Fixed and on-demand regimens of acetaminophen in periodontal surgery: randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized". Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen "as needed," at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery

Frequency and characterization of potential drug interactions in dentistry-a cross-sectional study.

AIM: This study aimed to identify medications taken by patients before dental appointments and to simulate and characterize their interactions with medications often prescribed by dental surgeons. MATERIALS AND METHODS: A retrospective cross-sectional study evaluated 320 medical records, 118 from the Emergency Service (ES) archives, and 202 from elective appointments at the Dental Clinic (DC) of a university in southern Brazil. Drug interactions were identified and classified according to severity using the Medscape® application into four grades: (1) Minor, (2) Monitor closely, (3) Serious, or (4) Contraindicated. Descriptive and inferential statistical analyses were carried out (α = 5%). RESULTS: Preexisting systemic conditions were noted in 55.9% of the medical records from the ES and 64.35% from the DC. In the ES records, 47.45% contained information on continuous use medication for treatment of systemic conditions and 59.40% of DC records contained such information. A total of 359 potential interactions were found. Drug interactions with analgesics were most frequent, accounting for 50.41% of the sample. CONCLUSIONS: The most prevalent drug interaction severity was grade 2: monitor or use with caution. Many patients take medications to treat systemic conditions and seek dental care, generating a significant possible source of drug interactions. CLINICAL RELEVANCE: Prescribers must carefully analyze the patients' medical histories and obtain accurate data regarding their use of medications to be able to assess the risk-benefit relationships of possible combinations.

Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination.

BACKGROUND: Oral mucositis (OM) is one of the main adverse effects of the chemotherapeutic agent methotrexate (MTX). AIM: To evaluate the relationship of OM with MTX metabolism time and other toxicities in childhood, cancer patients receiving high-dose of methotrexate (HD-MTX). DESIGN: Seventy-seven childhood patients receiving HD-MTX for treatment of leukaemia, osteosarcoma or lymphoma were evaluated. MTX serum level, hepatic and renal function parameters, and presence and intensity of OM were analysed. RESULTS: The patients were submitted to 255 cycles of chemotherapy. OM was diagnosed in 191 (74.9%) cycles. Of these, 119 (46.6%) presented ulcerative lesions. Lymphoma was associated with severe OM (P = .01). OM was associated with higher serum levels of aspartate aminotransferase (P = .006), alanine aminotransferase (P = .04) and creatinine (P = .008). Increase of one unit of total bilirubin and indirect bilirubin associated, respectively, with 11% and 39% higher prevalence of OM. For each increase of one unit of creatinine serum level, it was observed a 37% higher prevalence of OM in patients with lymphoma. No association was found between delayed excretion of MTX and OM development. CONCLUSIONS: OM is a prevalent complication of childhood cancer patients receiving HD-MTX. Renal and hepatic toxicity could be considered risk factors for OM, especially in patients with lymphoma.

Self-reported confidence and anxiety over endodontic procedures in undergraduate students-Quantitative and qualitative study.

PURPOSE: The current literature shows a growing interest to assess the feelings and perceptions of students associated with the performance of elective endodontic procedures. This study aimed to evaluate the students' anxiety and self-perceptions related to performing such treatments. METHODS: Forty-five students participated in the research (G1 = 22 beginners students; G2 = 23 senior students). Demographic data, STAI-State and Numerical Rating Scale (NRS) for pre-operative anxiety were completed before the appointment with patient. The STAI-Trait; NRS for post-operative anxiety; previous experiences in endodontics; and level of confidence in each stage of endodontic treatments were collected after appointment. Focal groups for qualitative data collection were performed on separate occasion. RESULTS: Both groups showed higher scores in STAI-State than for STAI-Trait scale. G1 showed higher levels of anxiety in the pre-operative, compared with post-operative moment in the NRS scale. G2 reported feeling more confidence to insert intracanal medication and to restore teeth between appointments than G1. In both focus groups, participants reported insecurity in performing endodontic procedures due to difficulty in visualisation and to anatomic complexities. G1 reported that all the confidence they had was based in pre-clinical experience, and G2 mentioned concern about the end of graduation. CONCLUSION: The participants' anxiety diminishes as they gain more experience in performing endodontic procedures. However, as they approach the end of the course anxiety levels increase. Greater availability of elective courses in endodontics could be a valuable alternative to provide students with more exposure to and experience with these procedures.

