E-learning as a strategy in dentistry in the context of COVID-19: a path to follow?

The current study aims to assess the effectiveness of e-learning in compliance with the new biosafety recommendations in dentistry in the context of COVID-19 applied to the clinical staff of a dental school in Brazil. A quasi-experimental epidemiological study was carried out by means of a structured, pre-tested online questionnaire, applied before and after an educational intervention, using an e-learning format. After data collection, statistical tests were performed. A total of 549 members of the clinical staff participated in the study in the two collection phases, with a return rate of 26.9%. After the e-learning stage, a reduction was found in the reported use of disposable gloves, protective goggles, and surgical masks. The course had no impact on the staff's knowledge concerning the proper sequence for donning PPE and showed 100% effectiveness regarding proper PPE doffing sequence. Knowledge about avoiding procedures that generate aerosols in the clinical setting was improved. Despite the low rate of return, it can be concluded that online intervention alone was ineffective in significantly improving learning about the new clinical biosafety guidelines. Therefore, the use of hybrid teaching and repetitive training is highly recommended.

E-learning as a strategy in dentistry in the context of COVID-19: a path to follow?

Abstract The current study aims to assess the effectiveness of e-learning in compliance with the new biosafety recommendations in dentistry in the context of COVID-19 applied to the clinical staff of a dental school in Brazil. A quasi-experimental epidemiological study was carried out by means of a structured, pre-tested online questionnaire, applied before and after an educational intervention, using an e-learning format. After data collection, statistical tests were performed. A total of 549 members of the clinical staff participated in the study in the two collection phases, with a return rate of 26.9%. After the e-learning stage, a reduction was found in the reported use of disposable gloves, protective goggles, and surgical masks. The course had no impact on the staff's knowledge concerning the proper sequence for donning PPE and showed 100% effectiveness regarding proper PPE doffing sequence. Knowledge about avoiding procedures that generate aerosols in the clinical setting was improved. Despite the low rate of return, it can be concluded that online intervention alone was ineffective in significantly improving learning about the new clinical biosafety guidelines. Therefore, the use of hybrid teaching and repetitive training is highly recommended.

A national study on the use of opioid analgesics in dentistry.

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010.

OBJECTIVE: To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. METHODS: A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD) for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year. RESULTS: There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30%) of anxiolytics and 1,269,580.00 mg (35.70%) of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD). The anxiolytics most frequently dispensed were bromazepam (25.30%), alprazolam (19.19%), and diazepam (15.60%). Sedatives and hypnotics mostly prescribed were zolpidem (9.55%), midazolam (6.99%), and flunitrazepam (2.14%). The per capita rates (100,000 inhabitants) of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively. CONCLUSIONS: Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription.

Root fracture in patient in the pre-liver transplantation phase / Fratura de raiz em paciente em fase pré-transplante de fígado

ABSTRACT Liver transplantation is the treatment of choice for end-stage liver disease patients, and offers them the possibility of returning to active and longer life. A dental evaluation before transplantation is a recommended prerequisite to avoid oral infections, which can worsen the patient's overall situation. This case report refers to the root fracture of an anterior tooth in a patient who was undergoing dental treatment prior to liver transplantation. On clinical examination, the maxillary right central incisor (11) presented without color change, but with mobility in the buccolingual direction, slight flaring and extrusion, and fistula in the attached gingiva on the distal side of tooth 11. The patient reported that he had suffered a trauma in that region 30 years before. The radiographic examination showed a horizontal fracture of the middle third of the root, associated with bone damage, indicated by a radiolucent area at the distal surface of 11. The proposed treatment consisted of: scraping procedure and straightening of the distal surface, radical endodontic treatment of the coronal portion of the root, subsequent filling with Mineral Trioxide Aggregate and dental immobilization. The clinical and radiographic follow-up at three-monthly intervals allowed us to observe gradual regression of the lesion with bone formation, contributing to maintenance of the patient's general and emotional health, preserving his smile and quality of life.

