The association of oral health with length of stay and mortality in the intensive care unit.

OBJECTIVES: To analyze the relationship between the oral and systemic health status of adult patients admitted to the intensive care unit (ICU) with the length of stay and mortality. MATERIAL AND METHODS: A daily oral examination and oral hygiene were performed in patients admitted to an adult ICU. Dental and oral lesions, systemic health status, the need for mechanical ventilation, length of stay, and mortality were registered. Multivariate linear and logistic regression analyses were performed to identify associations between length of stay and death of patients, respectively, with oral and systemic health status. RESULTS: In total, 207 patients were included, 107 (51.7%) male. Ventilated patients presented an increased length of stay (p < 0.001), mortality (p < 0.0001), number of medications (p < 0.0001), edentulism (p = 0.001), mucous lesions and bleeding (p < 0.0001), oropharyngitis (p = 0.03), and drooling (p < 0.001) compared to non-ventilated patients. The number of days in the ICU was associated with mechanical ventilation (p = 0.04), nosocomial pneumonia (p = 0001), end-stage renal disease (p < 0.0007), death (p < 0.0001), mucous bleeding (p = 0.01), tongue coating (p = 0.001), and cheilitis (p = 0.01). Mortality was associated with length of stay in the ICU (p < 0.0001), number of medications (p < 0.0001), and the need for mechanical ventilation (p = 0.006). CONCLUSION: ICU patients present poor oral health. Soft tissue biofilm and mucous ulcerations were associated with the length of stay in the ICU, but not with the mortality rate. CLINICAL RELEVANCE: Mucous lesions are associated with an increased length of stay in the ICU, and critically ill patients should receive oral care to control oral foci of infection and mucous lesions.

Salivary levels of Interleukin-6 and Tumor Necrosis Factor-alpha in girls aged 7-17 years practicing volleyball / Niveles salivales de interleucina 6 y factor de necrosis tumoral alfa en niñas de 7 a 17 años que practican voleibol

INTRODUCTION: The purpose of the study was to evaluate the salivary concentrations of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNFalfa) and correlate the findings with the caries index, body mass index (BMI), potency of lower limbs (vertical jump), cardiorespiratory fitness, and risk of developing cardiovascular diseases in girls practicing volleyball. MATERIAL AND METHODS: Two studies were performed: 1) a cross-sectional study (n = 120) on the association of IL-6 and TNFalfa with the caries index, anthropometric measures, physical tests, and experience in volleyball practice; 2) longitudinal study (n = 63) on the effects of 8 weeks of training on salivary IL-6 and TNFalfa in girls with intermediate experience in volleyball and competitive girls. RESULTS: The median levels of IL-6 were 1.98 [1.55-3.11] pg/ml and TNFalfa, 0.46 [0.28-0.59] pg/ml and these did not correlate with the caries index, BMI, training volume, training practice, or cardiovascular risk. A correlation was observed between IL-6 and TNFalfa (r = 0.34; p < 0.001), IL-6 and vertical jump height (r = -0.28, p < 0.005), and TNFα and age (r = 0.33; p < 0.001). After 8 weeks of training, TNFα levels increased in the intermediate and competitive groups (p < 0.05), while IL-6 levels decreased only in the intermediate level group (p < 0.05). CONCLUSION: the median levels of IL-6 and TNFalfa did not correlate with the caries index, BMI, training volume, experience practice, or cardiovascular risk. Salivary levels of IL-6 were downmodulated in the group with intermediate experience and TNFalfa was upmodulated by training

