Perfil do atendimento odontológico na Unidade de Pronto Atendimento do Município de Santa Maria / Dental care profile at an Urgent Care Unit in the city of Santa Maria, Brazil

O objetivo do estudo foi buscar informações documentais para caracterizar casos de urgências e emergências odontológicas na Unidade de Pronto Atendimento (UPA), em Santa Maria/RS. Para isso, realizou-se uma análise retrospectiva de dados nos prontuários dos pacientes de ambos os sexos e maiores de 18 anos, no período de seis meses. A amostra foi coletada de acordo com o perfil do paciente e levou-se em consideração: queixa principal, procedimentos realizados,tempo de permanência na UPA, sexoe idade.Aamostra foi composta pordados de 625 prontuários. A média de idade dos usuários foi de39,6±14,5 anos. A principal queixa encontrada foi ador (190, 24,4%), seguida de edema (49,6,3%), enquanto prescrições de medicamentos (250, 27,1%) e acesso àpolpa (235, 25,5%) foram os procedimentos mais realizados. O retorno de consultas no período analisado se deu em 189 (30,2%) dos casos, para realização de procedimentos como prescrição de medicamentos (130,27%), acesso àpolpa (122,26%) e troca de medicação intracanal (96,20%). Concluiu-se que, à medida em que a idade dos pacientes aumenta, os tratamentos endodônticos diminuem e as exodontias crescem. Além disso, foi possível identificar o perfil da população atendida: pacientes de ambos os sexos, comidade mediana de 37 anos, cujo tempo de permanência na UPA foi inferior a1hora, tendo como queixa principal a dor, enquanto o procedimento mais realizado foi a prescrição de medicamentos (AU).

The aim of the present study was to analyze documental information to characterize cases of urgent and emergency dental care at an Urgent Care Unit in the city of Santa Maria, state of Rio Grande do Sul, Brazil. A retrospective analysis was performed of data from the records of male and female patients 18 years of age or older in a six-month period. The variables of interest were patient's sex, age and main complaint as well as the procedures performed and duration in the Urgent Care Unit. The sample was composed of 625 patient records. Mean age was 39.6±14.5 years.The main complaint was pain (n = 190;24.4%), followed by edema (n = 49;6.3%). The most frequent procedures were the prescription of medication (n = 250;27.1%) and pulp access (n = 235;25.5%). Follow-up appointments occurred in 189 cases (30.2%) for procedures such as the prescription of medication (n = 130;27%), pulp access (n = 122;26%) and exchange of the intracanal medication (n = 96;20%). Endodontic treatment diminished and extractions increased with the increase in patient age. In summary, the following urgent dental care profile was found: male and female patients with a median age of 37 years who spent less than one hour at the Urgent Care Unit whose main complaint was pain and the most frequent procedure was the prescription of medication (AU).

Reação liquenoide oral ao amálgama: uma lesão ainda vista / Oral lichenoid reaction to amalgam: a lesion still seen

O amálgama dental ainda é amplamente utilizado na prática odontológica, apesar do acordo assinado na Convenção de Minamata, na qual 140 países comprometeram-se a reduzir o uso do mercúrio. O uso desse material restaurador pode desencadear reações liquenoides orais (RLO) cujas lesões apresentam semelhanças clínicas e histológicas com líquen plano oral (LPO), dificultando o diagnóstico. Aqui relatamos o caso de uma paciente do sexo feminino, de 72 anos, que foi encaminhada com uma lesão na mucosa bucal esquerda, com 10 meses de evolução e queixa de dor. A lesão era adjacente ao segundo molar inferior esquerdo que tinha uma restauração de amálgama. A paciente não apresentava doença sistêmica ou hábitos deletérios e não estava usando drogas continuamente. O diagnóstico clínico presuntivo foi RLO versus LPO. Sessenta dias após a substituição da restauração do amálgama, observou-se a regressão completa da lesão e o diagnóstico final de RLO foi realizado. A avaliação clínica associada aos resultados obtidos após a substituição do material suspeito pode ser suficiente para estabelecer o diagnóstico, embora em alguns casos seja necessária a avaliação histopatológica.

