Experiências de acesso à saúde bucal de mulheres em situação de rua / Experiences of access to oral health of homeless women

RESUMO O objetivo deste estudo foi compreender a experiência de acesso a ações e serviços de saúde bucal de mulheres em situação de rua na cidade de Teresina, Piauí. Pesquisa qualitativa, norteada pelo paradigma interpretativo, desenvolvida com mulheres em situação de rua acompanhadas por instituições de referência. Os dados foram obtidos mediante entrevistas semiestruturadas, gravadas e transcritas. As análises foram baseadas na hermenêutica de Hans-Georg Gadamer (2015) associada às contribuições de Paul Ricoeur (1976). Foram realizadas 13 entrevistas, identificando-se duas unidades de significado: Sermulher em situação de rua; e Acesso a ações e serviços de saúde bucal. Diversas problemáticas cruzam as vidas das mulheres em situação de rua, sendo agravadas pela condição de gênero. Precárias condições de saúde bucal e dificuldade de acesso a ações e serviços de saúde bucal foram indicadas nas narrativas. É imperativo que as políticas existentes sejam postas em prática e contemplem as peculiaridades femininas. Apesar de todos os cirurgiões-dentistas da rede serem responsáveis pela atenção à saúde bucal das pessoas em situação de rua, a presença de um membro da saúde bucal dentro da equipe de consultório da rua foi apontada como necessária.

ABSTRACT This study aimed to understand the experience of access to oral health initiatives and services of homeless women in the city of Teresina, Piauí. A qualitative research, guided by the interpretative paradigm, was conducted with homeless women who were under the care of specialized institutions. The data were obtained using semi-structured interviews, which were recorded and transcribed. The analyses of the interviews were based on the hermeneutics of Hans-Georg Gadamer (2015), combined with the contributions of Paul Ricoeur (1976). Thirteen interviews were conducted, identifying two units of meaning: Being-woman and homeless; and Access to oral health initiatives and services. Poor oral health conditions and difficulty in accessing oral health initiatives and services were reported by the participants. Those problems were aggravated by the status of being a woman. The existing health policies should be put into practice and should, additionally, take into account female peculiarities. Although the public health system is available for the oral health care of homeless people, the Street Clinic service would benefit from the participation of an oral health professional.

Analysis of smile photos posted on social networks as an alternative for human identification / Análise de fotos do sorriso postadas em redes sociais como alternativa para a identificação humana

ABSTRACT Photos of smiles posted on social media contain information on individuals' anatomical and oral morphological characteristics, which can be important for ante and post-mortem human identification, during confrontation for forensic purposes. Objective: The study aimed to evaluate the feasibility of using smile photographs on social networks as a source of information for human forensic identification. Methods: The study sample consisted of forty individuals, randomly divided into four equal groups, two groups in Instagram (IG®) and two groups in Facebook (FB®). Standardized oral photographs of the anterior teeth of the participants, from three different angles (post-mortem photos) were taken using a Nikon® EOS 550D camera. Photos of smiles posted in FB and IG by the participants were also collected (ante-mortem photos). The analysis were carried out by 4 forensic experts, 18 dental professors, and 21 dental students. They compared simulated ante and post-mortem photos, to identify the alleged victims. Results: The correct identification score ranged from 28.6% (students) to 100% (forensic experts). The most frequently reported dental characteristics used for the identification were morphology of the anterior teeth, zenith, and gingival recessions. There was no statistically significant association between the rate of correct identification and the degree of difficulty reported during the analysis (p= 0,068), whereas there was also no association between this index and or the duration of the analysis (p=0,884). Conclusions: Therefore, the photographs of the smile posted on social media proved to be a database of dental information, and with potential to assist in identification with dental forensic purposes.