Pedagogical training profile of basic health sciences faculty in biomedical and related fields at Brazilian public and private higher education institutions.

Historically, Brazilian higher education teachers' pedagogical training has not been a concern. Even today, a graduate degree is the main requirement to be a faculty member. However, a set of competencies is necessary to teach: pedagogical competency, political competency, and knowledge of specific content. Most graduate training covers only knowledge of specific content. Therefore, this work aimed to outline the profile of basic health sciences faculty members teaching in biomedical and related fields regarding their undergraduate and graduate training, as well as the initial and continued pedagogical training in Brazilian public and private higher education institutions (HEIs). An electronic questionnaire was sent to these professionals, and a total of 763 responses were analyzed (66.4% from public and 33.6% from private HEIs). Compared with private HEI faculty, faculty from public HEIs were more experienced in teaching, and more time had passed since they finished their graduate training. On the other hand, faculty from private HEIs had a more intense undergraduate teaching workload than faculty from public HEIs. Additionally, faculty from private HEIs attended more extensive and more frequent pedagogical training activities (PTAs). Both groups expressed that activities closely related to their classroom practice and recognition for good pedagogical performance were incentives for their participation in PTAs. In conclusion, differences between the faculty from public and private HEIs may be due to the characteristics of HEIs themselves. Hypothetically, private HEIs focus on teaching, which may explain why faculty from these institutions seek improvement in this area, whereas public HEIs focus on research.

Calcium Hypochlorite Solutions - An In Vitro Evaluation of Antimicrobial Action and Pulp Dissolution.

OBJECTIVE: To compare the antimicrobial activity and tissue dissolution capacity of calcium hypochlorite (Ca(OCl)2) solution with sodium hypochlorite (NaOCl) solution at 0.5%, 1.0%, 2.5%, and 5.25% concentrations. METHODS: To determine the inhibition halos produced by the tested substances against Enterococcus faecalis, the agar diffusion method was employed. Additionally, the broth contact method was used to determine the time required for the inhibition of E. faecalis. Bovine pulp fragments were used to test the dissolution. Half of the pulps were freely deposited samples in cell culture wells, and the remaining samples were fixed on bovine dentine bases. RESULTS: For both Ca(OCl)2 and NaOCl solutions, the greatest inhibition zones were observed at 5.25% con-centration. However, the most significant inhibition zone was measured with 5.25% Ca(OCl)2 solution (17.38 mm). Hypochlorite solutions at 2.5% and 5.25% concentrations required less time to inhibit E. faecalis than those at 0.5% and 1.0% concentrations (P<0.05). There was no difference in inhibition times between 2.5% and 5.25% hypochlorite solutions (P>0.05). The most effective hypochlorite solution concentrations were 5.25% and 2.5% for dissolving pulp fragments (P<0.05). Additionally, suspended pulp fragments were more susceptible to dissolution than fragments attached to dentine blocks (P<0.05), except for 0.5% Ca(OCl)2. CONCLUSION: Ca(OCl)2 solutions showed antimicrobial activity against E. faecalis and can dissolve pulp tissues. Future studies are warranted to examine the suitability of Ca(OCl)2 in the chemico-mechanical preparation of the root canal system.

