Prevalence of burnout by social demographic factors and salivary biomarkers through Fourier transform infrared spectroscopy in military police officers of the São Paulo health care team who worked during Covid-19 / Análise de biomarcadores salivares, através da espectroscopia de infravermelho por transformada de Fourier, como ferramenta de diagnóstico de burnout em policiais militares do quadro de saúde de São Paulo que atuaram na pandemia do Covid-19, segundo indicadores sociodemográficos

ABSTRACT Objective: Study the prevalence of burnout and the salivary biomarkers in military police officers in the São Paulo health-care team who worked during the Covid-19 pandemic in Brazil. Method: An observational cross-sectional study was conducted in a sample of 104 participants distinguished by age, skin color, gender, military rank, function performed, length of service, use of medications, smoking, alcohol consumption, and income. The analysis of the social demographic data collected used an adapted Maslach Burnout Inventory and saliva examination through Fourier transform infrared spectroscopy. The statistical tests of chi-square, PLS-DA, and hypothesis were fixed at the 95% confidence. Results: The social demographic indicators presented statistical association with burnout, with chi-square 62.72 (p<0.05). The prevalence of burnout (80.77%) and risk of development (19.23%) were observed. The presence of biomarkers in saliva (amide, genetic fragments and polysaccharides) in those experiencing burnout aligned with current literature. Conclusion: Of the total sample, 80.77% had burnout and 19.23% risk of developing the disease. Young white women, in the role of health assistants, with median income between 3 and 6 times the minimum wage and with less than 10 years of service`s length had the highest prevalence of burnout in relation to their peers. There was an association of social demographic indicators with measured stress levels. Salivary biomarkers were also associated with stress in the initial phase of burnout. There is a pressing need for further studies, aiming to support greater knowledge for this population researched.

RESUMO Objetivo: Mensurar a prevalência de burnout e de biomarcadores salivares em policiais militares do quadro de saúde de São Paulo que atuaram frente à pandemia do Covid-19. Métodos: Realizado estudo observacional com corte transversal em amostra de 104 participantes estratificado por idade, cor da pele, gênero, patente militar, função desempenhada, tempo de serviço, uso de medicamentos, tabagismo, etilismo e renda econômica. A apuração dos dados sociodemográficos coletados utilizou o inventário de burnout de Maslach- adaptado e exame da saliva, através da espectroscopia de infravermelho por transformada de Fourier. Os testes estatísticos de qui-quadrado, de PLS-DA e de hipótese foram fixados em IC=95%. Resultados: Quando em análise conjunta, os indicadores sociodemográficos apresentaram associação estatística com burnout, pelo p-valor de 62,72. Do total da amostra 80,77% apresentaram burnout e 19,23% apresentaram risco de desenvolvimento. Os testes salivares indicaram a presença de biomarcadores (amida, fragmentos genéticos e polissacarídeos) que reforçam os parâmetros validados de diagnóstico precoce para burnout. Conclusões: Do total da amostra estudada, 80,77% apresentaram burnout e 19,23% risco de desenvolvimento da doença. Mulheres brancas, entre 30 a 40 anos, auxiliares de saúde, com mediana entre 03 e 06 salários mínimos e com menos de 10 anos de serviço apresentaram as prevalências mais altas do burnout quando comparados aos seus pares durante o enfrentamento do Covid-19. Houve associação dos indicadores sociodemográficos em sua totalidade em relação aos níveis mensurados de estresse. Biomarcadores salivares apresentaram associação com estresse na fase inicial.

Prevalence of periodontitis in young adults living with HIV/Aids using antiretroviral therapy / Prevalência da periodontite em adultos jovens vivendo com HIV/Aids em uso de terapia antirretroviral

ABSTRACT The therapeutic management, as well as the HIV virus itself, has been associated with alterations at the bone level, which may also have a relationship with the maxillomandibular alveolar processes and potential development of periodontal diseases, especially periodontitis. Objective: The objective of this study was to evaluate the periodontal health condition of young adults living with HIV/AIDS, through the measurement of the Periodontal Clinical Insertion Level (CAL) and to raise general data on the health conditions facing HIV and on the quality of life of this audience. Methods: Data were collected at a Reference Center for STI/AIDS in São Paulo - SP, Brazil. The method used was guided by previously validated indicators. In total, 31 individuals aged between 20 and 24 years, both genders and using TAAP were evaluated. For the analyses, the Excel Microsoft® software was used. Results: There was a prevalence of periodontitis in the assessed public of 45.17%. In view of the quality of life, the public was classified as "Regular" and no cases of Necrozing Periodontitis were observed, which is strongly associated with HIV infection. Conclusions: The evaluated public showed a high prevalence of periodontitis, which reinforces the importance of Dentistry in monitoring People Living with HIV/AIDS, in order to prevent the worsening of periodontal diseases.

