Effectiveness and Legitimacy of the Motivational Interviewing With Caregivers on the Oral Health of Special Patients

ABSTRACT: Difficulty of caregivers in performing oral hygiene for Patients with Special Needs, usually leads to demotivation and negligence. In order to adhere to healthy habits, an intervention model was created: Motivational Interview (MI). It consists of a collaborative conversation to strengthen motivation and commitment to change. Objective: To evaluate the effectiveness and legitimacy of MI in a single session on the oral health of children with special needs, unable to perform the ir hygiene. Methods: Exploratory study with paired randomization, double-blind, including caregivers of patients aged 2 to 19 years treated at the Physical and Motor Rehabilitation Center of IMIP/Recife-Brazil. Caregivers were allocated to a test (Motiv ational Interview) or control (Traditional Counseling) group. In t0, they answered questionnaires, and the child's dental chart and Vis ible Plaque Index (VPI) were filled. MI group participated in a 10 min Motivational Interview involving guidance on brushing techniq ues and making mouth openers. TC group attended a lecture addressing the same theme. In t1, questionnaires were reapplied, followed by a new VPI and dental chart, in addition to a satisfaction survey regarding the methodology used. Results: After 30 days, the MI group showed a decrease in VPI when comparing the medians (14.70 vs. 10.71) and an increase in the frequency of daily brushing to 03 x or more (44.4 % vs. 77.8 %), while the TC group remained practically stable (8.75 vs. 10.71 and 28.6), but with no statistically significant difference between groups (p = 5 %). Both legitimized the workshop as a pleasurable activity (100 %) and felt motivated after completion (TC = 85.7 %, MI = 100 %). Conclusion: A single session of MI reduced VPI from disabled children, however, without proving to be more effective than Traditional Counseling.

RESUMEN: La dificultad de los cuidadores para realizar la higiene oral en pacientes con necesidades especiales, generalmente conduce a la desmotivación y negligencia. Con el objetivo de adherirse a los hábitos saludables, se creó un modelo de intervención a partir de una conversación colaborativa: Entrevista Motivacional (EM). El objetivo de este trabajo fue evaluar la eficacia y la legitimidad de la EM en la salud oral para los PNE infantiles. Estudio exploratorio con aleatorización pareada, doble ciego, que incluye cuidadores de pacientes de 2 a 19 años tratados en el Centro de Rehabilitación Física y Motora del IMIP/Recife- Brasil. Los cuidadores fueron asignados en dos grupos: prueba (Entrevista Motivacional - EM) y control (Consejería Tradicional - CT). En t0, se respondieron los cuestionarios y se realizó el Odontograma y el Índice de Placa Visible (IPV) del niño. Grupo EM participó en una entrevista motivacional de 10 minutos que incluyó orientación sobre las técnicas de cepillado y la apertura de la cavidad oral. Grupo CT asistió a una conferencia sobre el mismo tema. En t1, se volvieron a aplicar los cuestionarios, seguidos de una nueva IPV y un odontograma, además de una encuesta de satisfacción sobre la metodología utilizada. Después de 30 días, el grupo EM mostró una disminución en IPV al comparar las media- nas (14,70 vs. 10,71) y un aumento en la frecuencia diaria de cepillado a 03x o más (44,4 % vs. 77,8 %), mientras que el grupo CT permaneció prácticamente estable (8,75 vs. 8,92 y 28,6), pero sin diferencias estadísticamente significativas entre los grupos (p = 5 %). Ambos legitimaron el taller como una actividad placentera (100 %) y se sintieron motivados después de la finalización (AT = 85,7 %, EM = 100 %). Una sola sesión de EM redujo la IPV de las PNE, sin demostrar que es más efectiva que la asesoría tradicional.

Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding / Avaliação do frênulo lingual em recém-nascidos com dois protocolos e sua relação com o aleitamento materno

Abstract Objective: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. Methods: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). Results: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410 mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p = 0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p = 0.028). Conclusion: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.