RESUMO Fotos de sorrisos postadas nas redes sociais contêm informações sobre as características anatômicas e morfológicas orais dos indivíduos, que podem ser importantes para a identificação humana ante e post-mortem, durante o confronto para fins forenses. Objetivo: O estudo teve como objetivo avaliar a viabilidade do uso de fotografias de sorrisos em redes sociais como fonte de informação para identificação forense humana. Métodos: A amostra do estudo foi composta por quarenta indivíduos, divididos aleatoriamente em quatro grupos iguais, dois grupos no Instagram (IG®) e dois grupos no Facebook (FB®). Fotografias orais padronizadas dos dentes anteriores dos participantes, de três ângulos diferentes (fotos post-mortem), foram tiradas com uma câmera Nikon® EOS 550D. Também foram coletadas fotos de sorrisos postados no FB e IG pelos participantes (fotos ante-mortem). As análises foram realizadas por 4 peritos forenses, 18 professores de odontologia e 21 alunos de odontologia. Eles compararam fotos simuladas ante e post-mortem, para identificar as supostas vítimas. Resultados: A pontuação correta de identificação variou de 28,6% (alunos) a 100% (especialistas forenses). As características dentais mais frequentemente relatadas e utilizadas para a identificação foram morfologia dos dentes anteriores, zênite e recessões gengivais. Não houve associação estatisticamente significativa entre a taxa de identificação correta e o grau de dificuldade relatado durante a análise (p = 0,068), assim como não houve associação entre esse índice e/ou a duração da análise (p = 0,884). Conclusão: Portanto, as fotografias do sorriso postadas nas redes sociais mostraram-se um banco de dados de informações odontológicas, e com potencial para auxiliar na identificação para fins odontológicos forenses.

Odontologia para Pacientes com Necessidades Especiais no ensino de graduação: percepção de discentes e docentes em uma instituição do Piauí e um panorama brasileiro / Dentistry for Special Needs Patients in undergraduate teaching: perception of students and professors at a university in Piaui and a Brazilian overview

A inexperiência do graduando em Odontologia no manejo de Pacientes com Necessidades Especiais (PNE) gera lacunas na formação e pode contribuir para a barreira de acesso desses indivíduos aos serviços de saúde bucal. Este estudo analisou a percepção de discentes e docentes do curso de Odontologia da Universidade Federal do Piauí (UFPI)sobre a inclusão de atendimento a PNE no ensino de graduação e o panorama nacional da oferta de disciplina de PNE na estrutura curricular de cursos de Odontologia. Foi realizado um estudo transversal, descritivo e exploratório, com aplicação de questionários a discentes e docentes do curso de Odontologia da UFPI. As matrizes curriculares dos cursos foram consultadas em endereços eletrônicos institucionais. Foi realizada análisedescritiva dos dados e teste Exato de Fisher foi aplicado. A maioria dos discentes relataram nunca ter atendido um PNE (54,8 %) e,destes, 67,7% não se sentem preparados para este atendimento. A maioria dos discentes (84,7%) e docentes (53,8%) aprova a obrigatoriedade da disciplina de PNE na estrutura curricular. Insegurança foi a reação mais comum dos discentes ao atendimento odontológico fictício a um paciente PNE. Entre os docentes participantes do estudo, 73,1% informaram já ter atendido PNE. Em 67,8% dos cursos de Odontologia pesquisados há oferta de disciplina de PNE. Em conclusão, a ausência de atendimento a PNE gera insegurança aos graduandos em Odontologia. A inclusão do tema PNE na matriz curricular é apoiada por discentes e docentes. A disciplinaestá presente na maioria dos cursos de Odontologia do Brasil (AU).

Dentistry undergraduates do not acquire much experience managing Patients with Special Needs (PSN) during their university training. This knowledge deficit contributes to the situation where PSNs face barriers to accessing oral health services. This study was a cross-sectional, descriptive and exploratory study about the perception of Dentistry students and professors at the Federal University of Piaui (UFPI -Brazil) on whether care of PSN should be included in their course. The reactions ofstudents facing a simulated situation of dental care for PSN was also analyzed. A survey of the situation regarding PSN inclusion at other universities in Brazil was alsocarried out. Professors and students filled out questionnaires and information regarding university curriculums was collected from their websites. Descriptive data analysis was performed, and Fisher's exact test was applied. Most UFPI students reported never having treated a PSN (54.8%) and, of these, 67.7% did not feel confident to providethis treatment. Most professors (73.1%) reported having treated PSN. Most students (84.7%) and professors(53.8%) agree that Dentistry for PSN should be mandatory in the curricular structure. Lack of confidencewas the most common reaction of students to a simulation ofdental care for a PSN. Dentistry for PSN is part of the curriculum of 67.8% of the Dentistry courses surveyed. In conclusion, the lack of Dentistry for PSN during student training can makedentists-to-be unsure about how to treat PSN in real-life situations. The inclusion of dental care for PSN in the curriculum is supported by students and teachers. The topic is present in most Dentistry courses in Brazil (AU).

Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study.

This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.

Impact of dental treatment on the oral health-related quality of life of children and adolescents with Autism Spectrum Disorder.