O ensino de Endodontia pré-clínica nos cursos de Odontolologia brasileiros / Preclinical Endodontics teaching in Brazilian Dentistry courses

O objetivo desse estudo foi obter informações quanto ao ensino de Endodontia em atividades préclínicas nos diferentes cursos de graduação em Odontologia no Brasil, além de avaliar o perfil e a distribuição por regiões do país dessas instituições. Foi realizado um estudo observacional transversal do tipo censo, envolvendo 246 instituições de ensino, por meio do acesso aos sítios eletrônicos das respectivas instituições, obtendo-se dados de domínio público. As informações relacionadas às instituições de ensino foram obtidas em base de dados pública, em sítio eletrônico do Conselho Federal de Odontologia (CFO). Foram registradas as seguintes variáveis de interesse: dados sobre a instituição de ensino, a distribuição das disciplinas relacionadas ao ensino de pré-clínica na área de Endodontia, e a carga horária e relacionada com o ensino de Endodontia. Foi realizada análise estatística descritiva dos dados obtidos. A maioria dos cursos ocorrem em instituições privadas, localizadas no Sudeste do país, com maior número de cursos diurnos e apresentando duração mínima de 10 semestres. Em relação à presença de informações relativas à estrutura curricular dos Cursos de Odontologia nas instituições avaliadas, verificou-se que foi possível acesso direto em sítios eletrônicos de 190 instituições (77,2%). O Projeto Pedagógico está disponível no sítio eletrônico de 57 cursos (23,2%). Observou-se grande diversidade de organização das disciplinas nas diferentes instituições. Constatou-se que há informações limitadas disponíveis para acesso na forma de domínio público, o que dificulta uma análise mais criteriosa acerca dos modelos didáticos e conteúdos abordados pelas instituições. Ainda, observou-se que as informações disponibilizadas sugerem que há abordagens heterogêneas para o ensino da endodontia pré-clínica (AU).

This study aimed to achieve information concerning the teaching of Endodontics in preclinical activities in different undergraduate courses in Dentistry in Brazil, and analyzed the profile and distribution of these institutions across the country regions. This was a crosssectional observational census study, involving 246 teaching institutions, by accessing the electronic websites of institutions, achieving public domain data. The information related to the teaching institutions were obtained from a public database, on the electronic website of the Brazilian Federal Dental Council (CFO). The following variables of interest were recorded: data on the teaching institution, distribution of disciplines related to preclinical teaching in the field of Endodontics, and workload related to the teaching of Endodontics. Data were submitted to descriptive statistical analysis. Most courses are offered in private institutions, located in the Southeast region of the country, with greater number of daytime courses presenting minimum duration of 10 semesters. Concerning the presence of information related to the curriculum of Dentistry courses in the institutions analyzed, direct access was possible to the electronic websites of 190 institutions (77.2%). The Pedagogical Project was available on the electronic website of 57 courses (23.2%). There was great diversity of organization of disciplines in the different institutions. It was observed that there is limited information available for access as public domain, which impairs a more careful analysis of the didactic models and contentes addressed by the institutions. Also, the information available suggest heterogeneous approaches for the preclinical Endodontics teaching (AU).

Experiences during the execution of emergency endodontic treatment and levels of anxiety in dental students.

PURPOSE: This study aims to evaluate the experience of dental students and assess their anxiety levels when performing emergency endodontic treatments. METHODS: Undergraduate students completed the STAI-Trait/State and a questionnaire to assess their confidence level to perform each step of an emergency endodontic procedure. They also answered a numerical scale (NRS) for anxiety before and after emergency care. Ten randomly selected students from the same sample further participated in a focus group aimed at obtaining qualitative data on their perception of endodontic treatments' conduction and the learning process necessary to perform them. RESULTS: A total of 23 students joined the study. The majority of the participants reported feeling "confident" when performing local anaesthesia (57.6%), rubber dam placement (57.6%) and coronal sealing (72.7%). However, a small number reported feeling "little confident" to perform access cavity (15.2%) or pulpotomy/pulpectomy (24.2%). Students who scored above the 3rd quartile of STAI-Trait/State were classified as "highly anxious," and comprised 26.1% of the sample. The values of NRS scale were higher in the preoperative when compared with the post-operative assessment. All students classified as "highly anxious" reported low confidence in performing "access cavity" and "pulpotomy/pulpectomy." CONCLUSION: Both quantitative and qualitative analysis showed different anxiety levels in dental students. It can possibly contribute to a reduction in confidence prior to emergency endodontic procedures. The current findings suggest it might be important to rearrange activities in order to allow for more practical classes in Endodontics.

Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students.

AIM: Evaluate factors associated with pain and analgesic consumption following non-surgical periodontal therapy. MATERIALS AND METHODS: The sample consisted of 218 patients with chronic periodontitis, submitted to non-surgical scaling and root planing under local anaesthesia at a public dental service in southern Brazil. The data collection instruments included a demographic questionnaire, as well as State-Trait Anxiety Inventory, Corah's Dental Anxiety Scale, Visual Analogue Scale, Numerical Rating Scale and Verbal Rating Scale. The presence and intensity of pain were evaluated at 2, 6, 12, 24 and 48 hr after scaling and root planing. RESULTS: A total of 52.3% of the patients reported mild intensity pain at some point during the 48 hr after scaling and root planing with local anaesthesia. Smoking (PR = 1.47; 95% CI = 1.16-1.65), severe periodontal inflammation (PR = 1.31; 95% CI = 1.09-1.58) and dental anxiety (PR = 1.24; 95% CI = 1.03-1.49) were associated with postoperative pain after adjusting for age, gender and state and trait anxiety scores. Moreover, 46.8% of the subjects used analgesics at some time during the 48-hr follow-up period and dental anxiety was the only factor associated with postoperative analgesic use. CONCLUSIONS: Smoking, severe periodontal inflammation and dental anxiety were identified as factors associated with pain after non-surgical scaling and root planing with local anaesthesia. Dental anxiety was also a factor associated with postoperative analgesic use.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial.

INTRODUCTION: Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. OBJECTIVE: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. MATERIAL AND METHODS: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. RESULTS: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. CONCLUSION: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Anti-inflammatory effect of an adhesive resin containing indomethacin-loaded nanocapsules.

OBJECTIVE: To analyze the anti-inflammatory and analgesic effects of an adhesive resin containing indomethacin-loaded nanocapsules in rat model. DESIGN: Adhesive resin disks with or without indomethacin-loaded nanocapsules were subcutaneously implanted into right hind paw of rats. A week after surgical procedure, 2% formalin solution was intradermally injected into plantar surface of paw. Nociceptive and inflammatory responses were evaluated by formalin test. Paw edema by pletismometer and mechanical hyperalgesia by von Frey test were performed on day 2, day 4, day 6, day 8, day 10 and day 12 after surgery. IL-6, IL-10, and lactate dehydrogenase (LDH) serum levels were determined by ELISA-sandwich test. RESULTS: Group containing indomethacin-loaded nanocapsules (NC) presented lower edema in the right hind paw at 24h after formalin injection than those of the control group (CT) (P<0.01). NC group showed decrease in the nociceptive response in phase I (neurogenic pain) compared to CT group (NC - 66.86±22.83s X CT - 130.17±35.83s, P<0.001). NC group presented supporting higher intensity of stimulus on days 8 and 12 (24h and 72h after formalin injection) (P<0.01 and P<0.02 respectively). The IL-6 serum level was also significantly higher in the NC group than CT group (p<0.001). CONCLUSIONS: These results indicate that an adhesive resin containing indomethacin-loaded nanocapsules has anti-inflammatory and nociceptive activities in a chemical model of acute inflammation. The present investigation confirms an adhesive resin with drug-loaded nanocapsules may be useful for improving therapeutic effect for adhesives to be used in deep cavities.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Low brain-derived neurotrophic factor levels are associated with active disease and poor prognosis in childhood acute leukemia.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related receptor kinase B (TrkB) are involved in the maturation of B lymphocytes in the bone marrow (BM), promote cell differentiation in B-cell malignancies, and are associated with poor prognosis in adults with acute leukemia (AL). However, the role of BDNF in pediatric AL remains poorly understood. OBJECTIVE: We carried out a cohort observational study to evaluate BDNF levels in BM or peripheral blood (PB) samples from children with AL. METHODS: BM or PB samples were collected from 57 children and adolescents with acute lymphoid leukemia (ALL), 14 children and adolescents with acute myeloid leukemia (AML), and 44 healthy individuals (HI) of the same age range. RESULTS: BDNF levels at diagnosis in AL patients were significantly lower when compared to HI. Samples from patients in complete remission from disease had higher levels of BDNF compared to those obtained from patients with malignant cells. Moreover, BDNF levels at diagnosis in patients who died were significantly lower compared to those found in survivors. CONCLUSIONS: These findings provide the first evidence for a possible role of BDNF as a marker of active disease and poor prognosis in pediatric AL.