RESUMO O transplante de fígado é o tratamento de escolha para o estágio final da doença hepática e oferece a possibilidade ao paciente de retorno a uma vida ativa e longa. Uma avaliação dentária antes do transplante é recomendada como pre-requisito para a eliminação de infecções orais, as quais podem piorar o quadro do paciente. Este relato de caso se refere a uma fratura radicular de dente anterior em um paciente em tratamento odontológico prévio ao transplante de fígado. No exame clínico, o incisivo central superior direito (11) apresentava-se sem alteração na coloração mas com mobilidade no sentido vestíbulo-lingual, ligeira vestibularização e extrusão, e fístula na gengiva inserida na distal do 11. O paciente relatou ter sofrido traumatismo na região há mais de 30 anos. Ao exame radiográfico, foi identificada uma linha de fratura radicular horizontal no terço médio, associada à lesão óssea indicada por uma área radiolúcida na superfície distal do 11. O tratamento proposto para o caso envolveu procedimentos de raspagem e alisamento subgengival da superfície distal, o tratamento endodôntico radical da porção coronária radicular com posterior obturação com Agregado Trióxido Mineral e imobilização dental. O acompanhamento clínico e radiográfico, em intervalos de três meses, permitiu observar a regressão gradual da lesão, com formação de osso no local, contribuindo para manutenção do quadro de saúde geral e emocional do paciente, preservando seu sorriso e sua qualidade de vida.

Tratamento odontológico prévio a transplante de células tronco-hematopoiéticas: um relato de caso / Dental treatment prior to hematopoietic stem cell transplant: a case report

O linfoma é uma neoplasia malígna que se desenvolve nos gânglios linfáticos e uma possível abordagem terapêutica para esta doença é o transplante de medula óssea. Sob condições de imunossupressão, todo foco infeccioso pode ser ativado e, em função disto, toda infecção ativa em pacientes pré-transplantes de células hematopoiéticas deve ser erradicada previamente, para prevenir ou reduzir riscos de complicações sistêmicasnestes pacientes. Objetivo: Relatar um caso de atendimento odontológico a um paciente com necessidade premente de transplante de células tronco-hematopoiéticas, acometido de Linfoma não-Hodgkin.

Avaliação da resistência de união de reparos de resina composta, utilizando-se diferentes tratamentos de superfície / Evaluation of microtensile bond strength of composite resin repair using different surface treatments

Objetivo: Avaliar a resistência de união de reparos de restaurações em resina composta utilizando-se diferentes tratamentos de superfície. Materiais e Métodos: Foram utilizadas 180 amostras de resina composta Tetric Ceram® (Ivoclar/Vivadent), distribuídas em 9 grupos (n=20/grupo). No momento do reparo, cada grupo recebeu tratamento de superfície específico: ácido fosfórico a 37% (Ivoclar/Vivadent); ácido hidrofluorídrico a 10% (Dentsply) ou microjateamento com partículas de óxido de alumínio de 50μm (Micro Jato VH®). Em seguida, aplicou-se o sistema adesivo Heliobond® (Ivoclar/Vivadent), associado ou não ao agente silanizadorMonobond-S® (Ivoclar/Vivadent). Foram também confeccionados espécimes que não sofreram nenhum tipo de reparo (grupo controle). Os espécimes ficaram armazenados em água deionizada por 18 meses. Posteriormente cada amostra foi submetida ao teste de resistência de união à microtração em máquina de ensaio universal (EMIC DL500BF), a uma velocidade de 0,5 mm/minuto. Os dados obtidos em MPa foram submetidos a avaliação da normalidade da variável microtração por meio do teste Kolmogorov-Smirnov. Considerando quea variável não apresentou distribuição normal (p<0,001) foram realizados os testes de Kruskal-Wallis e Mann-Whitney. O valor de p considerado foi menor que 0,05, exceto, quando se utilizou da correção de Bonferroni(p<0,00138). Resultados: Os espécimes do grupo controle apresentaram resistência à tração estatisticamente superior em relação aos demais grupos. O emprego do ácido fosfórico e posterior inserção do sistema adesivo apresentou resultados estatisticamente significante em relação aos demais grupos reparados. Conclusões: A resistência coesiva da resina composta foi superior às outras técnicas de reparo utilizadas. O emprego do ácido fosfórico e posterior inserção do sistema adesivo demonstrou ser o tratamento ideal para o reparo derestaurações em resina composta.

[Dental loss and prosthetic replacement expectation: qualitative study]. / Perda dentária e expectativa da reposição protética: estudo qualitativo.

This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

[Impact of tooth loss in quality of life]. / Impacto da perda dentária na qualidade de vida.