RESUMO O manejo terapêutico, bem como o próprio vírus do HIV tem sido associados à quadros de alterações em nível ósseo, podendo ter uma relação também com os processos alveolares maxilo-mandibulares e potencial desenvolvimento de quadros de doenças periodontais, em especial a periodontite. Objetivo: O objetivo do trabalho foi avaliar a condição da saúde periodontal de indivíduos adultos jovens vivendo com HIV/AIDS, por meio da aferição do Nível de Inserção Clínica Periodontal e levantar dados gerais sobre as condições de saúde frente ao HIV e sobre a qualidade de vida desse público. Os dados foram coletados em um Centro de Referência em IST/AIDS de São Paulo - SP, Brasil. Métodos: O método empregado teve como guia norteadora indicadores previamente validados. No total, foram avaliados 31 indivíduos com idades entre 20 e 24 anos, ambos os gêneros e em uso da terapia antirretroviral. Para as análises foi utilizado o software Excel Microsoft®. Resultados: Foi observado uma prevalência de periodontite no público avaliado de 45,17%. Frente a qualidade de vida o público foi classificado como "Regular" e não foi observado quadros de Periodontite Necrozante, que está fortemente associado a infecção pelo HIV. Conclusão: O público avaliado apresentou alta prevalência de periodontite, o que reforça a importância da Odontologia no acompanhamento das Pessoas Vivendo com HIV/Aids, no sentido de prevenir o agravamento dos quadros de doenças periodontais.

Bacterial infiltration and detorque at the implant abutment morse taper interface after masticatory simulation.

This study evaluated the bacterial infiltration and the detorque of indexed and non-indexed abutments of Morse taper implants (MTI) after mechanical cycling (MC). 40 MTI were distributed into four groups: IIA (indexed implant abutments); NIIA (non-indexed implant abutments); IIAMC (indexed implant abutments submitted to MC); NIIAMC (non-indexed implant abutments submitted to MC), which were carried out under one million 5 Hz frequency and 3 Bar pressure. After mechanical cycling, all groups were immersed in a bacterial solution in Brain Heart Infusion Agar. After detorque, the bacteria infiltration was evaluated by counting the colony-forming units. For the bacterial infiltration, analysis was applied to the Kruskal-Wallis test (p = 0.0176) followed by Dunn's test. For the detorque analysis, the two-way repeated-measures ANOVA was applied, followed by the Tukey's test (p < 0.0001). Bacteria infiltration was highly observed in NIIA (p = 0.0027) and were absent in IIAMC and NIIAMC. The detorque values for IIA (19.96Ncm ± 0.19Ncm), NIIA (19.90Ncm ± 0.83Ncm), and NIIAMC (19.51Ncm ± 0,69Ncm) were similar and remained close to the initial value, while IIAMC (55.2Ncm ± 2.36Ncm) showed an extremely significant torque value increase (p < 0.0001). The mechanical cycling resulted in mechanical sealing of the implant-abutment interface, preventing bacterial infiltration in the indexed and non-indexed specimens, and increasing the detorque strength in the group of indexed abutments.

Importancia del dentista y del equipo auxiliar de salud bucal en el proceso de diagnóstico de sífilis / Importance of the dentist and the auxiliary oral health team in the diagnosis of syphilis

ABSTRACT Introduction: Syphilis is classified as a sexually transmitted infectious-contagious disease with the causative agent Treponema pallidum (Tp). It presents distinct stages of evolution: The primary phase is characterized by the appearance of the hard chancre, the secondary phase by the spread of Tp through the bloodstream and systemic involvement, and the tertiary phase by organ infection and nervous system impairment. In congenital syphilis, the Tp is transmitted vertically from mother to child. Objective: Report a case in which the dental team participated in the diagnosis of syphilis. Case presentation: A male 26-year-old patient with leukoderma, HIV-positive and under regular antiretroviral treatment, with no other chronic systemic changes and no previous history of Tp infection, was referred for evaluation by the oral health team. The patient reported having had bisexual relations in recent months with a condom and orogenital contact without a condom. He had not noticed any type of "wound" on the body. Intraoral examination found multiple reddish macules scattered on the lingual dorsum, with a slight detachment and little pain. The quick test was a reagent for syphilis. The patient was referred for evaluation at the medical clinic. Treatment started by two applications of benzyl penicillin with a 7 days' separation between them. Complementary blood tests were also indicated, with special attention to VDRL, which eventually confirmed the Tp infection. Conclusions: Participation of the oral health team in the diagnosis of syphilis constitutes a complementary force for the improvement of health care processes(AU)