AIM: To evaluate the impact of dental treatment on the oral health-related quality of life (OHRQoL) of children and adolescents with Autism Spectrum Disorder (ASD), through the perception of caregivers. METHODS AND RESULTS: A prospective longitudinal study was conducted on 115 individuals with ASD, 6-14 years of age, recruited from the referral centers for special needs individuals at Teresina, Brazil. A clinical examination was carried out and the OHRQoL was measured using the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) before and 3 months after dental treatment. Data were analyzed using Kolmogorov-Smirnov, Levene, Mann-Whitney, Kruskall-Wallis, and Wilcoxon tests, and the Poison regression with backward method (P < .05). Treatment needs of children with ASD consisted of dental restorations (81.7%), oral prophylaxis (66.1%), endodontic treatment (10.4%), and tooth extractions (10.4%). The baseline P-CPQ total score varied from 1 to 33 (mean score = 13.2 [±6.4]), and at 3 months after treatment it ranged from 0 to 10 (mean score 3.4 [±2.2] (P < .001). The effect magnitude varied between 0.55 and 0.56. CONCLUSION: According to the perception of the caregivers, dental treatment had a positive impact on the OHRQoL of children and adolescents with ASD.

Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study

Abstract This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial.

Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Physiological and Behavioral Manifestations of Children and Teenagers with Down Syndrome During the Dental Appointment: A Comparative Cross-Sectional Study

Abstract Objective: To measure the heart rate (HR) and the behavior of children and teenagers with Down Syndrome (DS) during the dental appointment. Material and Methods: Two groups (n = 52), of both genders, aged 2-14 years, matched by age group were formed: study group (SG) - individuals with DS and control group (CG) - normotypical school children. The participants were submitted to clinical examination and prophylaxis. An oximeter was used to measure the HR at five moments of the dental consultation: before entering the practice room (T0), when sitting in the dental chair (T1), during the clinical examination (T2), during prophylaxis (T3) and immediately after prophylaxis (T4). Behavior, classified according to the Frankl Scale, was observed at T3. Mann Whitney, Kruskal-Wallis, Dunn and Pearson's Chi-square tests were used to analyze and compare variables (significance level at 5%). Results: In SG, a significant difference in HR was observed according to the moment of dental appointment (p<0.001 SG; 0.3385 CG). The highest HR value in SG was observed at T3 (median 110.00; IIQ 96.00-124.00), the only moment significantly different (p<0.001) from HR values for CG. A difference in behavior between groups (p<0.001) was also observed. Conclusion: HR of individuals with DS varied throughout the dental appointment, and they also had a higher prevalence of uncooperative behavior.

Prevalence and predictive factors of dentin hypersensitivity in Brazilian adolescents.

AIM: To measure the prevalence of dentin hypersensitivity (DH) in adolescents. METHODS: The diagnosis was based on self-report and was confirmed by tactile and evaporative tests. The association between DH and predictor factors was determined using a multivariate model. The sample consisted of 384 adolescents. RESULTS: The prevalence was 19.0%. DH prevalence to tactile stimulus was higher in those participants whose toothbrush movement was vertical/horizontal (OR = 0.53, 95% CI = 0.47-0.60, p < 0.001), in the presence of dental biofilm (OR = 2.45, 95% CI = 1.94-3.09, p < 0.001), of non-carious cervical lesion (OR = 2.76, 95% CI = 2.40-3.18, p < 0.001), of gingival recession (OR = 1.63, 95% CI = 1.44-1.86, p < 0.001) and gyroversion (OR = 1.60, 95% CI = 1.40-1.82; p < 0.001). When DH was diagnosed by evaporative stimulus, there was an association with brush movement in a vertical/horizontal direction (OR = 0.73, 95% CI = 0.66-0.82, p < 0.001), with the use of mouthwash solutions (OR = 2.65, 95% CI = 2.16-3.25, p < 0.001), in the presence of non-carious cervical lesion (OR = 1.75, 95% CI = 1.57-1.96, p < 0.001), of gyroversion (OR = 1.75, 95% CI = 1.51-1.90, p < 0.001) and gingival recession (OR = 1.78, 95% CI = 1.59-1.99, p < 0.001). CONCLUSIONS: The prevalence of DH in the sample was worrying, since almost 1 in 5 adolescents had DH. Individuals with DH were more likely to report traumatic dental brushing, and presence of dental biofilm, non-carious cervical lesion, gingival recession and gyroversion in the affected teeth.