INTRODUCCIÓN: el objetivo del estudio fue evaluar las concentraciones salivales de interleukina-6 (IL-6) y factor de necrosis tumoral alfa (TNFalfa) y correlacionarlas con el índice de caries, el índice de masa corporal (IMC), potencia muscular de miembros inferiores (salto vertical), la aptitud cardiorrespiratoria y riesgo de desarrollar enfermedades cardiovasculares en niñas que practican voleibol. MATERIAL Y MÉTODOS: se realizaron dos estudios: 1) un estudio transversal (n = 120) sobre la asociación de IL-6 y TNFalfa con índice de caries, medidas antropométricas, pruebas físicas y experiencia en la práctica de voleibol; 2) estudio longitudinal (n = 63) sobre el efecto de 8 semanas de entrenamiento em IL-6 y TNFalfa salivales en niñas con experiencia intermedia en voleibol y chicas competitivas. RESULTADOS: los niveles medianos de IL-6 fueron 1.98 [1.55 - 3.11] pg/ml y TNFalfa fue 0.46 [0.28 - 0.59] pg/ml y no se correlacionaron con el índice de caries, el IMC, el volumen de entrenamiento, la práctica de entrenamiento y el riesgo cardiovascular. Se observó una correlación entre IL-6 y TNFalfa (r = 0.34; p < 0.001), IL-6 y altura de salto vertical (r = -0.28, p < 0.005), y TNFalfa y edad (r = 0.33; p < 0.001). Después de 8 semanas de entrenamiento, los niveles de TNFalfa aumentaron en los grupos intermedios y competitivos (p < 0.05), mientras que los niveles de IL-6 disminuyeron solo en el grupo intermedio (p < 0.05). CONCLUSIÓN: los niveles medianos de IL-6 y TNFalfa no se correlacionaron con el índice de caries, el IMC, el volumen de entrenamiento, la experiencia práctica y el riesgo cardiovascular. Los niveles salivales de IL-6 se modificaron a la baja en el grupo con experiencia intermedia y el TNFα se moduló al alza mediante el entrenamiento

Sweetness Taste Preference Levels and Their Relationship to the Nutritional and Dental Caries Patterns among Brazilian Preschool Children

Objective: To evaluate the sweetness taste preference levels and their relationship with the nutritional and dental caries patterns among preschool children. Material and Methods: The participants of this cross-sectional study were 191 children aged 4 to 5 years, who were regularly attending public Child Education Centers of a city southern Brazil. Children's preference for sugar was evaluated by the Sweet Preference Inventory; caries prevalence, according to the World Health Organization criteria, and nutritional status, by anthropometric weight and stature measurements, in accordance with child growth standards of the World Health Organization. Results: High levels of sweetness preference were identified. The majority of children (67.5%) opted for the most concentrated sucrose solutions. Excess weight was recorded in 27.7% of the preschoolers. The prevalence of caries was 51.8%, with the mean dmf-t equal to 1.92 (± 2.72) and the decayed (c) component responsible for 94.2% of the index. No significant association between sweetness preference and the nutritional or the oral health patterns could be established. In addition, no association between excess weight and dental caries was identified. The diseases studied were only associated with sociodemographic variables. Excess weight was associated with maternal age (p=0.004) and caries experience with family income (p=0.013). Conclusion: No significant associations could be stablished between the sweetness taste preference and the diseases studied, nor between excess weight and dental caries. However, the findings of high patterns of sweet preference, excess weight and untreated caries experience, highlight the need for the implementation of integrated public policies aimed at controlling both nutritional and of oral health problems in the studied population.

Adesão do Selante Clinpro™ XT à Superfície Oclusal de Molares Decíduos: Avaliação Longitudinal / Clinpro ™ XT Sealant Adhesion to the Occlusal Surface of Primary Molars: Longitudinal Evaluation