RESUMEN Introducción: La sífilis se clasifica como una enfermedad contagiosa infecciosa de transmisión sexual, con el agente causal Treponema pallidum (Tp). Presenta distintos estadios de evolución: la fase primaria caracterizada por la aparición del chancre duro; la fase secundaria, la diseminación de la Tp a través del torrente sanguíneo y la afectación sistémica; y la fase terciaria, en que hay infección de órganos y deterioro del sistema nervioso, además de sífilis congénita, forma esta en la que Tp es transmitida verticalmente por la mujer embarazada. Objetivo: Informar sobre un caso en el que la participación del equipo dental colaboró ​​en el proceso de diagnóstico de la sífilis. Presentación del caso: Paciente con 26 años de edad, leucodermia, VIH positivo y en tratamiento antirretroviral regular, sin otros cambios crónicos a nivel sistémico y sin antecedentes de infección por Tp. Se remitió para evaluación con el equipo de salud oral. Informó haber tenido relaciones bisexuales en los últimos meses con un condón y contacto orogenital sin condón. No notó ningún tipo de "herida" en el cuerpo. En el examen intrabucal, se encontraron múltiples máculas rojizas dispersas en el dorso lingual, con un ligero desprendimiento y con poco dolor. La prueba rápida fue un reactivo para sífilis. El paciente fue remitido para su evaluación a clínica médica. Comenzó el tratamiento con dos aplicaciones de penicilina bencilo, con un intervalo de 7 días y se solicitó análisis de sangre complementarios, con especial atención al VDRL, que posteriormente confirmó la infección por Tp. Conclusiones: La participación del equipo de salud bucal frente al diagnóstico de la sífilis, se constituye como una fuerza complementaria para la mejora de los procesos en salud(AU)

Condiciones periodontales asociadas con hiposalivacíon en pacientes con síndrome de Down / Condições periodontais associadas com hipossalivação em pacientes com síndrome de Down / Periodontal conditions associated with hiposalivation in patients with Down syndrome

El curso de enfermedades periodontales en el Síndrome de Down (SD) es más temprano y agresivo y está mediado por numerosos factores, como los hábitos de higiene bucal, el perfil inflamatorio y las alteraciones salivales. Objetivo: Evaluar cómo la hiposalivación y otros parámetros salivales pueden influir en las enferme-dades periodontales en los pacientes con síndrome de Down en diferentes edades. Materiales y métodos: Una muestra compuesta por 124 pacientes (Grupo A - 62 síndrome de Down; Grupo B - 62 pacientes no sindrómi-cos) de 6 a 52 años fue excedida para evaluar los parámetros salivales (flujo salival, pH y capacidad tampón) y enfermedades periodontales (índice de placa, sonda de sangrado, profundidad de sondeo y otros). Además, se recopiló información sobre salud general y hábitos de higiene oral. Resultados: El grupo A presentó un alto índice de placa, baja capacidad tampon y bajo flujo salival. Se encontró una alta prevalencia de enfermedades periodontales en pacientes con SD y una correlación entre el flujo salival bajo y la gravedad de la enferme-dad periodontal (correlación = -0,27, p = 0,002). Estos datos revelan el impacto sobre el indicador salival y la enfermedad periodontal. Conclusión: Los pacientes con SD e hiposalivación presentan un mayor riesgo de desarrollar enfermedad periodontal.

The periodontal diseases course in Down syndrome (DS) are earlier and aggressive and are mediated by nume-rous factors, such as oral hygiene habits, inflammatory profile and salivary alterations. Objective: To evaluate how the hyposalivation and other salivary parameters can influence a periodontal disease on patients with Down syndrome in different ages. Material and methods: A sample composed by 124 patients (Group A ­ 62 Down syndromes; Group B ­ 62 Non-syndromic patient) from 6 to 52 years old was excessed to evaluate the salivary parameters (salivary flow, pH and buffer capability) and periodontal diseases (plaque index, bleeding probing, probing depth and others). Also, was collected information about general health and oral hygiene habits. Re-sults: The Group A exhibited high rate of plaque, low buffer capacity and low salivary flow. It was found a high prevalence of periodontal diseases in DS patients and a correlation among the low salivary flow and the seve-rity of the periodontal disease (correlation = -0,27, p = 0,002). These data reveal the impact upon the salivary indicator and the periodontal disease. Conclusion: Patients with DS and hyposalivation present a greater risk to developing periodontal disease.

O curso de doenças periodontais na Síndrome de Down (SD) é precoce e agressivo e mediado por inúmeros fatores, como hábitos de higiene bucal, perfil inflamatório e alterações salivares. Objetivo: Avaliar como a hipossalivação e outros parâmetros salivares podem influenciar as doenças periodontais em pacientes com síndrome de Down em diferentes idades. Métodos: Amostra composta por 124 pacientes (Grupo A - 62 com Síndrome de Down; Grupo B - 62 não sindrômicos) com 6 a 52 anos de idade foi excedida para avaliar os parâ-metros salivares (fluxo salivar, pH e capacidade tampão) e doenças periodontais (índice de placa, sangramento sondagem, profundidade de sondagem e outros). Além disso, foram coletadas informações sobre saúde geral e hábitos de higiene bucal. Resultados: O grupo A apresentou alto índice de placa, baixa capacidade tampão e baixo fluxo salivar. Foi encontrada uma alta prevalência de doenças periodontais em pacientes com SD e uma correlação entre o baixo fluxo salivar e a gravidade da doença periodontal (correlação = -0,27, p = 0,002). Esses dados revelam o impacto sobre o indicador salivar e a doença periodontal. Conclusão: Pacientes com SD e hipossalivação apresentam maior risco de desenvolver doença periodontal.