Self-medication in Children and Young Patients at University Dental Service

Objective: To analyze the pattern of self-medication in cases of dental infection for children and pre-teens at University Dental Service. Material and Methods: It was performed a structured survey interview with the parents/caregivers of the patients. The survey consisted in seventeen questions about tooth infection episodes experienced by the children during their lives, and which medication was used, as well as information about demographic characteristics of the patient and parents/caregivers. Statistical analysis was performed with the Software SPSS for Windows, version 15.0. Descriptive analysis was performed (mean and standard deviation [SD] or median and percentis). The association between the self-medication and the variables (child age, mother age, mother educational level) was measured by chi-squared test. Results: One hundred and fifty questionnaires were analyzed. In episodes of dental infection, the most common medicaments were amoxicillin (34.8%) and acetaminophen (32.6%). The practice of self-medication was observed in 21.7% of cases. There was no association between the self-medication and the variables as child age, mother age and mother educational level (P>.05; chi-squared test). Conclusion: Children treated at University Dental Service were exposed to frequent previous use of medicines without prescription, and the data revealed a non-rational use of medications.

Distribution of genes related to antimicrobial resistance in different oral environments: a systematic review.

INTRODUCTION: The oral cavity is the main source of microorganisms for odontogenic infections. It is important to perform an extensive analysis regarding the reports on the presence of bacteria that carry resistance genes to antimicrobial agents. The aim of the study was to verify the reports on the distribution of genes associated with resistance to antibiotics prescribed in dentistry in different human oral sites. METHODS: A systematic review was conducted in electronic databases and gray literature to analyze clinical studies that detected genes of bacterial resistance to antibiotics in saliva, supragingival biofilm, and endodontic infections. Data regarding the research group, geographic location, sample source, number of subjects, methods for sample analysis, the targeted gene groups, and the detection rates were collected. Descriptive data analysis was performed. RESULTS: Preliminary analysis was performed in 152 titles; 50 abstracts were reviewed, and 29 full texts were obtained. Nine articles matched the inclusion criteria (saliva = 2, supragingival biofilm = 1, and endodontic infections = 6). The presence of 33 different targeted genes was evaluated. The most frequently investigated groups of genes were tetracycline and lactamics (tetM, tetQ, tetW, and cfxA). There was a wide range for the detection rates of each resistance gene among studies and for each specific gene group. CONCLUSIONS: This systematic review highlights the presence of resistance genes to antimicrobial agents in saliva, dental biofilm, and endodontic infections, especially for tetracycline and lactamics. There is a lack of reports on the presence of genes and resulting outcomes obtained through the therapeutic approaches for infection control.

Saliva, supragingival biofilm and root canals can harbor gene associated with resistance to lactamic agents.