Saúde Bucal de Indivíduos com Transtorno do Espectro Autista / Oral Health of Individuals with Autistic Spectrum Disorder

Transtorno do Espectro Autista (TEA) é um espectro de transtornos do desenvolvimento neurológico que afeta o desenvolvimento e funcionamento do cérebro, por mecanismos ainda desconhecidos. A prevalência estimada para TEA é de um a dois para cada mil nascidos vivos e estes indivíduos apresentam limitações físicas e psicológicas que incluem atrasos no desenvolvimento da linguagem, dificuldades de comunicação e interação social, comportamentos restritos e repetitivos e muitos podem ter deficiência intelectual. Supõe-se que a saúde bucal de indivíduos com TEA é precária, em parte por suas limitações e pouca destreza manual para realização de cuidados em saúde, bem como pelo maior consumo de alimentos com adição de açúcar e retenção prolongada do bolo alimentar na cavidade bucal, que são observados nesta população. O objetivo deste artigo é apresentar uma revisão da literatura sobre as condições de saúde bucal de indivíduos autistas. Para o desenvolvimento da presente revisão de literatura foram realizadas buscas nas bases de dados MedLine/PubMed, Scopus e SciELO. Os artigos foram selecionados segundo descritores relacionados com saúde bucal e transtorno do espectro autista. Menor prevalência de cárie em indivíduos com TEA é relatada na maioria dos estudos, porém, observa-se a necessidade de estudos longitudinais que possam avaliar incidência e fatores associados com cárie dentária nesta população. Estudos sugerem que indivíduos autistas tenham pior condição periodontal, havendo uma lacuna sobre as condições associadas a essa maior prevalência. Embora com um número limitado de estudos, indivíduos autistas parecem não serem mais propensos a traumatismos dentários. (AU).

Autism Spectrum Disorder (ASD) is a spectrum of neurodevelopmental disorders that affect the brain development and functioning, by still unknown mechanisms. The estimated prevalence for ASD is one to two per thousand live births and these individuals present physical and psychological limitations that include delays in language development, difficulties in social interaction, communication and restricted and repetitive behaviors, and many may have intellectual disabilities. It is assumed that the oral health of ASD individuals is precarious, in part because of their limitations and little manual dexterity to perform health care, as well as the high consumption of foods with added sugar and prolonged retention of the food bolus in the oral cavity, which are observed in this population. The aim of this article is to present a review of the literature about the oral health conditions of autistic individuals. For the development of the present literature review, the MedLine / PubMed, Scopus and SciELO databases were searched. The articles were selected according to descriptors related to oral health and autism spectrum disorder. Lower caries prevalence in ASD individuals is reported in most of the studies, however, it is observed the need for longitudinal studies that can assess incidence and factors associated with dental caries in this population. Studies suggest that autistic individuals have worse periodontal conditions, and there is a lack of conditions associated with this higher prevalence. Despite the limited number of studies, autistic individuals do not appear to be more prone to dental trauma. (AU).

Clinical performance of class I occlusal composite resin restorations: a multicenter double-blinded randomized clinical trial / Performance clínica de restaurações oclusais classe I em resina composta: ensaio clínico randomizado duplo-cego e multicêntrico

Objective: To evaluate the 6-month clinical performance of class I occlusal composite resin restorations through a multicenter, randomized, double-blind, clinical trial. Material and Methods: Two hundred and eighty class I occlusal restorations were performed in 70 patients (aged between 17 to 50 years). The restorations were divided into four groups: G1 (Filtek P60/3M ESPE); G2 (Rok/SDI); G3 (Filtek™ P90/3M ESPE); G4 (Evolux/Dentsply). Two pre-calibrated dental practitioners performed and evaluated the restorative procedures regarding to color match, marginal discoloration, recurrent caries, wear (anatomic form) and marginal integrity according to the USPHS criteria. Results: In 85.8% of the evaluated restorations was observed the ideal score (A) for color match; 91.4% for marginal discoloration; 100% for recurrent caries; 87.7% for wear (anatomic form) and 99.3% for marginal integrity. Conclusion: The composite resins used in this study presented satisfactory and similar clinical performance in a 6-month clinical evaluation. (AU)