Avaliação da deformação superficial do osso gerada por cargas axiais em implantes de diferentes comprimentos / Evaluation of superfi cial bone deformation for axial loads with different implants lengths

Objetivo: avaliar, por meio de extensometria, a transmissão da carga mastigatória axial ao osso de suporte em próteses unitárias implantossuportadas por implantes de diferentes comprimentos. Material e métodos: em um bloco de poliuretano que simula 2 mm de osso cortical e o restante de medular, segundo a norma ASTM­F1839, com 22 mm x 16 mm x 150 mm, foram instalados quatro implantes cone-morse infraósseos 2 mm: G1) 4 mm x 7 mm; G2) 4 mm x 9 mm; G3) 4 mm x 11 mm; G4) 4 mm x 13 mm. Sobre os mesmos, foram instalados pilares do tipo esteticone e cilindros metálicos. Dois extensômetros lineares foram colados na superfície do bloco, tangenciando a plataforma de cada implante (mesial e distal). Em uma máquina de ensaio universal, foi aplicada uma carga de 100 N sobre a superfície oclusal de cada cilindro. Para cada grupo, foram realizados cinco medições e os dados obtidos em microdeformacão (µÆ). Foi verificada a normalidade dos dados pelo teste de Shapiro-Wilk e realizada a análise de variância 1 critério (p < 0,05), e o teste Tukey (p  0,5). Resultados: as médias e os desvios-padrão das amostras foram, respectivamente, G1: 346.16,3 ± 10,28 µÆ; G2: 216.91 ± 15,47 µÆ; G3: 114,41 ± 2,33 µÆ; e G4: 76.83,3 ± 7,13 µÆ. O teste de Shapiro-Wilk constatou a normalidade dos dados, e os testes Anova e Turkey a diferença estatística significante entre todos os grupos. Conclusão: para cargas axiais, implantes com menor comprimento produziram maior deformação no osso superfi cial.

Purpose: the aim of this study was to evaluate, by extensometry, the transmission of the axial masticatory load to supporting bone around implants of different lengths. Material and methods: in a block of polyurethane that simulates 2 mm of cortical bone and the remaing of medullary bone, according to the ASTM-F1839 standard, with 22 mm x 16 mm x 150 mm, were installed 4 morse tappered dental implants, 2 mm subcrestal: G1) 4 mm x 7 mm; G2) 4 mm x 9 mm; G3) 4 mm x 11 mm; G4) 4 mm x 13 mm. Estheticone-like abutments and metallic cylinders were placed. Two linear strain gauges were bonded on block surface, tangential to the platform of each implant (mesial and distal). A 100 N load on the occlusal surface of each cylinder was applied to a universal test machine. For each group, five measurements and the data obtained in microdeformation (µÆ) were performed. The normality of the data was verified by the Shapiro-Wilk test and (p < 0.05) and Tukey's test (p  0.5). Results: the means and standard deviation of the samples were respectively G1: 346.16.3 ± 10.28 µÆ; G2: 216.91 ± 15.47 µÆ; G3: 114.41 ± 2.33 µÆ; G4: 76.83.3 ± 7.13 µÆ. The Shapiro-Wilk test exhibit the normality of the data, and the Anova and Turkey tests exhibit statistically significant difference between all groups. Conclusion: axial load produced more tension for short implants on the superficial bone.

Dental treatment of a patient with Opitz G/BBB syndrome.

Opitz G/BBB syndrome is a genetic condition characterized by several abnormalities along the midline of the body, such as hypertelorism, craniofacial deformities, and dysphagia. This study reports the clinical features of Optiz syndrome and its importance in the knowledge of patients who are developmentally challenged as a whole, in order to establish adequate dental treatment for a certain clinical case. A 19-year-old patient visited the Paulista University for a dental treatment. The extraoral examination revealed ocular hypertelorism (wide-spaced eyes), oblique eyelids, epicanthus, low-set cart, and intellectual disability. During the intraoral examination, large caries lesions were observed surrounding the braces of the fixed orthodontic appliance and poor oral hygiene. Preventive and restorative treatments were carried out. It was concluded that the knowledge of patients with special needs as a whole is mandatory for an adequate dental treatment. This is a case report that highlights the importance of dentist and interdisciplinary care attendance for all patient systems, the examination and analyses should not be restricted to the oral cavity.

