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1.
Ned Tijdschr Tandheelkd ; 126(11): 571-578, 2019 Nov.
Artigo em Holandês | MEDLINE | ID: mdl-31730134

RESUMO

Dentists frequently have to deal with anxious children and adults. Whether these patients can be treated successfully in a regular dental office depends on the type of fear and its severity. Proper diagnostic procedures are therefore paramount. This article gives an overview of how dental fear develops, is sustained, and can be treated. It elaborates on the communication skills important in reducing anxiety and preventing children from developing dental fear.


Assuntos
Ansiedade ao Tratamento Odontológico , Relações Dentista-Paciente , Adulto , Criança , Comunicação , Assistência Odontológica , Consultórios Odontológicos , Humanos
2.
Ned Tijdschr Tandheelkd ; 124(4): 215-221, 2017 Apr.
Artigo em Holandês | MEDLINE | ID: mdl-28418416

RESUMO

Dental treatment anxiety is a common fear among children. The dental health care provider is faced with difficult dilemmas about ensuring good oral health for these children in general daily practice. The indicated treatment usually exceeds the capacity of the frightened child, but when treatment is not performed, the child is at risk of serious general health problems and its quality of life could diminish. This article provides an overview of the aetiology of dental treatment anxiety in children. In addition, the dental practitioner is provided with insight into the possibilities that allow him/her to enhance the treatability of the child and reduce anxiety to such an extent that the indicated dental care can be provided. Psychotherapy and cognitive-behavioural techniques, as well as pharmacological therapies, are currently considered the most acceptable and successful treatments for anxiety and phobia. The dental care provider will have to determine a well-motivated and carefully considered course of treatment, always keeping in mind the individual context of the child.


Assuntos
Ansiedade ao Tratamento Odontológico/prevenção & controle , Assistência Odontológica para Crianças/métodos , Relações Dentista-Paciente , Medo/psicologia , Criança , Ansiedade ao Tratamento Odontológico/diagnóstico , Ansiedade ao Tratamento Odontológico/psicologia , Assistência Odontológica para Crianças/psicologia , Humanos , Padrões de Prática Odontológica
3.
Ned Tijdschr Tandheelkd ; 122(3): 139-40, 2015 Mar.
Artigo em Holandês | MEDLINE | ID: mdl-26181390

RESUMO

In the December issue of the Nederlands Tijdschrift voor Tandheelkunde (Dutch Journal of Dentistry) in 2014, an article was devoted to the use of light sedation with midazolam by dentists. A number of dentists who are active in the area of Special Dentistry (anxiety management, care of the disabled) and a anesthesiologist offer a response to the article and argue that the administration of intravenous sedation with midazolam by dentists is unsafe.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Midazolam/efeitos adversos , Segurança do Paciente , Anestesia Intravenosa , Anestésicos Intravenosos/administração & dosagem , Sedação Consciente , Humanos , Midazolam/administração & dosagem , Resultado do Tratamento
4.
J Oral Rehabil ; 42(7): 495-502, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25678327

RESUMO

The Gagging Problem Assessment (GPA) is an instrument to evaluate dental gagging. Although the GPA seemed to be reliable and valid in a pilot study, a replication study with more subjects was needed. Based on the pilot study, the number of items was reduced, resulting in the revised version of the GPA (GPA-R). The aims of this study were to replicate the reliability of the GPA-R and to investigate the correlation between dental gagging and general anxiety. Dental gagging patients (n = 59) were compared with a control group (n = 17) at t0 and 3 weeks later. The 'gagging group' also filled in the SCL-90 anxiety scale. Gagging-specific homogenous domains and internal consistency were determined. Stability and distinguishing capacity of the GPA-R were assessed. SCL-90-Anxiety scores were compared with standard values in a non-clinical population. The GPA-R patient part was able to reliably discriminate between the absence or the presence of dental gagging. However, the reliability of the GPA-R-dentist part was insufficient. The GPA-R seems to be sensitive to subtle differences in acts of the dentists. To overcome these problems, more detailed and explicit instructions on how to use the GPA-R should be formulated and more specific gagging stimuli should be included. The 'gagging group' reported 'fear of choking' significantly more often than the control group (P = 0·008). This finding might be important for the treatment of dental gagging. Considering the outcome of our study, development of a new diagnostic gagging tool needs another approach that focuses on gagging severity.