Objetivos: Avaliar através de um ensaio clínico randomizado duplo-cego e multicêntrico o desempenho clínico de restaurações classe I oclusais realizadas em dentes posteriores. Material e Métodos: Foram realizadas duzentas e oitenta restaurações em 70 pacientes dos gêneros masculino e feminino (entre 17 e 50 anos). As restaurações foram divididas em 4 grupos: G1 (Filtek P60/3M ESPE); G2 ( Rok/SDI); G3 Filtek TM P90/3M ESPE); G4 (Evolux/Dentsply). Dois operadores précalibrados avaliaram os procedimentos restauradores em relação a reprodução da cor, descoloração marginal, incidência de cárie, desgaste e integridade marginal de acordo com os critérios da USPHS. Resultados: De um total de restaurações avaliadas, 85,8% receberam score ideal (A) para reprodução da cor; 91,4% para descoloração marginal; 100% para incidência de cárie; 87,7% para contorno e 99,3% para integridade marginal. Conclusão: Os materiais empregados neste estudo apresentaram desempenho clínico satisfatório e semelhante após avaliação clínica de 06 meses. (AU)

The impact of hospitalization on periodontal health status: an observational study / O impacto da hospitalização sobre a condição periodontal: um estudo observacional

ABSTRACT Objective To evaluate the impact of hospitalization on the periodontal status of patients admitted to a private hospital. Methods A sample of 41 patients answered a questionnaire on oral hygiene habits before and after hospitalization. An examiner measured the Periodontal Screening and Recording ratio (PSR) within 24 hours after hospitalization (T0), after five (T1) and after ten days of hospital admission (T2). Results 47 patients were examined at T0, 37 at T1 and 21 at T2. Between T0 and T1, the periodontal condition of 32.4% of patients worsened (p = 0.001). The score of ten patients changed from PSR = 0 to PSR = 1 and the score of two changed from PSR = 1 to PSR = 2, after 5 days of hospitalization. At T2, 38% of patients had deteriorated (p = 0.005) with 4 developing gingival bleeding and 4 presenting calculus. 19% of patients (p=0.046) declined between T1 and T2, and 4 patients presented calculus. None of the patients received any guidance on oral hygiene by hospital staff. Conclusion The periodontal condition of hospitalized patients deteriorated over the course of the stay in hospital and, consequently, there was an increased need for treatment. This draws attention to the importance of oral hygiene care in hospital.

RESUMO Objetivo Avaliar o impacto da internação hospitalar sobre a condição periodontal de pacientes em um hospital privado. Métodos A amostra de 41 pacientes respondeu questionário sobre hábitos de higiene bucal antes e após a internação. Um examinador mensurou o índice Periodontal Screening and Recording (PSR) no início, cinco e dez dias a partir da admissão hospitalar. Resultados Nenhum paciente recebeu orientação sobre higiene bucal por profissionais do hospital. Após 5 dias do exame inicial, 58,8% dos pacientes sadios apresentaram sangramento à sondagem e 16,7% dos pacientes com sangramento apresentaram cálculo dental; e 10 dias depois, 70,0% dos pacientes sadios apresentaram sangramento gengival e 57,1% daqueles que já tinham sangramento gengival apresentaram cálculo dental. Houve um aumento das necessidades de tratamento. Conclusão A condição periodontal de pacientes internados agravou-se com o decorrer do tempo de internação e, consequentemente, houve um aumento da necessidade de tratamento. Isso desperta a atenção para a importância dos cuidados de higiene bucal no hospital.

Sucrose induced dentin demineralization in a microcosm biofilm model / Desmineralización de la dentina inducida por sacarosa en un modelo de biofilm microcosmo

The aim of this in vitro study was to assess the root dentin demineralization caused by a microcosm biofilm model that has been exposed to sucrose in different ways. Materials and Methods: Saliva of two volunteers was inoculated into an artificial medium for biofilm growth and dentin blocks were immersed into these media. Dentin specimens were randomly exposed to one of the five experimental conditions: C (control group - no saliva inoculum or sucrose), 0S (saliva inoculum without sucrose, negative control), 3S (three daily one-minute immersions in 20 % sucrose), 6S (six daily one-minute immersions in 20 % sucrose), and CS (continuously immersed in 5 % sucrose). After five days, biofilm was collected to determine the concentration of intracellular and extracellular polysaccharides and the dentin surface hardness loss (SHL) was measured. The experiment was carried out in triplicate. Results: The dentin SHL was higher in groups that were exposed to sucrose (3S, 6S and CS) and there was a statistically significant difference between all groups (p<0.001). CS had higher concentrations of polysaccharides (p>0.001) and there was no statistically significant difference between the other groups (0S, 3S and 6S) (p>0.005). Conclusion: The microcosm biofilm model developed has the potential to produce root dentin demineralization at different exposures to sucrose.

