Utilização do diamino fluoreto de prata como estratégia para tratamento da cárie na primeira infância em paciente não colaborador: relato de caso / Use of silver diamine fluoride as a strategy for treating early childhood caries in a non-cooperative patient: case report

Objetivo: relatar o uso do diamino fluoreto de prata (DFP) para tratamento da cárie na primeira infância em paciente não colaboradora de 3 anos. Relato do caso: ao exame clínico inicial, realizado com auxílio da estabilização protetora, notou-se que a paciente estava na fase de dentição decídua, possuía excessivo acúmulo de biofilme visível, sem sensibilidade ou qualquer outro sintoma, porém apresentando múltiplas lesões de cárie ativas em todos os dentes, exceto nos incisivos inferiores. Optou-se pelo uso do DFP 30% (Cariestop®) para o tratamento das lesões de cárie e também como alternativa para o manejo do comportamento, que foi classificado usando a Escala Comportamental de Frankl. Já na consulta inicial foi realizada a primeira aplicação, durante 2 minutos, diretamente sobre as lesões cavitadas em dentina dos dentes do hemiarco superior esquerdo, após profilaxia dentária prévia. Na segunda consulta, foi realizada a aplicação do produto nas lesões do hemiarco superior direito, enquanto no terceiro atendimento foi aplicado o DFP nos molares e caninos inferiores. Em todas as consultas foi realizada instrução de higiene bucal e de dieta com a responsável. Resultados: no decorrer do tratamento a paciente apresentou expressiva melhora no comportamento, que havia sido definitivamente negativo na primeira consulta. Ela sentou-se sozinha na cadeira e não precisou da estabilização protetora na última consulta, apresentando comportamento positivo. Verificou-se também a paralisação das lesões de cárie em decorrência do uso do DFP. Conclusão: o uso de DFP para tratamento de lesões cavitadas de cárie em pacientes não colaboradores foi considerado uma estratégia eficaz tanto para paralisação das lesões quanto para auxílio no condicionamento do comportamento.

Objective: to report the use of silver diamine fluoride (SDF) for the treatment of caries in early childhood in a 3-year-old non-collaborating patient. Case report: at the initial clinical examination, performed with protective stabilization, it was verified that the patient was in the primary dentition period, had excessive accumulation of visible biofilm, no dental sensibility or any other symptom, but had multiple active caries lesions in all teeth except the lower incisors. It was decided to use SDF 30% (Cariestop®) for the treatment of caries lesions and also as an alternative for managing behavior, which was classified using the Frankl Behavioral Scale. In the initial consultation, the first application was performed, for 2 minutes, directly on the dentin cavitated lesions of the teeth of the upper left hemiarch, after previous dental prophylaxis. In the second appointment, the product was applied into the lesions on the upper right hemiarch, while in the third visit, the SDF was applied to the lower molars and canines. In all consultations, instructions on oral hygiene and diet were given to the guardian. Results: during the treatment, the patient showed a significant improvement in behavior, which had been definitely negative in the first consultation. She sat alone in the dental chair and did not need protective stabilization at her last visit, showing positive behavior. There was also an arrest of carious lesions due to the use of DFP. Conclusion: The use of SDF for the treatment of cavitated carious lesions in non- collaborating patients was considered an effective strategy both for arresting the lesions and for improving the condition behavior.

Dispersion and persistence of antimicrobial resistance genes among Staphylococcus spp. and Mammaliicoccus spp. isolated along a swine manure treatment plant.

Staphylococcus spp. and Mammaliicoccus spp. colonize the skin and mucosa of humans and other animals and are responsible for several opportunistic infections. Staphylococci antibiotic resistance may be present in the environment due to the spread of treated and untreated manure from the livestock industry due to antibiotic use to disease control or growth promoter. In this work, we analyzed the species distribution and antimicrobial susceptibility of Staphylococcus and Mammaliicoccus species along different sites of a swine manure treatment plant from Southeastern Brazil. Bacterial colonies were obtained on mannitol salt agar, selected after catalase test and Gram staining, and finally identified by mass spectrometry and sequencing of the tuf gene. According to the results, S.cohnii and S. simulans were the most prevalent species. Antibiotic resistance test revealed that several strains were resistant to multiple drugs, with high levels of chloramphenicol resistance (98%), followed by erythromycin (79%), tetracycline (73%), gentamicin (46%), ciprofloxacin (42%), cefoxitin (18%), sulfamethoxazole + trimethoprim (12%), and linezolid (4%). In addition, gene detection by PCR showed that all strains carried at least 2 resistance genes and one of them carried all 11 genes investigated. Using the GTG5-PCR approach, a high genetic similarity was observed between some strains that were isolated from different points of the treatment plant. Although some were seemingly identical, differences in their resistance phenotype and genotype suggest horizontal gene transfer. The presence of resistant bacteria and resistance genes along the treatment system highlights the potential risk of contamination by people in direct contact with these animals and the soil since the effluent is used as a biofertilizer in the surrounding environment.