Assuntos
Ansiedade ao Tratamento Odontológico/psicologia , Assistência Odontológica/psicologia , Engasgo , Psicometria/métodos , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
5.
Eur J Orthod ; 31(5): 529-35, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19299245

RESUMO

Orthodontic tooth movement requires extensive re-modelling of the periodontium. Matrix metalloproteinases (MMPs) degrade the extracellular matrix during re-modelling, while their activity is regulated by the tissue inhibitors of metalloproteinases (TIMPs). The aim of this study was to investigate differences in MMP and TIMP levels in the gingival crevicular fluid (GCF) at the resorption and apposition sides of orthodontically moved teeth, and to compare these with control teeth. GCF samples were collected from eight orthodontic patients wearing fixed appliances with superelastic nickel-titanium coil springs. The samples were analysed by gelatin zymography, which allows detection of both active and latent MMPs, and reverse zymography for analysis of TIMPs. Western blotting was performed to confirm the identity of MMPs. The data were analysed using either the one-way analysis of variance or the Kruskal-Wallis test. In general, higher levels of MMPs and TIMPs were found at both the resorption and apposition sides compared with the control teeth. Remarkably, partially active MMP-1 was found in GCF from both the resorption and the apposition side but was barely present at the control teeth. TIMP-1 was strongly increased at the apposition side. Gelatinases were mainly present at the resorption side, while gelatinolytic fragments were exclusively detected at the apposition side. MMP-9, which is known to be involved in bone degradation, and a 48 kDa gelatinase were increased at the resorption side. The small increase in TIMP-1 at the resorption side might stimulate bone resorption, whereas the large increase at the apposition side reduces bone resorption. The analysis of MMPs and TIMPs may contribute to the improvement of orthodontic treatment regimens.


Assuntos
Líquido do Sulco Gengival/enzimologia , Metaloproteinases da Matriz/análise , Inibidores Teciduais de Metaloproteinases/análise , Técnicas de Movimentação Dentária , Adolescente , Criança , Ligas Dentárias , Precursores Enzimáticos/análise , Feminino , Gelatinases/análise , Humanos , Masculino , Metaloproteinase 1 da Matriz/análise , Metaloproteinase 13 da Matriz/análise , Metaloproteinase 2 da Matriz/análise , Metaloproteinase 8 da Matriz/análise , Metaloproteinase 9 da Matriz/análise , Níquel , Fios Ortodônticos , Periodonto/enzimologia , Fatores de Tempo , Inibidor Tecidual de Metaloproteinase-1/análise , Inibidor Tecidual de Metaloproteinase-2/análise , Titânio , Técnicas de Movimentação Dentária/instrumentação
6.
J Periodontal Res ; 44(2): 266-74, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18973523

RESUMO

BACKGROUND AND OBJECTIVE: Orthodontic tooth movement requires remodeling of the periodontal tissues. The matrix metalloproteinases (MMPs) degrade the extracellular matrix components of the periodontal ligament, while the tissue inhibitors of metalloproteinases (TIMPs) control their activity. Synthetic MMP inhibitors have been developed to inhibit MMP activity. In this study, periodontal ligament cells in contracting collagen gels served as a model for enhanced periodontal remodeling. The effect of MMP inhibitors on gel contraction and on MMP and TIMP expression was analyzed. MATERIAL AND METHODS: Human periodontal ligament cells were cultured in three-dimensional collagen gels and incubated with the MMP inhibitors BB94, CMT-3, doxycycline and Ilomastat. Gel contraction was determined using consecutive photographs. The relative amounts of MMPs and TIMPs were analyzed using substrate zymography and mRNA expression using quantitative polyermase chain reaction. RESULTS: All MMP inhibitors reduced MMP activity to about 20% of the control activity. They all reduced contraction, but CMT-3 and doxycycline had the strongest effect. These inhibitors also reduced MMP-2, MMP-3 and alpha-smooth muscle actin mRNA expression. The expression of MMP-1 mRNA seemed to be increased by CMT-3. No effects were found on the amounts of MMPs and TIMPs. CONCLUSION: Synthetic MMP inhibitors strongly reduced gel contraction by periodontal ligament cells. This was primarily caused by an inhibitory effect on MMP activity, which reduces matrix remodeling. In addition, alpha-smooth muscle actin expression was reduced by CMT-3 and doxycycline, which limits the contractile activity of the fibroblasts.