El objetivo de esta investigación in vitro fue evaluar la desmineralización de la dentina radicular causada por un modelo de biofilm microcosmo que fue expuesto de diferentes maneras a la sacarosa. La saliva de dos voluntarios fue colocada en un medio artificial para crecimiento del biofilm y los bloques de dentina fueron sumergidos en estos medios. Al aza rlos bloques fueron expuestos a una de las cinco condiciones experimentales: C (grupo control ­ sin inoculación de saliva o sacarosa), 0S (inoculación de saliva sin sacarosa, control negativo), 3S (tres inmersiones diarias de un minuto en sacarosa a 20 %), 6S (seis inmersiones diarias de un minuto en sacarosa a 20 %), y CS (sumergidos continuamente en 5 % de sacarosa). Después de cinco días, el biofilm fue recogido para determinar la concentración de polisacáridos intracelulares y extracelulares y fue medida la pérdida de dureza superficial de la dentina (SHL). El experimento se repitió en tres ocasiones. La dentina SHL era mayor en los grupos que fueron expuestos a la sacarosa (3S, 6S E CS) y hubo diferencia estadísticamente significativa entre todos los grupos (P<0,001). CS presentó mayor concentración de polisacáridos (p<0,001) y no hubo diferencia estadísticamente significativa entre los demás grupos (0S, 3S E 6S) (p>0,005). El modelo del biofilm desarrollado tiene potencial para producir desmineralización de la dentina radicular en diferentes exposiciones a la sacarosa.

Fístula oronasal após palatoplastia em pacientes fissurados / Oronasal fistula after palatoplasty in cleft patients

A fístula oronasal (FON) consiste na principal sequela pós-cirúrgica da palatoplastia podendo levar a problemas funcionais, como a fala hipernasal e regurgitação de alimentos pelo nariz. Essa condição compromete o resultado do tratamento da fissura labiopalatina, e seu reparo torna-se um desafio para a equipe multidisciplinar. Este trabalho relata três casos de pacientes com fissura lábio-palatina que apresentaram FON após palatoplastia. Nos casos, foram diagnosticadas FON tipo VII (alveolar na região labial), provocadas pela tensão muscular excessiva sobre a sutura após palatoplastia. O tratamento consistiu em uma cirurgia para fechamento da fístula através da técnica de retalho mucoperiosteal, realizada por um cirurgião bucomaxilofacial. É essencial um planejamento cirúrgico adequado a fim de promover o melhor prognóstico para o paciente, visando a uma melhor qualidade de vida... (AU)

The oronasal fistula (ONF) is the main postoperative sequel of palatoplasty and can leads to functional problems such as hypernasality of voice and regurgitation of food through the nose. This condition affects the outcome of treatment of cleft palate and is challenging for the multidisciplinary team. This paper reports three cases of patients with cleft lip and palate who presented ONF after palatoplasty. In these cases, type VII ONF (alveolar in the labial region) were diagnosed, and were caused by excessive muscle tension on the suture after palatoplasty. The treatment consisted of a surgery for closure of the fistula through the mucoperiosteal flap, which was carried out performed by a maxillofacial surgeon. It is essential an appropriate surgical planning in order to promote better prognosis for the patient aiming better quality of life... (AU)

Retrospective study of dental trauma in children with autism spectrum disorders: a paired study.

The objective was to evaluate the history of traumatic dental injury (TDI) among children with and without autism spectrum disorders (ASD) at the Centro Integrado de Educação Especial (CIES), in Teresina, Brazil. The dental records of 228 children, 114 with ASD (SG = study group) and 114 without ASD (CG = control group), paired by age, gender and socioeconomic characteristics between January 2007 and September 2014 were reviewed. Data were analyzed using chi-square test and multivariate logistic regression (alpha = 5.0%). Dental trauma in SG was lower than in the CG (24.6% and 41.2%, respectively, p = 0.007). The risk of trauma was lower among males in SG (OR: 0.35; 95%CI: 0.18 to 0.67). The likelihood of TDI in SG was 3.17 higher in females than that of males (p = 0.040). The prevalence of TDI was lower in ASD individuals compared to controls. Dental trauma was higher among ASD girls than ASD boys.