Resumo Objetivo: Caracterizar o frênulo lingual de recém-nascidos a termo, utilizando dois protocolos diferentes e verificar a relação do frênulo lingual com o aleitamento materno. Método: A amostra não probabilística foi constituída por 449 binômios mãe/bebê. Para a avaliação anatomofuncional do frênulo, utilizou-se o protocolo de avaliação do frênulo lingual para bebês "Teste da Linguinha" e o Bristol Tongue Assessment Tool. A mamada foi avaliada com o protocolo proposto pelo UNICEF. Foram criados escores (bom, regular, ruim) para avaliar cada aspecto da mamada a ser observada. Os resultados foram analisados através de estatísticas descritivas e inferenciais e testes de associação (Qui-quadrado de Pearson e Exato de Fisher). Resultados: O estudo mostrou que 14 bebês apresentaram alteração de frênulo lingual, nos quais três com dificuldade durante a sucção, necessitando de frenotomia na primeira semana de vida e 11 sem dificuldades durante a amamentação. Quanto à avaliação da mamada, 410 binômios mãe/bebê apresentaram o escore bom, 36 regular e 3 ruim. Houve associação estatisticamente significativa entre o protocolo "Teste da Linguinha" e amamentação (p = 0,028) e entre o protocolo Bristol Tongue Assessment Tool e amamentação (p = 0,028). Conclusão: Alterações no frênulo lingual estão associadas a interferências na qualidade da amamentação, sendo importante a avaliação do frênulo lingual em recém-nascidos.

Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding.

OBJECTIVE: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. METHODS: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). RESULTS: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p=0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p=0.028). CONCLUSION: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents.

AIMS: To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted with 1342 adolescents aged 10-17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS. RESULTS: The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD. CONCLUSIONS: The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD. CLINICAL RELEVANCE: The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly.

Remineralizing Potential of Nano-Silver-Fluoride for Tooth Enamel: An Optical Coherence Tomography Analysis

Objective: To evaluate the use of nanosilver fluoride in the enamel remineralization process through optical coherence tomography. Material and Methods: All samples were submitted to demineralization process by pH cycling during 14 days and randomly distributed into three groups (n = 11): Nanosilver Fluoride (NSF), Sodium fluoride (NaF), and negative control. Optical coherence tomography images were acquired at three different moments: initial stage (T0), post caries formation (T1), and post pH cycling (T2). The integrity of the enamel surface and the measurement of the volume loss for the tissue after pH cycling in comparison to initial images were obtained from optical coherence tomography images. Results: After analyzing the exponential decay of A-scans from each group, it was possible to identify differences in light propagation among samples. In T1 it is not possible to visualize the dentin-enamel junction, probably due to the higher back scattering of the demineralized enamel, which does not allow light to reach the dentin. The decay curves obtained from NaF and nanosilver fluoride groups showed similar behavior, while the negative group showed lower extinction coefficient. Conclusion: Nanosilver fluoride showed the best effect against caries compared to conventional fluoride treatments.

Effects of a New Nano-Silver Fluoride-Containing Dentifrice on Demineralization of Enamel and Streptococcus mutans Adhesion and Acidogenicity.

An experimental dentifrice containing nano-silver fluoride (NSF) and a sodium fluoride (NaF) toothpaste were tested in vitro, against S. mutans, to evaluate the minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), antiadherence, antiacid, enamel microhardness, and OCT. The microdilution technique was used to determine the MIC and MBC. Fragments of deciduous enamel were treated with dentifrice slurries, containing bacterial suspension and PBS-treated saliva. The quantification of the microorganisms that adhered to the enamel was determined after 24 hours of incubation, and media pH readings were performed after 2 hours and 24 hours. Deciduous teeth were evaluated for microhardness and OCT during 14 days of pH cycling. Data were statistically analyzed using Student's t-test, Mann-Whitney U test, ANOVA, and Tukey tests at 5% of significance. Dentifrices containing NSF presented a lower MIC and higher statistically significant results compared to NaF dentifrices with respect to preventing bacterial adhesion and pH decreases. NSF and NaF dentifrices showed the same ability to avoid enamel demineralization corroborated by the OCT images. The NSF formulation had a better antibacterial effect compared to NaF dentifrices and similar action on the demineralization of enamel indicating their potential effectiveness to prevent caries.

Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study.

Background The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria is used to identify instances of potentially inappropriate prescribing in a patient's medication regimen. Objective To determine the prevalence and predictors of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients at hospital discharge. Setting A university hospital medical clinic in Brazil. Method Discharge prescriptions were examined using the STOPP/START criteria. Subjects were inpatients aged ≥60 years receiving at least one medication prior to hospitalization and with a history of cardiovascular disease. The prevalence of PIMs and PPOs was determined and a multivariable binary regression analysis was performed to identify independent predictors associated with PIMs or PPOs. Main outcome measure Prevalence of PIMs and PPOs. Results Of the 230 subjects, 13.9% were prescribed at least one PIM. The most frequently prescribed PIMs were glibenclamide or chlorpropamide prescribed for type 2 diabetes mellitus (31.0%), and aspirin at doses >150 mg/day (14.3%). Ninety patients had at least one PPO (39.1%). The most prevalent PPOs were statins (29.8%) and antiplatelet therapy (13.7%) for diabetes mellitus when coexisting major cardiovascular risk factors were present. No predictors for PIMs were found. In contrast, diabetes was a risk factor while dyslipidaemia was a protective factor for PPOs. Conclusion PIMs and PPOs commonly occur with elderly people at hospital discharge. Diabetes and dyslipidaemia were significantly associated with PPOs. Our findings show the need for interventions to reduce potentially inappropriate prescribing, such as a pharmacist medication review process at hospital discharge.

Thrips collected in watermelon crops in the semiarid of Rio Grande do Norte, Brazil / Tripes coletados na cultura da melancia no semiárido do Rio Grande do Norte, Brasil

The aim of this research was to report the occurrence of two species of thrips in watermelon crops in the semiarid region of Rio Grande do Norte, Brazil. From August to September 2011, we performed weekly sampling of thrips in a commercial watermelon production area with 10,000m2, using 20 Moericke traps. We captured a total of 431 thrips, belonging to Frankliniella schultzei (Trybom) (Thripidae) and Haplothrips gowdeyi (Franklin) (Phlaeothripidae). This is the first report of H. gowdeyi in watermelon crops in Brazil.

O objetivo deste trabalho foi relatar a ocorrência de duas espécies de tripes na cultura da melancia na região do semiárido do Rio Grande do Norte, Brasil. Durante os meses de agosto e setembro de 2011 foram realizadas coletas de tripes semanalmente, em uma área de produção comercial de melancia de 10.000m2, utilizando-se 20 armadilhas Moericke. Foram capturados um total de 431 tripes, pertencente às espécies Frankliniella schultzei (Trybom) (Thripidae) e Haplothrips gowdeyi (Franklin) (Phlaeothripidae). Este é o primeiro relato de ocorrência destas espécies no semiárido do Rio Grande do Norte e o primeiro registro de H. gowdeyi na cultura da melancia no Brasil.

OBSERVAÇÃO DOS CRITÉRIOS PARA INDICAÇÃO DE TRATAMENTO ENDODÔNTICO EM DENTES DECÍDUOS NA PRÁTICA CLÍNICA / Note the indication criteria for endodontic treatment in primary teeth in clinical practice

Objetivo: Avaliar se os critérios radiográficos clássicos de indicação de terapia pulpar em dentes decíduos vêm sendo observados no cotidiano das atividades clínicas. Método: Foram avaliados 359 prontuários de pacientes atendidos na clínica de odontopediatria da Faculdade de Odontologia de Pernambuco (FOP/UPE), no período de janeiro de 2011 a junho de 2013. Dentre os 359 prontuários avaliados, 64 registraram tratamento pulpar em 78 dentes decíduos, os quais compõem a amostra final deste estudo. Mediante as radiografias intraorais, contidas nos prontuários, foram observados o grau de destruição coronária, o estágio de desenvolvimento de Nolla da raiz do sucessor permanente e o grau de rizólise do dente decíduo. Resultados: observou-se que a idade média das crianças incluídas no estudo foi de 6,62 anos (± 1,98). Em 11,5% dos casos, o critério que previa condições para que o dente decíduo pudesse ser restaurado não foi seguido, e em 32% dos casos não foram levados em consideração o grau de rizólise do dente decíduo ou o estágio de Nolla. Conclusão: Os critérios radiográficos clássicos de indicação para terapia pulpar em dentes decíduos não estão sendo rigorosamente observados na clínica odontopediátrica da instituição de ensino avaliada, indicando o risco de iatrogenias serem reproduzidas pelos futuros profissionais.