Dental amalgam is still widely used in dental practice, despite the agreement signed at the Minamata Convention, in which 140 countries have committed to reducing the use of mercury. The use of this restorative material may trigger oral lichenoid reactions (OLR) whose lesions show clinical and histological similarities with oral lichen planus (OLP), making diagnosis difficult. Here we report the case of a female patient, 72-year-old, who was referred with a lesion in the left buccal mucosa, with 10 months of evolution and complaint of pain. The lesion was adjacent to the second lower left molar which had an amalgam restoration. The patient had no systemic disease or deleterious habits and was not using drugs continuously. The presumptive clinical diagnosis were OLR versus OLP. Sixty days after the replacement of amalgam restoration the complete regression of the lesion was observed and the final diagnosis of OLR was done. Clinical assessment associated with the results obtained after the replacement of suspect material may be sufficient to establish the diagnosis, although in some cases it may be necessary histopathological evaluation.

Utilização de enxerto ósseo proveniente de banco de ossos na Implantodontia / Use of bone graft of bone bank in Implantology

Muitas vezes é necessário o uso de enxerto ósseo em cirurgias para instalação de implantes. A utilização de ossos homógenos provenientes de banco de ossos passou a despertar interesse devido inúmeras vantagens em relação aos outros tipos de enxertos ósseos. O objetivo deste estudo foi realizar uma busca sistemática da literatura para avaliar a utilização de osso homógeno na reabilitação de pacientes com altura e espessura ósseas insuficientes para a instalação de implantes dentários. Os artigos foram procurados através de uma estratégia de busca nas bases de dados eletrônicas Pubmed - Biblioteca nacional de Medicina US, Bireme - Biblioteca virtual em saúde e Biblioteca Cochrane. Foram encontrados 594 estudos, destes 590 foram excluídos após a leitura de títulos de resumos, e 4 foram selecionados para leitura completa do artigo e incluídos. Todos os estudos incluídos foram avaliados em relação à qualidade dos estudos e todos foram classificados com alto risco de viés. Concluiu-se que a utilização de homoenxertos demonstra ser uma ferramenta bastante útil para a Odontologia, com a finalidade de regenerar o tecido ósseo perdido dos maxilares, no entanto, serão necessários estudos futuros com mais critérios metodológicos para verificar os riscos e benefícios em utilizar enxertos de ossos homógenos provenientes de bancos de ossos na instalação de implantes (AU).

Many times the use of bone graft in surgeries for implant placement is necessary. The use of homogenous bone from bone bank began to awaken interest due to numerous advantages over other types of bone grafts. The aim of this study was to perform a systematic literature search to assess the use of homogenous bone in the rehabilitation of patients with insufficient bone height and thickness for the installation of dental implants. Articles were sought through a searching strategy in PubMed electronic databases - National Library of Medicine US, Bireme - Virtual Library in Health and Cochrane Library. As a result, 594 studies were found, 590 were excluded after reading abstract titles, and 4 were selected for complete article reading and were included. All included studies were assessed for their quality and all them were classified as high risk of bias. It was concluded that the use of homografts proves to be a useful tool for Dentistry, in order to regenerate lost bone jaw, however, it will require future studies with more methodological criteria to verify the risks and benefits of using homogenous bone from bone banks in implant placement (AU).

Uso de Bio-Oss® como enxerto em elevação de seio maxilar para instalação de implantes û revisão sistemática / Use of Bio-Oss® as grafting in maxillary sinus elevation for installation of implants û systematic literature search

Muitas vezes para a reabilitação por implantes na região posterior da maxila se faz necessária a elevação do seio maxilar e vários biomateriais podem ser utilizados. Sendo assim, o objetivo do estudo é avaliar, através de uma busca sistemática da literatura, a utilização do Bio-Oss® puro em procedimentos de enxerto em elevação de seio maxilar. A busca sistemática da literatura foi realizada pelos pesquisadores nas bases de dados eletrônica PUBMED (Biblioteca Nacional de Medicina, US), Bireme (Biblioteca Virtual em Saúde) e Biblioteca Cochrane. Os artigos incluídos foram avaliados para grau de qualidade por dois pesquisadores independentes. Seiscentos e vinte e dois artigos foram avaliados, destes, 616 foram excluídos, permanecendo 6 artigos. Dos 6 artigos incluídos todos apresentaram alto viés no grau de qualidade dos estudos. Concluiu-se que apesar do alto viés dos artigos incluídos, devido diversas falhas metodológicas, a busca sistemática da literatura mostrou que o Bio-Oss® é um biomaterial adequado para cirurgias de aumento de seio maxilar...