Survival time of direct dental restorations in adults / Sobrevida de restaurações dentárias diretas em adultos

Introduction: The presence of dental caries is the main reason for the placement and replacement of restorations. Maintaining restorations to a satisfactory clinical condition is a challenge, despite the evolution of materials and surgical operative techniques. Objective: To investigate the survival time and technical-operatory characteristics of dental restorations among adults in Teresina-PI. Material and method: Data collection was carried out from September 2009 to January 2010 at a non-profit dental service. Data were collected at the moment of restoration replacement. The sample consisted of 262 defective restorations in 139 individuals. Survival time was calculated using the placement date that was registered on the individual’s dental form. Kruskal-Wallis and Mann-Whitney tests were used to compare the survival time of the different types of restorations and the chi-square test was used to assess the association between qualitative variables, at a 5% significance level. Result: The median survival time of the restorations was 2 years. The survival time for amalgam was higher than for composite and glass ionomer cement (p=0.004). The most replaced dental material was the composite (66.4%). The majority of the replaced restorations had been placed in anterior teeth, in proximal surfaces. Conclusion: Amalgam restorations have a longer survival time than composite resin. Technical and operatory variables had no influence on the survival time of restorations. Dental restorations have a low survival time and this fact might be associated with the decion-making process that is adopted by the professionals.

Introdução: A cárie dentária é o principal motivo para a instalação e troca de restaurações. A preservação destas em condição clínica satisfatória é um desafio, apesar da evolução dos materiais e técnicas cirúrgico-operatórias. Objetivo: Investigar o tempo de sobrevida e características técnico-operatórias das restaurações dentárias diretas de adultos em Teresina, Piauí. Material e método: A coleta de dados ocorreu de setembro de 2009 a janeiro de 2010, em clínicas de tratamento odontológico sem fins lucrativos. Os dados técnicos e operatórios do preparo cavitário e da restauração foram coletados no momento da substituição. A sobrevida foi calculada a partir da data de instalação que constava no prontuário. Os dados foram registrados em um formulário criado com esse fim. Kruskal-Wallis e Mann-Whitney foram empregados para comparar a sobrevida dos diferentes tipos de restaurações e o teste qui-quadrado para associações entre variáveis qualitativas, ambos com nível de significância de 5%. Resultado: As 262 substituições de restaurações deficientes estavam em 139 pacientes. A mediana de sobrevida das restaurações foi 2 anos. As restaurações de amálgama tiveram sobrevivência maior que as de resina composta (p=0,004). O material restaurador mais substituído foi resina composta (66,4%). A maioria das restaurações localizava-se em dentes anteriores e em preparos proximais. Conclusão: As restaurações de amálgama teve sobrevida maior que as de resina composta. As variáveis técnico-operacionais não influenciaram na taxa de substituições. As restaurações diretas possuem reduzido tempo de sobrevida o que pode estar associada à filosofia adotada pelo serviço para o tratamento fornecido.

The impact of the cost of oral hygiene products on the domestic budget in the urban region of a midsize Brazilian capital city / O impacto do custo de produtos de higiene bucal sobre o orçamento doméstico na zona urbana de uma capital de porte médio Brasileira

OBJECTIVE: To evaluate the impact of the cost of oral hygiene products in Teresina, Piauí, on the Brazilian minimum salary (MS) over the period of two years. METHODS: The writer of this study visited 12 businesses from five geographical areas of the city during four consecutive months in 2011 and 2013 to collect the prices of toothbrushes, toothpaste, dental floss and mouth rinse solutions of different brands. The prices were used to calculate the monthly expense that one individual would have if they consumed the ideal quantity of the products, as recommended by the dental literature. Brazil's MS at the time of the study was used as a parameter to calculate the impact of the cost of the items on the family budget. RESULTS: The mean monthly cost per individual was R$ 17.93 in 2011 (2.88% of the MS) and R$ 24.92 in 2013 (3.67% of the MS). There was an increase of 38.9 % in the mean price of products and the impact on the MS increased by 27.43 % during the study period. CONCLUSION: The impact of the cost of the oral care items was high on the Brazilian MS for the studied region. Dentists should be aware that the cost of these products can be an obstacle for their patients. .

OBJETIVO: Avaliar o impacto do custo dos produtos de higiene oral em Teresina, Piaúi sobre a o salário mínimo brasileiro ao longo de dois anos de observação. MÉTODOS: Doze estabelecimentos comerciais nas zonas geográficas do município foram visitados em quarto meses consecutivos em 2011 e 2013 para coletar o preço de escovas dentais, dentifrícios, fios dentais e antissépticos bucais de diferentes marcas. Para o cálculo do consumo mensal, considerou-se que os produtos foram consumidos em quantidade ideal para o uso. Para o impacto do custo dos itens, o salário mínimo brasileiro na época do estudo foi usado como parâmetro. RESULTADOS: O custo mensal médio por indivíduo seria de R$17,93 em 2011 (2,88% do salário mínimo) e R$24,92 em 2013 (3,67% do salário mínimo). CONCLUSÃO: Houve aumento de 38,9% no preço dos produtos e o impacto sobre o SM aumentou em 27,43% no período do estudo. Os cirurgiões-dentistas devem estar bem informados sobre o custo desses produtos ao prescrevê-los a seus pacientes. .

Promoção de saúde bucal e extensão universitária: novas perspectivas para pacientes com necessidades especiais / Oral Health Promotion and Extension Project: new perspectives for patients with Special Needs

Este relato de experiência faz uma reflexão acerca da importância da extensão universitária para consolidação das mudanças nos conceitos de atenção à saúde dos pacientes com necessidades especiais. O projeto de extensão "Promoção de Saúde Bucal para Pacientes Especiais- PROSBE" ocorre no Centro Integrado de Educação Especial (CIES ­ Teresina/Piauí), promovendo capacitação para professores e responsáveis sobre a importância da promoção de saúde bucal, através de práticas de uma equipe multidisciplinar. Ações educativas podem desenvolver competência e estímulo aos responsáveis pelos pacientes e propiciar aos estudantes segurança e familiaridade no atendimento aos pacientes especiais. O PROSBE favorece o convívio entre os profissionais e o binômio aluno/professor universitário, propiciando pesquisas e uma relação social de impacto entre a Universidade e a sociedade. Além disso, este trabalho enaltece a indissociabilidade ensinopesquisa-extensão que reafirma a extensão como processo acadêmico de formação e de geração de conhecimentos (AU).

This experience report is on the undergraduate extension projects and their importance for the consolidation of the concept changes in oral health care of patients with special needs. The extension project PROSBE (Project of Oral Health Promotion for Special Needs Patients) takes place at the Integrated Center for Special Education (CIES) and educates caregivers on the importance of the oral health promotion, through the practice of a multidisciplinary team. Educational actions can develop competences and stimulate those responsible for the patients and undergraduate students to create confidence and familiarity in the treatment of special needs patients. Projects of this nature favor the work between professionals and the double student/professor, propitiating researches and a social relationship of impact between the University and society. Furthermore, this study emphasizes the importance of the triad teaching-research-extension, based on which the Brazilian university system is currently working. University extension is an academic process of professional formation and generation of knowledge (AU).

Dentin hypersensitivity treatment of non-carious cervical lesions – a single-blind, split-mouth study

This study aims to compare the in vivo effect of a desensitizing therapy associated with a restorative technique for the treatment of cervical dentin hypersensitivity (CDH) in non-carious lesions. The sample consisted of 68 teeth with moderate or severe dentin hypersensitivity in 17 individuals (one tooth per quadrant). The sensitivity levels of the teeth were scored, and the teeth were randomly distributed into four groups: T1 – desensitizing gel applied once per week until remission of pain; T2 – desensitizing gel applied once per week followed immediately by restoration with resin composite (Filtek Z250, 3M Espe); T3 – desensitizing gel once per week until remission of pain and then restoration with resin composite; and T4 - restoration with resin composite. Dentin hypersensitivity was assessed at 0, 7, 30, 90 and 180 days. The Kruskal-Wallis, Wilcoxon and Mann-Whitney (p< 0.05) tests were used to compare the treatments. The mean baseline CDH scores were T1 - 2.41, T2 - 2.41, T3 - 2.47, and T4 - 2.70 (p > 0.05). At seven and 180 days, the mean CDH scores were as follows: T1 - 1.47/0.65, T2 - 1.35/0.71, T3 - 0.71/0.53, and T4 - 1.12/0.59, all of which were significantly lower (p< 0.001) than the baseline scores. The scores at 30, 90 and 180 days were not significantly different when compared to the score of the previous period. At 180 days, CDH scores were similar among groups (p> 0.05). Teeth with moderate or severe hypersensitivity that required a filling responded similarly regardless of whether the desensitizing procedure was carried out prior to the filling.