Evaluation of the Root Canal Morphology of Molars by Using Cone-beam Computed Tomography in a Brazilian Population: Part I.

INTRODUCTION: One of the factors influencing the success of endodontic treatment is anatomic knowledge of the root canal system. Because of the difficulties of using conventional radiographic methods to evaluate root canals, cone-beam computed tomography (CBCT) has been very useful for evaluating the morphology of root canals. The purpose of this study was to use CBCT to evaluate differences in the anatomy of the mandibular first molars with respect to the patient's sex and the location of the tooth in a Brazilian population. METHODS: The study included CBCT images from 198 patients (106 women and 92 men), representing a total of 342 teeth. RESULTS: Of the 342 mandibular first molars included in the study, 0.3% had 2 canals, 75.1% had 3 canals, 23.7% had 4 canals, and 0.9% had 5 canals. The ages of the patients ranged from 19 to 81 years old, with an average age of 48.9 years. Women were more likely to have 2 canals on the distal root of the right side than men were (P < .05). CONCLUSIONS: Because the Brazilian population has differences in root canal morphology compared with other populations around the world, further studies are needed to aid endodontic diagnosis and treatment.

Trèlat's beads as oral manifestations in patients with HIV/TB / Manifestaciónes orales en pacientes con VIH/TB evidenciado a través de los Granos de Trélat

Tuberculosis (TB) is a contagious infectious disease caused by Mycobacterium tuberculosis (Koch's bacillus). Co-infection with human immunodeficiency virus (HIV) and TB has reached a significant importance as a public health problem and this association has been recognized as the most significant event that changed "the balance between man and Koch's bacillus" in the last century, and has a large contribution to the risk for disease spreading. Tuberculosis has two main standard categories of clinical manifestations: primary and secondary. Primary TB is responsible for the initial infection with lungs being the involved organ. Oral lesions are observed as a secondary TB clinical manifestation with most frequent sites being hard and soft palate, tongue, lips, gums, tonsils, and salivary glands. A case of classical TB lesions in the oral cavity is reported, and the importance of a correct diagnosis through careful history taking is emphasized. Treatment selection needs to be done assertively, with great determination and building a link between patient and treatment protocol, in order to promote patient's adherence (AU9

La tuberculosis (TB) es una enfermedad infecciosa contagiosa causada por Mycobacterium tuberculosis (bacilo de Koch). La coinfección del Virus de Inmunodeficiencia Humana (VIH) con TB son problemas de salud pública graves, además que esta asociación ha sido identificado como el evento más significativo que cambió "el equilibrio entre el hombre y el bacilo de Koch" en el último siglo y es crucial en el riesgo de propagación de la enfermedad. La tuberculosis se manifiesta en dos estándares: primaria y secundaria; el primario es responsable de la infección inicial y el órgano de elección es el pulmón. Las lesiones orales se observan a nivel secundario y los sitios más frecuentes son el paladar duro y blando, lengua, labios, encías, amígdalas y las glándulas salivales. Esta revisión presenta un caso con lesiones clásicas de tuberculosis en la cavidad bucal haciendo hincapié en la importancia de un correcto diagnóstico a través de la anamnesis. El tratamiento se debe hacer con la seguridad, la determinación y la formación de enlaces que facilitan la adherencia del paciente al tratamiento (AU)

Indicadores salivares e o risco de cárie na Síndrome de Down utilizando o software Cariogram® / Salivary indicators and the caries risk in Down Syndrome using Cariogram software

O objetivo deste estudo foi analisar o risco de cárie em indivíduos com Síndrome de Down (SD) utilizando o Software Cariogram®, associando aos indicadores salivares. Participaram do estudo 124 pacientes, entre 6-52 anos, 62 indivíduos SD e 62 indivíduos controles sem a síndrome. Foram recolhidos dados sobre dieta, uso de flúor, pH salivar, capacidade tampão e contagem de Streptococcus mutans. Os resultados mostraram que os indivíduos SD apresentaram maior índice de placa, capacidade tampão e fluxo salivar reduzidos. A hipossalivação mostrou uma associação moderada com índice CPOD e índice de placa. Na análise Cariogram® verificou-se alto risco de cárie nestes pacientes, e dada a importância e facilidade deste método de diagnóstico, sugerimos que seu uso seja ampliado como uma ferramenta importante para facilitar o controle da cárie em indivíduos SD.

The aim of this study was to analyze the caries risk in Down Syndrome individuals (SD) using the Cariogram® software and salivary parameters. We considered a sample of 124 patients aged 6-52 years, 62 with SD and 62 without the syndrome (controls). Data were also collected on diet, use of fluoride, saliva pH, buffer capacity and Streptococcus mutans count. The results were that the SD patients had a higher plaque index, lower buffering capacity and reduced salivary flow. A higher prevalence of hyposalivation, showing a moderate association with DMFT and plaque index. In the Cariogram® analysis we found a high risk of caries in these patients, and given the importance and ease of this method of diagnosis, we suggest that its use be established as an important tool in facilitating the control of caries in Down syndrome individuals.

