Pulpectomies with Iodoform Versus Calcium Hydroxide-Based Paste: A Preliminary Randomised Controlled Clinical Trial

ABSTRACT Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies.

Conhecimento, percepções e práticas de uma equipe de enfermagem sobre saúde bucal em ambiente hospitalar: uma abordagem qualitativa / Knowledge, perceptions and practices of a nursing team on oral health in a hospital: a qualitative research

A odontologia hospitalar tem demonstrado maior preocupação com a abordagem integral do paciente, visto que o não tratamento ou agravamento de patologias da cavidade bucal podem impactar a saúde geral. O objetivo deste estudo foi analisar, em caráter exploratório e com uma abordagem qualitativa, o conhecimento, as percepções e práticas da equipe de enfermagem sobre a saúde bucal em ambiente hospitalar. A amostra foi composta por 2 enfermeiras e 6 técnicas em enfermagem. A coleta de dados foi feita através de entrevista semi-estruturada e a análise do conteúdo foi realizada em 3 núcleos temáticos: práticas de higiene, conhecimentos sobre saúde bucal e significados dos cuidados em saúde. Diante dos dados obtidos, foi possível observar deficiência com relação ao conhecimento, percepção e prática quanto aos cuidados com a saúde bucal em ambiente hospitalar, bem como a necessidade de orientação e capacitação da equipe de enfermagem para executar tais cuidados. Concluiu-se que necessária a adoção de medidas voltadas a atenção a saúde bucal, com vista à promoção da saúde, reforçando a importância do cuidado com a saúde bucal como parte integrante do restabelecimento da saúde geral, de forma integral ao paciente hospitalizado.

The hospitalar dentistry has shown greater concern with the the integral approach of patients, since the non-treatment or deterioration of pathologies of the oral cavity can impact their general health. The aim of this study was to analyze, using a qualitative approach of an exploratory nature, the knowledge and practices of the nursing staff on oral health in a hospital. The sample consisted of 2 nurses and 6 nursing techniques. Data collection was done through semi-structured interviews and the content analysis was performed on 3 thematic groups: practice and hygiene, oral health knowledge, meanings of health care. According to the obtained data, it was possible to observed the lack of attention regarding the oral health care in hospitals, as well as the need for guidance and training of nursing staff to perform such care. It could be concluded that it is necessary to adopt measures focused on oral health care, to promote health, reforcing the importance of oral health, in an integral part of reestablishment of general health, in full attention to hospitalized patient.

The clinical practice of Pediatric Dentistry post-COVID-19: The current evidences.

The Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV-2 virus has quickly spread all over the world, directly affecting the dentistry practice. This study aimed to perform a literature review about the current evidences on biosafety practices and clinical recommendations regarding the return to the elective dental care in the practice of Pediatric dentistry. An electronic search was performed in PubMed, Scopus, Web of Science and Grey literature databases using the terms "Pediatric dentistry" and "COVID-19". Initially, 38 studies were retrieved. After title and abstract were read, it was identified that 22 studies referred specifically to children's dental practice. A total of 19 studies were included in this study. The COVID-19 pandemic will imply significant changes in the reorientation of dental practices, from biosafety issues to technical procedures. Greater rigor in the use of Personal Protective Equipment (PPE) may cause strangeness for children. Consequently, an improvement in the management of patient's behavior before and during the treatment and new approaches to perform the procedures will be demanded. Non-aerosol techniques and minimally invasive procedures will be preferable whenever possible. Professionals will need to be constantly updated based on what the scientific literature recommends. The moment is suitable for the use of preventive practice and minimally invasive techniques.

Proteção da vitalidade dentino-pulpar em odontopediatria: uma revisão de literatura / Dentin-pulp protection in pediatric dentistry: a review

Dentin and pulp are considered interdependent substrates, known as the dentin-pulp complex. In front of injuries such as caries and trauma, this complex should be protected with restorative materials considered to be protective agents. An ideal material should have properties such as biocompatibility, be antimicrobial, be insoluble in the oral environment, be thermal and electrically insulating, have therapeutic potential, and adequate mechanical properties. As these characteristics are not found in all materials, the dentist must know the advantages and disadvantages of those that are available. This study aimed to perform a critical review of the indirect materials indicated for the protection of dentin-pulp vitality (PDPV) to ensure the success of indirect pulp treatment in primary teeth. A search was carried out in books, theses, dissertations, monographs, printed articles and databases, PubMed, SciELO, and MEDLINE. According to the literature, the success in protecting the dentin-pulp vitality is achieved through an excellent marginal seal, preventing bacterial infiltration in the dentin and controlling the progression of caries. Further clinical studies are needed to evaluate other outcomes after indirect pulp treatment. There isn't a material that has all the desired characteristics for PDPV, and recent studies show that the key to PDPV isn't found in the protective material, but in the restorations marginal sealing, enabling the inactivation of the progression of dental caries.