This study aimed to determine the presence of Prevotella strains and genes associated with resistance to lactamics in different oral niches from patients with/without primary endodontic infections. Saliva (S) and supragingival biofilm (SB) were collected from three patient groups: Group I - no endodontic infection (n = 15); Group II - acute endodontic infection (n = 12); and Group III - chronic endodontic infection (n = 15). Root canal (RC) samples were collected from Groups II and III. The presence of P. intermedia, P nigrescens, P. tannerae and cfxA/cfxA2 gene was assessed by PCR. The cfxA/cfxA2 gene was not detected in all environments within the same patient. The cfxA/cfxA2 gene was present in 23.81% of S samples, 28.57% of SB samples, and 7.41% of RC samples. Prevotella species were detected in 53.97%, 47.62% and 34.56% of the S, SB, and RC samples, respectively. P. intermedia had a high frequency in saliva samples from Group 3. Saliva samples from Group 1 had higher detection rates of P. nigrescens than did Groups 2 and 3. Patients without endodontic disease had high frequencies of P. nigrescens in the SB samples. The presence or absence of spontaneous symptoms was not related to the detection rates for resistance genes in the RC samples. Saliva, supragingival biofilm and root canals can harbor resistant bacteria. The presence of symptomatology did not increase the presence of the cfxA/cfxA2 gene in the supragingival biofilm and inside root canals.

Saliva, supragingival biofilm and root canals can harbor gene associated with resistance to lactamic agents

This study aimed to determine the presence of Prevotella strains and genes associated with resistance to lactamics in different oral niches from patients with/without primary endodontic infections. Saliva (S) and supragingival biofilm (SB) were collected from three patient groups: Group I – no endodontic infection (n = 15); Group II – acute endodontic infection (n = 12); and Group III – chronic endodontic infection (n = 15). Root canal (RC) samples were collected from Groups II and III. The presence of P. intermedia, P nigrescens, P. tannerae and cfxA/cfxA2 gene was assessed by PCR. The cfxA/cfxA2 gene was not detected in all environments within the same patient. The cfxA/cfxA2 gene was present in 23.81% of S samples, 28.57% of SB samples, and 7.41% of RC samples. Prevotella species were detected in 53.97%, 47.62% and 34.56% of the S, SB, and RC samples, respectively. P. intermedia had a high frequency in saliva samples from Group 3. Saliva samples from Group 1 had higher detection rates of P. nigrescens than did Groups 2 and 3. Patients without endodontic disease had high frequencies of P. nigrescens in the SB samples. The presence or absence of spontaneous symptoms was not related to the detection rates for resistance genes in the RC samples. Saliva, supragingival biofilm and root canals can harbor resistant bacteria. The presence of symptomatology did not increase the presence of the cfxA/cfxA2 gene in the supragingival biofilm and inside root canals.

Patient automedication and professional prescription pattern in an urgency service in Brazil.

Several studies have indicated an increased resistance of microorganisms resulting from the widespread use of antimicrobial agents. However, few data are available in the dental literature. The aim of this study was to conduct a survey on the patterns of patient usage of antimicrobial prescriptions agents by dentists. A retrospective cross-sectional study was based on the medical records of 223 patients who sought treatment at the Urgency Service, from a Dental School in the South of Brazil, from March 2009 to March 2011. A specific data sheet was used, with questions regarding: patient age and gender; the main complaint; medications used prior to the service; final diagnosis; proposed dental treatment (including prescription medications); and characteristics of the final prescription. Descriptive and inferential statistics were obtained. There was a high frequency of antibiotic use prior to attendance by young patients (Fisher's exact test, p < 0.05). Toothache of endodontic origin was the most frequent patient complaint (72.6%). Endodontic procedures were the measures most frequently adopted to treat the pain (31.2%). The frequency of patient use of antimicrobials prior to the appointment was 14.3%. According to patient records, 83.9% had no systemic drug prescription after receiving urgency treatment. There were few antimicrobial prescriptions after the urgency treatment. The most frequently prescribed agents were amoxicillin, chlorhexidine, and metronidazole. Local measures were more frequently used than systemic approaches to treat urgencies of dental origin. Antimicrobial agents were not frequently prescribed as adjunctives to local administered at the urgency service.