In order to achieve the rehabilitation using implants in the posterior maxillary region a maxillary sinus elevation is required and for this purpose there are various biomaterials that can be used. Thus, the aim of this study is to evaluate, through a systematic literature search, the use of Bio-Oss® in pure grafting procedures in maxillary sinus elevation. A systematic literature search was conducted in the electronic databases PUBMED (National Library of Medicine, US), Virtual Library Bireme-health and the Cochrane Library. The included articles were assessed for level of quality by two independent researchers. Six hundred and twenty-two articles were evaluated, and 616 of those were excluded, remaining 6 articles. All six articles included showed high degree of bias in the quality of studies. It was concluded that despite the high bias of the articles due to several methodological flaws, this systematic literature search showed that Bio-Oss® is a suitable biomaterial for augmentation of the maxillary sinus surgeries...

Effect of self-performed mechanical plaque control frequency on gingival inflammation revisited: a randomized clinical trial.

AIM: To evaluate the effect of self-performed mechanical plaque control (SPC) frequency on gingival health. METHODS: Thirty-nine subjects exhibiting limited gingival inflammation and minimal clinical attachment loss were enrolled in a single-blind, parallel group, randomized clinical trial. The subjects that were divided into three groups were tasked to perform SPC (using tooth brush and dental floss) at 12, 24 or 48 h intervals. Gingival index (GI), plaque index (PlI), and gingival crevicular fluid (GCF) volume were evaluated at baseline and 30 days follow-up. Groups were compared using anova and Tukey. RESULTS: No significant differences in mean GI change were observed between the 12 and 24 h SPC intervals from baseline to 30 days (-0.06 ± 0.13 versus 0.05 ± 0.09; p = 0.11). In contrast, the 48 h interval had significantly higher mean GI change than the 12 and 24 h intervals (0.33 ± 0.17; p = 0.001). Similarly, mean PlI change was not significantly different between the 12 and 24 h SPC intervals (0.11 versus 0.28; p = 0.15), whereas SPC at 48 h-intervals yielded a significantly increased PlI (0.39; p = 0.001). CONCLUSIONS: Self-performed mechanical plaque control performed at 12 h or 24 h intervals appears sufficient to maintain gingival health in subjects with no or limited clinical attachment loss.

Instrument of self-perception and knowledge of dental erosion: cross-cultural adaptation to the Brazilian population.

There are few instruments available in Brazil for obtaining data on dental erosion among adults. For this reason, the interview entitled "A Survey on Hong Kong People's Dietary Behavior in Relations to Acid Erosion", published in English, was considered for translation. The aim of this study was to perform a cross-cultural adaptation and content validation for the Brazilian population. After obtaining the author's permission, the interview underwent several stages: translation, back translation, review by a bilingual person and a committee of experts, administration of the English instrument and of the Portuguese version to a bilingual group, and pretesting in a convenience sample of 50 adults. The interview was translated and adapted to the Portuguese language and the Brazilian culture. The analysis of the data revealed that the interview was easy to apply, conduct and understand; therefore, it was considered viable and capable of being used in different studies.

Instrument of self-perception and knowledge of dental erosion: cross-cultural adaptation to the Brazilian population

There are few instruments available in Brazil for obtaining data on dental erosion among adults. For this reason, the interview entitled “A Survey on Hong Kong People’s Dietary Behavior in Relations to Acid Erosion”, published in English, was considered for translation. The aim of this study was to perform a cross-cultural adaptation and content validation for the Brazilian population. After obtaining the author’s permission, the interview underwent several stages: translation, back translation, review by a bilingual person and a committee of experts, administration of the English instrument and of the Portuguese version to a bilingual group, and pretesting in a convenience sample of 50 adults. The interview was translated and adapted to the Portuguese language and the Brazilian culture. The analysis of the data revealed that the interview was easy to apply, conduct and understand; therefore, it was considered viable and capable of being used in different studies.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment.