A dentina e a polpa são consideradas substratos interdependentes, conhecido como complexo dentino-pulpar. Frente a injúrias como cárie e traumatismo, deve-se realizar a proteção desse complexo, baseando-se na inserção de materiais restauradores considerados agentes protetores. Os materiais considerados ideais devem apresentar propriedades como: biocompatibilidade, ser antimicrobiano, ser insolúvel ao meio bucal, ser isolante térmico e elétrico, ter potencial terapêutico e propriedades mecânicas adequadas. Como essas características não são encontradas em todos os materiais, é importante que o cirurgião-dentista conheça as vantagens e as desvantagens daqueles que estão disponíveis comercialmente. O objetivo deste trabalho foi realizar uma revisão crítica da literatura sobre os materiais indicados para proteção indireta da vitalidade dentino-pulpar (PVDP), em dentes decíduos. Para isso, foram pesquisados livros, teses, dissertações, monografias, artigos impressos e das bases de dados, PubMed, SciELO e MEDLINE. De acordo com a literatura, observou-se que a garantia de êxito na proteção da vitalidade dentino-pulpar é alcançada por meio de um ótimo selamento marginal, impedindo a infiltração bacteriana na dentina e controlando a progressão da cárie. São necessários mais estudos clínicos que avaliem outros desfechos após o tratamento indireto da polpa. Não existe um material que possua todas as características desejadas para a PVDP, e estudos recentes demonstram que a chave não se encontra no material protetor, mas sim na vedação marginal das restaurações, propiciando a inativação da progressão da cárie dentária.

A importância da equipe multidisciplinar no manejo clínico frente à alteração na cronologia de irrupção / The importance of a multidisciplinary team in the clinical management of chronological changes of teeth

A cronologia de irrupção é de fundamental importância em se tratando da busca por uma oclusão balanceada. Contudo, certas patologias podem alterar a cronologia e com isso influenciar o estabelecimento da oclusão. O odontoma é o tipo mais comum de tumor odontogênico, sendo representado por 70% dos casos cuja formação é definida como má-formação benigna. A localização mais frequente é observada na região anterior da maxila, sendo o dente canino o mais envolvido, entretanto exceções tem sido observada. Este trabalho teve por objetivo avaliar a importância da inter-relação de especialidades no diagnóstico e conduta frente à alterações na cronologia de irrupção de dentes permanentes. Realizou-se revisão da literatura sobre a temática, nas bases Medline via PubMed, SciELO e Bireme, até novembro de 2017. Os descritores utilizados foram "pediatric dentistry", "unerupted" e "dental eruption". Pode-se constatar a existência de poucos trabalhos descrevendo a importância da inter-relação entre especialidades, sendo mais divulgados revisões de literatura sobre determinadas patologias, bem como relatos de casos, com as condutas frente a existência de tais patologias. Diante do exposto, acredita-se que quando as especialidades trabalham em conjunto, o desdobramento do caso clínico faz-se de forma adequada, beneficiando o prognóstico, além de melhorar a qualidade de vida do paciente.

The chronology of irruption has fundamental role when it is considered the balanced occlusion. However, some pathologies may alter the chronology and thereby influence the establishment of the occlusion. This study aimed to evaluate the importance of the interrelation of specialties in the diagnosis and management of changes in the chronology of permanent teeth eruption. In the first paper, a review of the literature on the subject was carried out in the Medline databases via PubMed, SciELO and Bireme, until November 2017. The descriptors used were "pediatric dentistry", "unerupted" e "dental eruption". It was possible to verify the existence of few studies describing the importance of the interrelation between specialties, being more published literature reviews on certain pathologies, as well as case reports, with managements used with such pathologies. It could be concluded that when the different specialties work together, the unfolding of the clinical case is done adequately, benefiting the prognosis, besides improving the quality of life of the patient.

Effect of storage time and chlorhexidine addition on the mechanical properties of glass ionomer cements

Aims: To evaluate the effect of the chlorhexidine (CHX) incorporation and the storage time on the mechanical properties of glass ionomer cements (GICs). Methods: The following GICs were evaluated: Ketac Molar Easymix (KM), Vidrion R (VR) and Vitromolar (VM), containing or not CHX. GIC liquid was modified by adding 1.25 % CHX digluconate and then manipulated with the power and placed into the stainless steel cylindrical or bar-shaped molds. GICs specimens were stored into water for 1, 7 and 28 days. After these periods, specimens were submitted to flexural, diametral tensile and compressive strength tests, according to ISO standards. Data from mechanical tests were statistically analyzed using 2-way ANOVA and Tukey tests. Results: Overall, the storage time did not influence any of the mechanical properties of the GICs tested. In contrast, the inclusion of CHX reduced significantly these properties for all GICs tested. KM presented the highest values of compressive strength for all storage times. KM + 1.25% CHX had lower compressive strength results than KM, however, it showed similar results when compared to another GICs without CHX. Conclusions: The presence of chlorhexidine, independent of the storage time, interfered on the mechanical characteristics of GIC (AU)