Assessment of maxillary bone density by the tomodensitometric scale in Cone-Beam Computed Tomography (CBCT) / Avaliação da densidade óssea dos maxilares por meio de escala tomodensitométrica em Tomografia Computadorizada de Feixe Cônico (TCFC)

Objective ­ To analyze bone density in images of the anterior and posterior regions of the mandible and maxilla obtained with ConeBeam Computed Tomography. Planning of surgeries for implant placement requires information about bone density, which is directly related to stability. Methods ­ This retrospective study included female (25) and male (25) patients (50) with ages in the range 30-40/45 years. Images of their exams (200 transaxial slices; 2-mm thick) were analyzed in the anterior (50) and posterior (50) regions of the mandible and anterior (50) and posterior (50) regions of the maxilla using the bone density tool of the Xoran (i-CAT®) software. Our data were compared and correlated with computed tomography data obtained in the literature. Results ­ Mean gray values were utilized to determine the density values for the anterior mandible (562.2, 3.3) and maxilla (531.3, 2.8) and the posterior mandible (503.8, 3.0) and maxilla (394.5, 2.9). The results were statistically analyzed for correlation between our findings and those of the literature. The t test was utilized to obtain additional information related to gender; and the Pearson correlation analysis was utilized to assess the differences between observers 1 and 2. Conclusions ­ Statistically significant differences (p>0.05) between densities in the anterior and posterior regions were not found, and our values were consistent with those in the literature obtained with Computed Tomography.

Objetivo ­ Analisar a densidade óssea nas regiões anterior e posterior dos maxilares em imagens obtidas por meio de Tomografia Computadorizada de Feixe Cônico. O planejamento de cirurgias requer informações sobre a densidade óssea da região escolhida para instalação de implantes. Métodos ­ Este estudo retrospectivo incluiu 50 pacientes, sendo 25 do gênero feminino e 25 masculino com idades na faixa 30-40/45 anos. As imagens de seus exames (200 cortes transaxiais com espessura de 2 mm) foram analisadas nas regiões anterior (50) e posterior (50) da mandíbula e anterior (50) e posterior (50) da maxila usando a ferramenta de densidade óssea do software Xoran (tomógrafo i-CAT®). Os nossos dados foram comparados e correlacionados com aqueles de tomografia computadorizada obtidos na literatura. Resultados ­ Valores médios de cinza foram usados para determinar os valores de densidade para mandíbula (562,2; 3,3) e maxila (531,3; 2,8) anteriores, e mandíbula (503,8; 3,0) e maxila (394,5; 2,9) posteriores. Os resultados foram submetidos à análise estatística para comparação entre os achados deste estudo e aqueles da literatura. O teste t foi usado para obter informações adicionais relacionadas aos gêneros; e a análise de correlação de Pearson foi usada para avaliar a diferença entre os observadores 1 e 2. Conclusões ­ Diferenças estatisticamente significantes (p< 0,05) entre as densidades nas regiões anterior e posterior não foram encontradas, e os valores que nós obtivemos com Tomografia Computadorizada de Feixe Cônico foram compatíveis com aqueles da literatura com Tomografia Computadorizada.

Efeito do artefato de "beam hardening" na capacidade de identificação das alterações periodontais e peri-implantares / "Beam Hardening" artefact effect in identifying capacity of periodontal and peri-implant changes

O diagnóstico por imagem é um exame complementar importante para o diagnóstico e acompanhamento da doença periodontal e peri-implantar e atualmente a tomografia computadorizada de feixe cônico (TCFC) substitui o uso das tomografias convencionais odontológicas e da tomografia computadorizada médica. No entanto, artefatos ocorrem principalmente, próximos de estruturas de alta densidade como o metal, sendo que essa alteração pode interferir na interpretação das imagens e no diagnóstico. Sendo assim, o presente estudo tem como objetivo realizar uma revisão de literatura relacionada ao efeito do artefato de "beam hardening" na capacidade de identificação das alterações periodontais e peri-implantares. Conclui-se que a TCFC promove uma avaliação tridimensional de doença periodontal e da peri-implantite, mas na presença de artefatos metálicos pode haver uma limitação da qualidade da imagem do nível ósseo ao redor dos dentes e implantes.(AU)