Effects of acute and chronic administration of methylprednisolone on oxidative stress in rat lungs.

OBJECTIVE: To determine the effects of acute and chronic administration of methylprednisolone on oxidative stress, as quantified by measuring lipid peroxidation (LPO) and total reactive antioxidant potential (TRAP), in rat lungs. METHODS: Forty Wistar rats were divided into four groups: acute treatment, comprising rats receiving a single injection of methylprednisolone (50 mg/kg i.p.); acute control, comprising rats i.p. injected with saline; chronic treatment, comprising rats receiving methylprednisolone in drinking water (6 mg/kg per day for 30 days); and chronic control, comprising rats receiving normal drinking water. RESULTS: The levels of TRAP were significantly higher in the acute treatment group rats than in the acute control rats, suggesting an improvement in the pulmonary defenses of the former. The levels of lung LPO were significantly higher in the chronic treatment group rats than in the chronic control rats, indicating oxidative damage in the lung tissue of the former. CONCLUSIONS: Our results suggest that the acute use of corticosteroids is beneficial to lung tissue, whereas their chronic use is not. The chronic use of methylprednisolone appears to increase lung LPO levels.

Effects of acute and chronic administration of methylprednisolone on oxidative stress in rat lungs / Efeitos da administração aguda e crônica de metilprednisolona no estresse oxidativo em pulmões de ratos

Objective: To determine the effects of acute and chronic administration of methylprednisolone on oxidative stress, as quantified by measuring lipid peroxidation (LPO) and total reactive antioxidant potential (TRAP), in rat lungs. Methods: Forty Wistar rats were divided into four groups: acute treatment, comprising rats receiving a single injection of methylprednisolone (50 mg/kg i.p.); acute control, comprising rats i.p. injected with saline; chronic treatment, comprising rats receiving methylprednisolone in drinking water (6 mg/kg per day for 30 days); and chronic control, comprising rats receiving normal drinking water. Results: The levels of TRAP were significantly higher in the acute treatment group rats than in the acute control rats, suggesting an improvement in the pulmonary defenses of the former. The levels of lung LPO were significantly higher in the chronic treatment group rats than in the chronic control rats, indicating oxidative damage in the lung tissue of the former. Conclusions: Our results suggest that the acute use of corticosteroids is beneficial to lung tissue, whereas their chronic use is not. The chronic use of methylprednisolone appears to increase lung LPO levels. .

Objetivo: Determinar os efeitos da administração aguda e crônica de metilprednisolona no estresse oxidativo, por meio da quantificação da peroxidação lipídica (POL) e do potencial antioxidante reativo total (PART), em pulmões de ratos. Métodos: Quarenta ratos Wistar foram divididos em quatro grupos: tratamento agudo, com ratos recebendo uma dose única de metilprednisolona (50 mg/kg i.p.); controle agudo, com ratos recebendo injeção unida de salina; tratamento crônico, com ratos recebendo metilprednisolona v.o. na água do bebedouro (6 mg/kg por dia durante 30 dias; e controle crônico, com ratos recebendo água de bebedouro normal). Resultados: Os níveis de PART foram significativamente maiores no grupo tratamento agudo que no grupo controle agudo, sugerindo uma melhora do sistema de defesa pulmonar. Os níveis de POL foram significativamente maiores no grupo tratamento crônico que no grupo controle crônico, indicando dano oxidativo no tecido pulmonar. Conclusões: Nossos resultados sugerem que o uso agudo de corticoides foi benéfico aos tecidos pulmonares, enquanto seu uso crônico não o foi. O uso crônico de metilprednisolona parece aumentar os níveis pulmonares da POL. .