Oral rehabilitation in mixed dentition: the challenge of replacing permanent teeth

Aim: To present the report of a female patient, 10 years old, referred for treatment in the Dentistry Clinic of a Brazilian public university. Case report: The patient's oral health condition was unfavorable with biofilm accumulation, pain report and chewing difficulty. After anamnesis, clinical and radiographic examination, the treatment plan included removal of infectious foci (54, 55, 64, 65, 74, 75, 85, 16, 36 and 46) followed by prosthetic rehabilitation. At this stage, the functional restoration of the lower arch was restricted by the imminent eruption of the premolars. In the upper arch, the maintenance of the mesio-distal diameters aims to guarantee the chronological sequence of successors irruption and establishment of normal occlusion. During the monthly follow-up consultations the patient presents a more spontaneous smile, although she still needs constant reinforcement in oral hygiene habits. Conclusions: The rehabilitation of patients with loss of permanent teeth during the mixed dentition phase should consider the peculiarities of this period for the restoration of health without altering the normal pattern of occlusal development.

Impacto da Política Nacional de Saúde Bucal – Programa Brasil Sorridente – sobre a provisão de serviços odontológicos no Estado do Rio de Janeiro / Impact of the Brazilian Oral Health Policy – Programa Brasil Sorridente – on the provision of public dental services in the State of Rio de Janeiro

Resumo Esse estudo tem por objetivo avaliar o impacto da atual Política Nacional de Saúde Bucal, conhecida como Programa Brasil Sorridente (PBS), sobre a provisão de serviços odontológicos no Estado do Rio de Janeiro. Para tanto, foi investigada a evolução na disponibilidade de serviços focalizados pela PBS, entre o ano de implantação e 2010. Os itens analisados foram: Atenção Básica – Estratégia Saúde da Família: evolução no número de equipes de saúde bucal, e procedimentos (ações básicas, primeira consulta programática, preventivos coletivos, preventivos individuais, cirúrgicos) por habitante;Atenção Especializada: identificação dos municípios que possuem Centros de Especialidades Odontológicas – CEO, verificação da evolução dos procedimentos endodônticos e periodontais; e Fluoretação da águas: presença ou não de água fluoretada. De acordo com os resultados observou-se evolução nos indicadores analisados, os quais foram distintos segundo o porte demográfico dos municípios. Conclui-se que a PNSB favoreceu a organização dos serviços de saúde bucal nos municípios fluminenses, embora ainda existam desafios a serem superados.

Abstract This study aims to assess the impact of the current Brazilian Oral Health Policy (BOHP), named Programa Brasil Sorridente (PBS) on the provision of public dental services in the State of Rio de Janeiro. Therefore, the evolution in the availability of services focused on PBS, between 2004 and 2010, was investigated. The items discussed were: Primary Care – Family Health Strategy: evolution in the number of oral health teams, and procedures (basic actions, the first programmatic consultation, preventive collective, individual preventive, surgical), per capita; Specialized Care: identification of municipalities that have specialized dental clinics – CEO, checking the progress of periodontal and endodontic procedures, and Water fluoridation: presence or absence of fluoridated water. According to the results it was observed changes in the indicators analyzed, which were different according to the municipalities demographic size. It is concluded that the BOHP favored the organization of oral health services in the cities of Rio de Janeiro, although there are still challenges to overcome.

Effect of an erosive challenge on the enamel-composite resin interface in primary teeth: an in vitro study

AIM: The aim of this study was to evaluate whether different adhesive systems (etch-and-rinse or self-etch) render enamel-composite resin interface in primary teeth more susceptible to erosive challenge. MATERIAL AND METHODS: Thirty enamel specimens from caries-free primary incisors were selected and cavities were prepared for restoration. According to adhesive protocols, specimens were divided into groups: G1 (Adper Single Bond 2), G2 (Adper SE Plus), and G3 (35% phosphoric acid + Adper SE Plus). After restorative procedures, half of the surface of enamel and restorative material was protected with nail varnish, thus, only half of the sample was subjected to the erosive challenge (immersion in Coca-Cola®, 3 cycles of 5 minutes, for 5 days). Samples were analysed quantitatively through Knoop microhardness, the indentations were made on enamel-composite interface. Data were submitted to statistical analysis (Student's t test, two-way ANOVA, p<0.05). RESULTS: It showed that different adhesive systems did not significantly affect the percentage of superficial microhardness change after an erosive challenge (p=0.387). However, although no significant difference was observed, G2 (self-etch system) showed the lowest percentage of superficial microhardness change. CONCLUSION: The use of different adhesive systems did not influence superficial microhardness of enamel-composite interface after an erosive challenge. The incomplete removal of the smear layer, though self-etch systems, suggests a greater ability to withstand the erosive challenge on the enamel-resin interface.