The study aims to evaluate the bond strength of sealants on deciduous molars. Clinpro ™ XT, Vitremer ™, Fluroshield and Optibond FL materials were applied to the occlusal surface of 40 deciduous lower molars (n = 5). The teeth were prepared for the micro tensile test, obtaining a specimen in a stick format with a cross-sectional area of 0.8 mm2 . After 24 hours and 6 months of restorative procedures, the specimens were traversed in universal test machine. The statistical analysis used the tooth as experimental unit, considering the adhesive and mixed fractures data, through Variance Analysis of repeated measures and Tukey tests (α = 0.05). There was a difference among the adhesion of the materials in 24 h, with higher union strength for Optibond FL (31.20 ± 1.36 MPa), significantly higher than that of Clinpro ™ XT (20.23 ± 1.16 MPa), Fluroshield (24.61 ± 2.76 MPa) and Vitremer™ (21.31 ± 2.32 MPa), which were similar. After 6 months of storage, the Clinpro ™ XT bond strength remained (22.18 ± 2.91 MPa), Optibond FL decreased (20.77 ± 1.53 MPa), but remained similar to that of Clinpro ™ XT in 6 months. The lowest adhesion values at 6 months were of Fluroshield (11.14 ± 1.98 Mpa) and Vitremer (5.29 ± 0.58 Mpa). It was concluded that the bond strength of the sealants to the occlusal surface of the deciduous molars was influenced by the material, with Clinpro ™ XT being the only material that maintained the bond strength values after 6 months. (AU).

O presente estudo teve como objetivo avaliar a adesão de selantes em molares decíduos. Os materiais Clinpro™ XT, VitremerTM, Fluroshield e Optibond FL foram aplicados na superfície oclusal de 40 molares inferiores decíduos (n=5). Os dentes foram preparados para o ensaio de microtração, com obtenção de corpo-de-prova em formato de palito com área de seção transversal de 0,8 mm2 . Após 24 horas e 6 meses da realização dos procedimentos restauradores, os espécimes foram tracionados em máquina de ensaio universal. A análise estatística usou como unidade experimental o dente, considerando os dados de fraturas adesivas e mistas, pelos testes de Análise de Variância de medidas repetidas e Tukey (α=0,05). Houve diferença entre a adesão dos materiais em 24 h, com maior resistência de união para o Optibond FL (31,20 ±1,36 MPa), significativamente maior que a do Clinpro™ XT (20,23 ±1,16 MPa); Fluroshield (24,61 ±2,76 MPa) e VitremerTM (21,31 ±2,32 MPa) foram semelhantes. Decorridos 6 meses de armazenamento, a resistência de união do Clinpro™ XT se manteve (22,18 ±2,91 MPa) e a do Optibond FL diminuiu (20,77 ±1,53 MPa) mas se manteve semelhante à do Clinpro™ XT em 6 meses. Os menores valores de adesão em 6 meses foram do Fluroshield (11,14 ±1,98 Mpa) e do Vitremer (5,29 ±0,58 Mpa). Concluiu-se que a resistência de união dos selantes à superfície oclusal dos molares decíduos foi influenciada pelo material, sendo o Clinpro™ XT o único material que manteve os valores de resistência de união após 6 meses. (AU).

Salivary levels of SIgA and perceived stress among dental students / Imunoglobulina A salivar e fatores de estresse em estudantes de odontologia

Background: Academic stress may impair mucosal immunity and expose dental students to an increased risk of infections. Objective: to assess stress scores in dental students and their relationship with variation in SIgA levels. Methods: All students (n = 289) were invited to take part of the study, and 207 (71.63%) effectively participated, being 152 (73.4%) females. At the day of data collection, the students answered The Dental Environmental Stress Questionnaire (DES) and unstimulated saliva samples were collected for determination of salivary flow rate and SIgA concentration and secretion rate. Results: Mean DES scores were higher in females (78.97 ± 16.42), but no correlations between the sum of DES scores and salivary parameters were observed (P=0.08). A moderate inverse relationship was observed between SIgA secretion rates and the subscales Academic Performance (P=0.01), Interpersonal relationships (P=0.02) and Difficulties and Insecurities about Professional Future (P=0.05). A weak correlation was found between SIgA concentration and the items Amount of assigned classwork (P=0.02), Lack of confidence in self to be a successful dentist (P=0.01), Lack of time for relaxation (P=0.01), Financial responsibilities (P=0.02) and Personal physical health (P=0.005). Weak correlations between SIgA secretion rates and DES items were also found for Lack of cooperation by patient in their home care (P=0.003), Patients being late or not showing up for their appointments (P=0.02), Lack of self confidence to be a successful dentist (P=0.008), Personal physical health (P=0.019), and others. Conclusion: Different sources of stress were observed among first to fifth year students and some of these stressors may negatively impact on salivary SIgA secretion. (AU)