Diagnostic imaging is an important complementary method for the diagnosis and follow up of periodontal disease and peri-implant and nowadays cone-beam computed tomography (CBCT) replaces the use of conventional dental CT scans and medical CT scan. However, artifacts occur mainly near high-density structures such as metal, and this change may interfere interpretation of the images and diagnosis. Therefore, this study aims to conduct a literature review on the effect of "beam hardening" artifact in identifying capacity of periodontal and peri-implant changes. We conclude that CBCT promote three-dimensional evaluation of periodontal disease and peri-implantitis, but presence of metal artifacts could be a limitation of the image quality of bone level around the teeth and implants.(AU)

Estudo da tomografia computadorizadade feixe cônico na avaliação morfológicade raízes e canais dos molares e pré-molares da população brasileira / Study of cone beam computed tomography in the morphological evaluation of roots and canals of molars and premolars in theBrazilian population

O sucesso no tratamento endodôntico pode ser influenciado pela falta de conhecimento anatômico do sistema de canais radiculares. Esse conhecimento da morfologia ainda é mais complicado em dentes posteriores devido a sua complexa variação anatômica. Devido as dificuldades apresentadas nas avaliações do número de raízes e canais por métodos radiográficos convencionais, a Tomografia Computadorizada de Feixe Cônico (TCFC) se mostra de grande importância na avaliação morfológica de canais radiculares, assim como em estudos de acordo com etnias diferentes. O objetivo deste trabalho foi fazer uma revisão de literatura a respeito do uso da TCFC na avaliação de raízes e canais dos molares e pré-molares. A revisão foi realizada descrevendo a importância do uso da TCFC e relatando trabalhos a respeito do conhecimento de morfologia de canais. Conclui-se que a Tomografia Computadorizada de feixe cônico é uma importante ferramenta na avaliação de raízes e canais; e que a população brasileira difere de outras populações do mundo em relação a morfologia de canais radiculares...

Success in endodontic treatment can be influenced by the lack of anatomical knowledge of the root canal system. This knowledge of the morphology is further complicated in posterior teeth because of its complex anatomical variation. Because the difficulties presented in the evaluations of the root canals by conventional radiographic methods, Cone Beam Computed Tomography (CBCT) shown of great importance in the morphology of root canals. The objective was to make a review of literature regarding the use of CBCT in the evaluation of roots and canals of molars and premolars. The review was carried out describing the importance of using CBCT and reporting studies about the knowledge of root canals morphology. We conclude that cone beam computed tomography is an important tool in the evaluation of roots and canals; and that the Brazilian population differs from other world populations compared the morphology of root canals...

Cleidocranial dysplasia: report of six clinical cases.

Cleidocranial dysplasia (CCD) is an autosomal-dominant disorder that occurs due to mutations in the Cbfa 1 gene, also called Runx 2, located on the short arm of chromosome 6, affecting osteoblast skeletal-specific bones that have intramembranous ossification. This condition is characterized by hypoplastic clavicles, short stature, and great clinical significance in the stomatognathic complex, with involvement of facial bones, changes in the eruption patterns, including multiple supernumerary and retained teeth. This study reports six subjects of the same family with CCD identified in the Dentistry Clinic of Oral Diagnosis Department, Universidade Paulista, Campus Sorocaba, Sao Paulo State, Brazil. All cases had clinical and radiographic aspects of this important condition, such as short stature, hypertelorism, severe mobility of the shoulders, and supernumerary and retained teeth. Due to the rare incidence and phenotypic manifestations, CCD can be easily misdiagnosed. The oral commitments are one of the main (functional and aesthetic) causes of complaints in these subjects; and a dentist must establish the diagnosis as early as possible, followed by behaviors and practices that can minimize harmful manifestations of the syndrome and improve health associated with oral and multidisciplinary integration offering improvements in quality of life of these subjects.

Evaluation of bone alterations in the jaws of HIV-infected menopausal women

The advent of highly active antiretroviral therapy (HAART) has caused a reduction in mortality, thus contributing to an increase in the number of women with HIVࢧAIDS who reach the climacteric period, experience decline in ovarian function, and develop complications of viral infection and HAART, which can accelerate bone loss. The aim of this study was to detect possible alterations in the jaws of HIV-infected women by panoramic radiography. The study comprised a total of 120 women above 40 years of age who were divided into the following two groups: women who are HIV positive (Group I) and women with no known HIV infection (Group II). Measurement of the following three radiomorphometric indexes was performed by panoramic radiography: Mental Index (MI), Panoramic Mandibular Index (PMI) and Antegonial Depth (AD). A total of 70% of women in the control group and 50% of women in the HIV group were in the postmenopausal period, and the average values of both MI (p = 0.0054) and AD (p < 0.0001) for this period were lower in the HIV group than in the control group. For patients who were in the premenopausal period, the average AD was lower in the HIV group than in the control group (p = 0.0003). Despite the difference in the average age between groups, greater bone resorption in the mandible was found in the group of HIV-positive women.

Evaluation of bone alterations in the jaws of HIV-infected menopausal women.