In order to evaluate the impact of tooth loss in patient's quality of life, 50 volunteers were selected among patients who use the Public Health Services in treatment for their complete denture's placement or replacement. The Oral Health Impact Profile (OHIP-14) and a socio-demographic data collection were applied before treatment. The values were founded through the weight of each question in association with Likert's Scale. As higher was the score, higher was the impact in the quality of life. In this survey 82% were female, 52% of patients between 41 and 60 years old (average: 59.1), and 34% married. The higher values of OHIP-14 dimensions in patient's quality of life were: Psychological Discomfort (122), Physical Pain (121), Psychological Disability (113), Physical Disability (109), Functional Limitation (93), Handicap (82) and Social Disability (76). As it could be observed, the lost of teeth or the use of inadequate prosthesis could bring negative impacts in life's quality, especially regarding preoccupation, stress with mouth problems and shame, although people perceive minor impacts in social relationships and development of their daily activities. This information can be relevant to prepare dentists to raise their knowledge about edentulous people and how to work with them.

Perda dentária e expectativa da reposição protética: estudo qualitativo / Dental loss and prosthetic replacement expectation: qualitative study

Esse estudo qualitativo analisou as repercussões da perda dentária total de usuários do serviço público. Aplicou-se o Oral Health Impact Profile simplificado(OHIP14) a cinquenta voluntários e, após a apuração dos resultados, foram selecionados treze pacientes para entrevistas individuais baseadas em um roteiro com questões abertas. A seleção das pessoas foi de acordo com o grau de percepção do impacto da condição bucal na qualidade de vida, medida pela pontuação OHIP, de forma a incluir a maior variedade de perfis da amostra inicial. Da análise do conteúdo dos depoimentos, verificou-se que a perda dentária total tem forte impacto na vida das pessoas e implica consequências negativas como vergonha, dificuldade em se alimentar, prejuízo ao relacionamento social e sentimento de incompletude. A possibilidade de reposição protética dos dentes gera ansiedade nas pessoas e, embora elas saibam que a utilização das próteses possa representar sacrifícios, a expectativa de retorno ao padrão social geralmente aceito e de recuperação de sua própria imagem rejuvenescida faz valer a pena quaisquer sacrifícios.

This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

Impacto da perda dentária na qualidade de vida / Impact of tooth loss in quality of life

Para avaliar o impacto da perda dentária na qualidade de vida, foram selecionados cinquenta pacientes, usuários do Serviço Público de Saúde, em tratamento para inserção ou substituição do par de dentaduras. Antes do tratamento, aplicou-se o Oral Health Impact Profile (OHIP-14) e a coleta de dados sociodemográficos. Os escores do OHIP-14 foram obtidos por meio do peso de cada pergunta associado à escala de Likert. Maior a pontuação alcançada, maior o impacto negativo da dimensão na qualidade de vida. Na amostra, 82 por cento eram do gênero feminino, 52 por cento tinham 41 a 60 anos (média de 59,1 anos), e 34 por cento eram casados. Para cada dimensão, os valores máximos OHIP-14 foram: desconforto psicológico (122); dor (121); inabilidade psicológica (113); inabilidade física (109); limitação funcional (93); incapacidade (82) e inabilidade social (76). A perda dentária ou o uso de próteses inadequadas implicam impactos negativos na qualidade de vida, especialmente no que se refere à preocupação, estresse decorrente de problemas na boca e à vergonha. Foi percebido menor impacto no que se refere às relações interpessoais e ao desenvolvimento das atividades rotineiras - dimensão inabilidade social. Estas informações são relevantes para os profissionais, pois ampliam seu conhecimento sobre pessoas desdentadas e melhoram sua capacidade de lidar com elas.

In order to evaluate the impact of tooth loss in patient's quality of life, 50 volunteers were selected among patients who use the Public Health Services in treatment for their complete denture's placement or replacement. The Oral Health Impact Profile (OHIP-14) and a socio-demographic data collection were applied before treatment. The values were founded through the weight of each question in association with Likert's Scale. As higher was the score, higher was the impact in the quality of life. In this survey 82 percent were female, 52 percent of patients between 41 and 60 years old (average: 59.1), and 34 percent married. The higher values of OHIP-14 dimensions in patient's quality of life were: Psychological Discomfort (122), Physical Pain (121), Psychological Disability (113), Physical Disability (109), Functional Limitation (93), Handicap (82) and Social Disability (76). As it could be observed, the lost of teeth or the use of inadequate prosthesis could bring negative impacts in life's quality, especially regarding preoccupation, stress with mouth problems and shame, although people perceive minor impacts in social relationships and development of their daily activities. This information can be relevant to prepare dentists to raise their knowledge about edentulous people and how to work with them.