Introdução: o estresse acadêmico pode prejudicar a imunidade das mucosas e expor os estudantes de odontologia a um maior risco de infecções. Este estudo teve como objetivo avaliar os fatores de estresse em estudantes de odontologia e sua relação com a variação nos níveis de SIgA. Metodologia: Todos os alunos (n = 289) foram convidados a fazer parte do estudo, dos quais 207 (71,63%) participaram efetivamente, sendo 152 (73,4%) do sexo feminino. No dia da coleta de dados, os alunos responderam ao Questionário de Estresse no Ambiente Odontológico (DES) e foram coletadas amostras de saliva não estimuladas para determinação da taxa de fluxo salivar, da concentração de SIgA e da taxa de secreção. Resultados: os escores do DES foram maiores no gênero feminino (78,97 ± 16,42), mas não foram observadas correlações entre a soma dos escores DES e os parâmetros salivares (P = 0,08). Observou-se uma relação inversa moderada entre as taxas de secreção de SIgA e as subescalas Desempenho Acadêmico (P = 0,01), Relações Interpessoais (P = 0,02) e Insegurança em relação ao futuro profissional (P = 0,05). Uma correlação fraca foi encontrada entre a concentração de SIgA e os itens quantidade de trabalho exigido em sala de aula (P = 0,02), falta de autoconfiança para ser um dentista de sucesso (P = 0,01), falta de tempo para relaxar ou para lazer (P = 0,01), responsabilidades financeiras (P = 0,02) e saúde física pessoal (P = 0,005). Também foram encontradas correlações fracas entre as taxas de secreção de SIgA e os itens DES para falta de cooperação por parte do paciente em seus cuidados (P = 0,003), Atraso ou falta de pacientes nas consultas (P = 0,02), falta de autoconfiança para ser um dentista bem sucedido (P = 0,008), saúde física pessoal (P = 0,019) e outros. Conclusão: diferentes fontes de estresse foram observadas entre os estudantes do primeiro ao quinto ano e alguns desses fatores podem afetar negativamente a secreção de SIgA. (AU)

Anti-dentine Salivary SIgA in young adults with a history of dental trauma in deciduous teeth.

Anti-dentin autoantibodies are associated with inflammatory root resorption in permanent teeth and are modulated by dental trauma and orthodontic force. However, it is not known whether deciduous tooth trauma can stimulate the development of a humoral immune response against dentin. The aim of this study was to evaluate the levels of salivary SIgA reactivity against human dentin extract in young adults with a history of trauma in the primary dentition. A sample of 78 patients, aged 18 to 25, who had completed an early childhood (0 to 5 years old) caries prevention program years earlier at the Universidade Estadual de Londrina Pediatric Clinic, underwent radiographic examination and salivary sampling. Anti-dentin SIgA levels were analyzed by immunoenzymatic assay and Western blotting. Although dental trauma to deciduous teeth had occurred in 34 (43.6%) of the patients, no differences in SIgA levels were detected between individuals who had experienced trauma and those who had not (p > 0.05). Multivariate regression analysis showed no association between dental trauma and SIgA levels (p > 0.05). Patients with a history of deciduous trauma presented low levels of anti-dentin antibodies, associated with orthodontic root resorption (p < 0.05). Western blot analysis showed that salivary antibodies recognized a single band of approximately 45 kDa in dentin extract. We concluded that salivary SIgA recognizes a specific component of the dentin matrix and that anti-dentin antibodies were not triggered by trauma to primary teeth. However, trauma to deciduous teeth may down-modulate SIgA in response to orthodontic root response.