The advent of highly active antiretroviral therapy (HAART) has caused a reduction in mortality, thus contributing to an increase in the number of women with HIVࢧAIDS who reach the climacteric period, experience decline in ovarian function, and develop complications of viral infection and HAART, which can accelerate bone loss. The aim of this study was to detect possible alterations in the jaws of HIV-infected women by panoramic radiography. The study comprised a total of 120 women above 40 years of age who were divided into the following two groups: women who are HIV positive (Group I) and women with no known HIV infection (Group II). Measurement of the following three radiomorphometric indexes was performed by panoramic radiography: Mental Index (MI), Panoramic Mandibular Index (PMI) and Antegonial Depth (AD). A total of 70% of women in the control group and 50% of women in the HIV group were in the postmenopausal period, and the average values of both MI (p = 0.0054) and AD (p < 0.0001) for this period were lower in the HIV group than in the control group. For patients who were in the premenopausal period, the average AD was lower in the HIV group than in the control group (p = 0.0003). Despite the difference in the average age between groups, greater bone resorption in the mandible was found in the group of HIV-positive women.

Anti-infective periodontal therapy promoting improvement in systemic markers of HIV infection.

Research supports the theory that the chronic infectious response occurring in periodontal disease may have a role as a risk modifier of systemic diseases. This study assessed the impact of HIV-associated chronic periodontitis treatment on systemic HIV-related markers (CD4 T lymphocytes cell counts and HIV viral load). Fifteen HIV patients presenting chronic periodontitis [at least eight sites presenting a probing depth (PD) >4 mm and bleeding] were included in this study. Patients received full mouth periodontal treatment with an ultrasonic device and supragingival plaque control. Medical (CD4 cell counts and HIV load) as well as periodontal clinical parameters [probing pocket depth (PPD), clinical attachment level (CAL)] were assessed at baseline and 3 and 6 months after treatment. ANOVA/Tukey and Pearson's correlation tests were used for statistical analysis (α=5%). The results showed that PPD reduction and CAL gain were statistically significant at 3 and 6 months after periodontal therapy (p<0.05). At 6 months, CAL gain was 0.6±0.5 mm and PPD reduction was 0.7±0.5 mm. At the same time, a statistically significant increase in CD4 cell counts could be seen after the third month (p<0.05) and sixth month (p<0.05). Moreover, at 6 months, the relationship between the improvement in clinical parameters, i.e., PPD reduction, and the number of TCD4 lymphocytes could be highlighted. This was shown as the greater the PPD reduction, the greater the increase in TCD4 cells (r=0.68, p=0.02). These data suggest that periodontitis treatment could be associated with an improvement in medical conditions in HIV subjects.

Diagnosis of oral manifestations in HIV/AIDS patients who used HAART and developed diabetes mellitus

Aim: To assess the prevalence of oral manifestations in HIV/AIDS patients and a possible correlation of the development of diabetes mellitus due to highly active antiretroviral therapy (HAART) Methods: 56 patients were examined, divided into two groups, Group 1, the HIV group, with 28 patients known to be HIV+, who developed diabetes mellitus due to HAART, and Group 2, the control group, with 28 patients with HIV- diagnosed with diabetes mellitus. Results: In Group 1, normal salivary flow rate and buffering capacity were observed in 18 (64.3%) patients, but the bleeding index high (46.53%) and higher incidence of periodontal disease was found in this group. In Group 2, 11 (39.2%) and 15 (53.5%) patients had low and normal salivary flow rate, respectively. High T-CD4 indices with mean value of 22.46 for each patient, showing xerostomia in 9 (32.1%) patients and dental caries in 11 (39.3%). Conclusions: Regarding the oral and general manifestations, the HIV group showed higher rates of pathologies when compared with the control group. The HIV group and the control group were diagnosed with diabetes, but this condition in the HIV group presented earlier than in the control group, suggesting a possible association with HAART.

Laser Therapy of Recurrent Aphthous Ulcer in Patient with HIV Infection.

The recurrent aphthous ulcer (RAU) is a pathological change found in the oral mucosa, characterized by painful single or multiple ulcers. The etiologic aspect of RAU is not well understood; however it is known that due to lower CD4 cell counts patients had higher prevalence of these oral lesions, and immunosuppressed patients with HIV are predisposed. Patient FC is African descent, 26 years old, male, HIV + CD4 67 cells/mm(3), with minor RAU in the upper and lower right side lip, measuring about 4 mm, and major RAU in tongue and the tonsillar pillar measuring 2 cm. The patient was treated with laser therapy with the objective to help reverse the damage and decrease the symptoms. After one week there was remission of the lesions. The laser showed to be an important alternative therapy that promoted analgesic, healing effects and improving the quality of life of patients.

Conventional systemic treatments associated with therapeutic sites of local lesions of secondary syphilis in the oral cavity in patients with AIDS.

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions.