e fluoreto de sódio (NaF); e ausência de tratamento (GC). Biofilmes multiespécie (5 x 105 CFU/mL) foram formados na presença de sacarose a 2%. Após 24h, o pH e a concentração de fluoreto solúvel total (FST) foram analisados pelo meio de cultura. Foram avaliadas a presença de lesões de mancha branca (LMB), por meio da análise de macroscopia visual, e a porcentagem de perda de dureza (%PD). Também foi verificada a topografia do esmalte, usando microscopia eletrônica de varredura (MEV). Os dados foram analisados pelos testes Qui-quadrado, Kruskal-Wallis e Mann-Whitney (p < 0,05). Resultados: Os compostos contendo flúor levaram a uma redução do pH menor do que o CPP-ACP e GC (p<0,05). Houve diferença no FST entre os grupos (p <0,05), sendo TiF4> NaF > CPP-ACPF > CPP-ACP > GC. Quanto à presença de LMB e à %PD, o grupo NaF obteve os menores valores (p<0,05), enquanto TiF4 e CPP-ACPF foram semelhantes (p> 0,05). A MEV demonstrou que os grupos sem flúor tiveram uma dissolução superficial maior. Conclusão: Os grupos fluoretados, incluindo soluções e CPP-ACPF, foram mais eficazes do que o CPP-ACP sem flúor na redução da desmineralização do esmalte ao redor dos braquetes ortodônticos após uma única aplicação.

Association of sociodemographic characteristics, mental health, and sleep quality with COVID-19 fear in an elderly Brazilian population

Aim: This study determined whether COVID-19 fear is correlated with sociodemographic characteristics, general health, mental health, and sleep quality in an elderly Brazilians. Methods: Elderly people aged ≥ 60 years replied to an online survey containing questions about their sociodemographic characteristics; general health; levels of stress, anxiety, and depression; sleep quality; and COVID fear. Results: Data were statistically analyzed using descriptive statistics (α = 5%). In total, 705 elderly people with mean age of 66 ± 5 years, and most (82.7%) respondents were women, graduated and from southeastern Brazil. COVID-19 fear correlated positively and moderately with sleep quality and symptoms of depression, anxiety, and stress (all p < 0.001). It was associated with females. Elderly people from northern and northeastern Brazil and diabetics had increased COVID-19 fear (all p < 0.05). Conclusion: The fear of COVID-19 exists among Brazilian female old people, diabetics, increases anxiety and stress symptoms, and worsen sleep quality in elderly people