Restabelecimento estético e funcional em pacientes desdentados: percepção e impacto entre usuários da Faculdade de Odontologia da Universidade Federal de Minas Gerais / Aesthetic and functional re-establisment in edentulous patients: perception and impact among weares of Federal University of Minas Gerais School Dentistry

O estudo teve o objetivo de avaliar o impacto da perda dentária total na qualidade de vida de usuários do Serviço Público. Foram adotadas as abordagens quantitativa e qualitativa. A amostra inicial constitui-se de 50 voluntários, aos quais aplicou-se o questionário Oral Health Impact Profile (OHIP14) - metodologia quantitativa. Entre esses, de acordo com o score OHIP, foram intencionamente selecionados 12 para entrevistas - metodologia qualitativa. As entrevistas individuais - duas por paciente - ocorreram antes da incorporação das próteses e seis meses depois...

Os limites da atenção primária no curso de odontologia da Universidade Federal de Minas Gerais / The primary care limits in graduation dentistry course of Universidade Federal de Minas Gerais

Introdução: A Clínica Integrada de Atenção Primária (CIAP) é uma macrodisciplina do curso de Odontologia da UFMG e perpassa cinco dos nove períodos da graduação. O potencial de atendimento destas clínicas é, de no mínimo, 400 pacientes/ semestre, que são encaminhados dos Centros de Saúde da Prefeitura Municipal de Belo Horizonte (PMBH). Na dinâmica de atenção, os pacientes podem permanecer na CIAP por mais de um semestre e, ao concluir o tratamento, são incluídos no Programa de Manutenção Preventiva. Se apresentam demandas por atenção secundária são referenciados para as disciplinas de Endodontia, Dentística, Prótese Fixa, Prótese Removível, Periodontia, Cirurgia e Dor Oro-facial. Este estudo objetivou levantar as principais demandas por atenção secundária entre os pacientes e o tempo de espera para sua absorção na clínica referenciada, criando subsídios para discutir a interface atenção primária/atenção secundária e a melhoria do sistema de controle de pacientes. Métodos: Foram analisados todos os encaminhamentos de pacientes feitos pela CIAP no ano de 2003. O maior número de encaminhamentos foi para a manutenção preventiva e as maiores demandas por atenção secundária foram para endodontia e restaurações metálicas indiretas. O tempo de espera não pôde ser adequadamente analisado devido às falhas de registros nos encaminhamentos, mas dados parciais foram analisados. Conclusões: Concluiu-se que grande parte dos pacientes permanece por mais de dois semestres em tratamento na CIAP, onde suas principais necessidades têm sido solucionadas. São necessárias adequações do sistema de controle de pacientes para desenvolver análises mais aprofundadas.

Introduction: The Integrated Primary Care Clinic (CIAP) is a macro-discipline of the undergraduate orthodontics course of the Federal University of Minas Gerais, and takes up five of the nine semesters required for graduation. The potential caseload of these clinics is at least 400 patients per semester, who are referred by Belo Horizonte Municipal Public Health Centers (PMBH). The dynamics of care-giving allow patients to continue with CIAP for more than one semester and upon conclusion of treatment, to be included in the Preventative Maintenance Program. If they require secondary treatment, they are sent accordingly to the disciplines of Endodontics, Dentistry, Fixed Prosthesis, Removable Prosthesis, Periodontology, Surgery, and Dental-Facial Pain. This study was conducted with the purpose of classifying the most frequent needs among the patients for secondary treatment; measuring the waiting time until assisted by the clinic to which they were referred; and raising issues to discuss improvement in the interface between primary and secondary care and the administration of cases. Method: Ali referrals of patients by CIAP during the year 2003 were analyzed. The greatest number of referrals concerned preventative maintenance, and the most common reason to require secondary treatment was for endodontics and dentistry. The data regarding waiting time could not be adequately analyzed due to failures in record keeping, but partial data were raised. Conclusions: The following conclusions were reached: most patients remain more than two semesters in treatment by CIAP, during which time their principal needs are met. Additionaliy, solutions must be found in the administration of cases in order for more incisive analyses to be made.