Aim: To assess whether the radiographic classic criteria of pulp therapy indication in deciduous teeth have been observed in daily clinical activities. Methods: A total of 359 records of patients attended in pediatric dentistry clinic of the Faculty of Dentistry of Pernambuco (FOP / UPE), from January 2011 to June 2013. Of the 359 records evaluated 64 registered pulp treatments in 78 primary teeth, which make up the final sample. Through intra-oral radiographs, contained in the medical records, the degree of coronary destruction, the Nolla stage of development of the permanent successor root and the degree of tooth root resorption deciduous were observed. Results: It was observed that the average age of the children included in the study was 6.62 years (± 1.98). In 11.5% of cases, the criterion which provided conditions for the deciduous tooth could be restored was not followed, and in 32% of cases were not taken into account the degree of tooth root resorption deciduous or Nolla stage. Conclusion: The classic radiographic criteria indication for pulp therapy in primary teeth, are not being strictly observed in Pediatric Dentistry of assessed educational institution, indicating the risk of iatrogenic be reproduced by future professionals.

Aferência visual influência área e amplitude de oscilação corporal em indivíduos com hemiparesia crônica / Afferent visual influences area and amplitude of body sway in individuals with chronic hemiparesis

O objetivo do estudo foi analisar a influência da informação visual no controle postural de pacientes com hemiparesia crônica. Utilizou-se um estudo observacional do tipo ransversal e analítico para examinar o controle postural em 12 pacientes hemiparéticos crônicos em uma plataforma de força, a qual avalia o controle postural de forma espacial e temporal nas direções ântero-posterior e médio-lateral. Para tanto, foi proposto duas condições visuais, com e sem visão, e duas condições posturais, bipodal e tandem. Cada paciente permaneceu 30 egundos, por três tentativas, sobre a plataforma de força, primeiro com os olhos abertos e depois com os olhos fechados, nas posturas ortostática bipodal e semi-tandem. Para se determinar a influência visual sobre as variáveis do controle postural utilizou-se uma análise multivariada de medidas repetidas e para comparar as direções e as condições fez-se uso de teste post hoc, sendo considerado α ≤ 0,05. Observou-se que as variáveis temporais do controle postural não estão sob influência das aferências visuais. Por outro lado, as variáveis espaciais, amplitude média de oscilação e área de oscilação, demonstraram ser explicadas em parte pelas aferências visuais (p≤0,05), principalmente na direção médio-lateral com a condição sem visão sendo a menos estabilizante. As aferências visuais interferem apenas nos parâmetros de área e amplitude média de oscilação corporal, com maiores oscilações na direção médio-lateral, postura tandem e na condição sem visão.

The aim of the study was to analyze the influence of visual information on postural control in patients with chronic hemiparesis. We used a observational, analytical, cross-sectional study to examine the postural control in 12 patients with chronic hemiparesis on a force platform, which assesses postural control in a spatial and temporal form in the directions anterior-posterior and medial-lateral. Therefore, it was proposed two visual conditions, with and without vision, and two postural conditions, bipedal and semi-tandem. Each patient remained 30 seconds, for 3 attempts, on the force platform, first with eyes open and then with eyes closed, standing bipedal postures and tandem. To determine the visual influence on postural control variables used a multivariate analysis of repeated measures to compare the directions and conditions was made using post hoc test, it was considering α≤0.05. It was observed that the temporal variables of postural control are not under the influence of visual afferents. Moreover, the spatial variables, the mean amplitude of oscillation and the oscillation area, shown in part be explained by afferent visual (p≤0.05), especially in the medial-lateral direction to the viewing condition without being less stabilizer. The afferent visual interfere only in the parameters of area and mean amplitude of body sway, with greater oscillations in the medial-lateral direction, tandem stance and condition no vision.

Effect of stalk and leaf extracts from Euphorbiaceae species on Aedes aegypti (Diptera, Culicidae) larvae.

The objective of this study was to evaluate the larvicidal activity of essential oil aqueous solutions (hydrolates) obtained by steam distillation of stalks and leaves of Croton argyrophylloides, Croton nepetaefolius, Croton sonderianus and Croton zehntneri against Aedes aegypti larvae. Twenty-five larvae of third instar were placed in plastic beckers, containing the hydrolates (50 mL), in a four repetitions scheme. Water was used as control and the number of dead larvae was counted after 24 hours. The data obtained were submitted to Variance Analysis and Tukey test. Significant differences were observed among the hydrolates from different species and from different parts of each plant (p < 0.001). The hydrolates of stalk and leaf from C. nepetaefolius and C. zehntneri and leaf hydrolate of C. argyrophylloides presented 100% mortality against larvae. The compounds present in C. zenhtneri and C. nepetaefolius are oxygenated phenylpropanoids that are more soluble in water than the monoterpenes and sesquiterpenes detected in the oils of C. argyrophylloides and C. sonderianus. This study showed that all species analyzed presented compounds with larvicidal properties, with differences between each plant parts.

Effect of stalk and leaf extracts from Euphorbiaceae species on Aedes aegypti (Diptera, Culicidae) larvae / Efeito dos extratos de caule e folha de espécies de Euphorbiaceae sobre larvas de Aedes aegypti (Diptera, Culicidae)

The objective of this study was to evaluate the larvicidal activity of essential oil aqueous solutions (hydrolates) obtained by steam distillation of stalks and leaves of Croton argyrophylloides, Croton nepetaefolius, Croton sonderianus and Croton zehntneri against Aedes aegypti larvae. Twenty-five larvae of third instar were placed in plastic beckers, containing the hydrolates (50 mL), in a four repetitions scheme. Water was used as control and the number of dead larvae was counted after 24 hours. The data obtained were submitted to Variance Analysis and Tukey test. Significant differences were observed among the hydrolates from different species and from different parts of each plant (p < 0.001). The hydrolates of stalk and leaf from C. nepetaefolius and C. zehntneri and leaf hydrolate of C. argyrophylloides presented 100 percent mortality against larvae. The compounds present in C. zenhtneri and C. nepetaefolius are oxygenated phenylpropanoids that are more soluble in water than the monoterpenes and sesquiterpenes detected in the oils of C. argyrophylloides and C. sonderianus. This study showed that all species analyzed presented compounds with larvicidal properties, with differences between each plant parts.

O objetivo deste trabalho foi avaliar a atividade larvicida dos hidrolatos obtidos por destilação à vapor de caule e folha das espécies de Croton argyrophylloides, Croton nepetaefolius, Croton sonderianus e Croton zehntneri contra Aedes aegypti. Em cada bioensaio foram utilizadas 25 larvas de 3° estádio juntamente com 50 mL de cada hidrolato, dispostos em recipientes plásticos, num esquema de quatro repetições, utilizando-se como controle a água e avaliando-se a mortalidade com 24 horas de tratamento. Os dados foram submetidos à análise de variância e ao teste de Tukey. Verificou-se que houve diferença significativa tanto em relação aos hidrolatos das diferentes espécies vegetais, quanto em relação às diferentes partes de cada planta (p < 0,001). Os hidrolatos referentes ao caule e folha de C. nepetaefolius e C. zehntneri causaram 100 por cento de mortalidade das larvas e diferiram das demais espécies, exceto da folha do C. argyrophylloides que apresentou o mesmo resultado. Os compostos presentes em C. zehntneri e C. nepetaefolius são fenil propanóides mais solúveis em água que os monoterpenos e sesquiterpenos detectados em C. argyrophylloides e C. sonderianus. Esta pesquisa evidenciou que todas as espécies testadas possuem compostos com propriedades larvicidas, com diferenças entre as partes da planta analisadas.