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. .

OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo. .

Do the Clinical Effects of Enamel Matrix Derivatives in Infrabony Defects Decrease Overtime? A Systematic Review and Meta-Analysis

Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.

Revisões sistemáticas prévias tem demonstrado melhores resultados com proteínas derivadas da matriz de esmalte (PDME) em comparação a retalho de espessura total (RET) para o manejo de defeitos periodontais infraósseos (DPI). O objetivo desse estudo foi determinar se essas diferenças variam de acordo com o tempo de acompanhamento e com a qualidade dos estudos. As bases de dados Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Lilacs, Embase e Web of Science foram pesquisadas sem limitação de tempo ate agosto de 2013 para ensaios clínicos randomizados. Os desfechos elegíveis foram alterações na profundidade de sondagem (PS), nível de inserção clinica (NIC), recessão gengival (RG) e alterações ósseas (AO). Resultados: Estudos com acompanhamento de ate 12 meses mostraram diferenças de 0.97 mm (CI95% 0.52 – 1.43) e 1.19 mm (CI95% 0.77 – 1.60) para PS e NIC, favoráveis a PDME, respectivamente. Estudos com acompanhamento ≥24 meses demonstraram vantagens de 1.11 mm (CI95% 0.74 -1.48) para NIC e 0.83 mm (CI95% 0.19 -1.48) para PS, com o uso de PDME. Considerando a qualidade dos estudos, publicações com baixo risco de viés exibiram menores diferenças entre os grupos apresentando 0.8 mm (CI95% 0.24-1.36) para o NIC, sem diferenças para PS (0.51 mm, CI95% -0.21 – 1.23). Pode-se concluir que o tempo de acompanhamento (< ou > 2anos) e o risco de viés são variáveis que influenciam nos resultados do tratamento com PDME em DPIO.

Do the clinical effects of enamel matrix derivatives in infrabony defects decrease overtime? A systematic review and meta-analysis.

Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study.

BACKGROUND: There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT). METHODS: 330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models. RESULTS: Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index>25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index>30 (RR 1.32; 95% CI 1.20-1.46). CONCLUSIONS: Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.

Desconforto e dor após aumento de coroa clínica realizado com instrumentos rotatórios e manuais / Pain and discomfort after crow lengthening performed with rotatory and manuals instruments

0 objetivo do estudo foi avaliar os aspectos relacionados a percepções subjetivas do paciente, relacionadas aos procedimentos cirúrgicos após a cirurgia de aumento de coroa clínica (ACC), com necessidade de osteotomía realizada com instrumentos rotatórios (OR) e manuais (OM). O estudo apresentou um ensaio clínico randomizado com grupos em paralelo. Participaram do estudo 34 pacientes de ambos os sexos, necessitando de cirurgia de ACC, que aleatoriamente foram divididos em dois grupos: primeiro grupo (16 pacientes), a osteotomía realizada com instrumentos rotatórios, e o segundo grupo (18 pacientes) com instrumentos manuais. Imediatamente após a cirurgia e após sete dias foi avaliado através de uma escala analógica visual (VAS) o desconforto durante o procedimento e dor pós-operatória, respectivamente. O tempo cirúrgico foi também registrado. Os resultados indicaram não haver diferenças estatisticamente significantes entre o tempo cirúrgico (90,8 versus 99,1 minutos) para OR e OM, respectivamente. O desconforto e a dor pós-operatória foram (7,5 e 11,1 versus 14,8 e 19,9) para o grupo OR e OM, respectivamente, sem diferenças estatísticas entre os grupos. Portanto, o tipo de osteotomía parece não influenciar nas percepções subjetivas do paciente e no período clínico de cirurgia. Entretanto, estudos com maiores amostras são necessários para confirmar ou refutar estes achados.