Anti-dentine Salivary SIgA in young adults with a history of dental trauma in deciduous teeth

Anti-dentin autoantibodies are associated with inflammatory root resorption in permanent teeth and are modulated by dental trauma and orthodontic force. However, it is not known whether deciduous tooth trauma can stimulate the development of a humoral immune response against dentin. The aim of this study was to evaluate the levels of salivary SIgA reactivity against human dentin extract in young adults with a history of trauma in the primary dentition. A sample of 78 patients, aged 18 to 25, who had completed an early childhood (0 to 5 years old) caries prevention program years earlier at the Universidade Estadual de LondrinaPediatric Clinic, underwent radiographic examination and salivary sampling. Anti-dentin SIgA levels were analyzed by immunoenzymatic assay and Western blotting. Although dental trauma to deciduous teeth had occurred in 34 (43.6%) of the patients, no differences in SIgA levels were detected between individuals who had experienced trauma and those who had not (p > 0.05). Multivariate regression analysis showed no association between dental trauma and SIgA levels (p > 0.05). Patients with a history of deciduous trauma presented low levels of anti-dentin antibodies, associated with orthodontic root resorption (p < 0.05). Western blot analysis showed that salivary antibodies recognized a single band of approximately 45 kDa in dentin extract. We concluded that salivary SIgA recognizes a specific component of the dentin matrix and that anti-dentin antibodies were not triggered by trauma to primary teeth. However, trauma to deciduous teeth may down-modulate SIgA in response to orthodontic root response.

Avaliação dos níveis de SIgA salivar anti-dentina em pacientes adultos jovens que sofreram traumatismo da dentição decídua

A dentina pode induzir uma resposta imunológica específica, que está associada à reabsorção radicular inflamatória. Reações inflamatórias locais, como traumatismo dentário e aplicação de forças de movimentação ortodôntica estão relacionados a aumento nos níveis de anticorpos específicos contra antígenos dentinários. No entanto, não se conhece os efeitos do trauma da dentição decídua sobre o desenvolvimento de auto-imunidade contra a dentina. O objetivo do presente estudo é avaliar os níveis de Imunoglobulina A secretora (SIgA) salivar anti-dentina em pacientes adultos jovens que sofreram traumatismo da dentição decídua. Participaram da pesquisa 78 indivíduos, com idade entre 18-25 anos, que foram atendidos pela Clínica de Bebês da Universidade Estadual de Londrina, sendo que 34 pacientes sofreram traumatismo na dentição decídua. Foram realizados exames clínico e radiográfico, e coleta de saliva. A saliva foi submetida a ensaio imunoenzimático para determinação de níveis salivares de SIgA anti-extrato dentinário. Não foram encontradas diferenças nos níveis de anticorpos salivares e na taxa de secreção entre os indivíduos que apresentaram traumatismo da dentição decídua ou sem história de trauma (P>0,05). A análise de regressão linear não demonstrou associação entre a idade em que ocorreu o traumatismo da dentição decídua, traumatismo da dentição permanente e tratamento ortodôntico prévio com os níveis de anticorpos e taxa de secreção de SIgA anti-extrato dentinário (P>0,05). O ensaio de Western blotting demonstrou o reconhecimento por anticorpos SIgA da fração específica de proteína de extrato dentinário humano com massa molecular de aproximadamente 45 kDa. Além disso, níveis significantemente mais baixos de anticorpos SIgA anti-dentina foram observados em pacientes com história de trauma da dentição decídua, que realizaram tratamento ortodôntico e apresentaram reabsorção de incisivos permanentes (P<0,05). Os resultados obtidos sugerem que o traumatismo...