Assuntos
Análise do Estresse Dentário , Inibidores de Metaloproteinases de Matriz , Ligamento Periodontal/efeitos dos fármacos , Ligamento Periodontal/enzimologia , Actinas/biossíntese , Actinas/efeitos dos fármacos , Técnicas de Cultura de Células , Células Cultivadas , Colágeno/efeitos dos fármacos , Doxiciclina/farmacologia , Eletroforese em Gel de Poliacrilamida , Matriz Extracelular/fisiologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/enzimologia , Géis , Humanos , Ácidos Hidroxâmicos , Indóis/farmacologia , Metaloproteinases da Matriz/biossíntese , Ligamento Periodontal/citologia , Ligamento Periodontal/fisiologia , Fenilalanina/análogos & derivados , Fenilalanina/farmacologia , Inibidores de Proteases/farmacologia , Tetraciclinas/farmacologia , Tiofenos/farmacologia , Inibidores Teciduais de Metaloproteinases/biossíntese , Técnicas de Movimentação Dentária
7.
Arch Oral Biol ; 53(2): 161-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17920032

RESUMO

The main cells in the periodontal ligament (PDL) are the fibroblasts, which play an important role in periodontal remodelling. Matrix metalloproteinases (MMPs) are largely responsible for the degradation of extracellular matrix proteins in the PDL. Previous studies have indicated that MMP production can be stimulated by the hormone relaxin. This hormone facilitates delivery by softening the connective tissues of the reproductive tract, and it prepares the mammary gland for lactation. Periodontal remodelling takes place during orthodontic tooth movement, which might be enhanced by relaxin. Therefore, we investigated the effects of relaxin on gelatinase expression of human PDL cells. Cultures of human PDL cells were incubated with relaxin. Gelatinase (MMP-2 and -9) expression, alpha-smooth muscle actin expression (alpha-SMA), total MMP activity and DNA content were measured. Both proMMP-2 and active MMP-2 was identified in the cultures. There was a clear trend showing a dose-dependent increase of MMP-2 production, which was significant at 250 ng/ml. Total MMP activity was not affected. A stimulation of alpha-SMA expression was found at 50 ng/ml. The results indicate that relaxin activates human PDL cells by the stimulation of MMP-2 and alpha-smooth muscle actin.


Assuntos
Fibroblastos/efeitos dos fármacos , Gelatinases/metabolismo , Metaloproteinases da Matriz/metabolismo , Relaxina/farmacologia , Inibidores Teciduais de Metaloproteinases/metabolismo , Células Cultivadas , Feminino , Fibroblastos/enzimologia , Gelatinases/química , Expressão Gênica , Humanos , Masculino , Metaloproteinases da Matriz/química , Metaloproteinases da Matriz/genética , Ligamento Periodontal/citologia , Inibidores Teciduais de Metaloproteinases/química
8.
Arch Oral Biol ; 52(6): 571-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17174265

RESUMO

OBJECTIVE: Orthodontic tooth movement requires extensive remodeling of the periodontal ligament (PDL) and the alveolar bone. Osteoclasts resorb bone, allowing teeth to migrate in the direction of the force. Matrix metalloproteinases (MMPs) are able to degrade the extracellular matrix of the periodontal tissues. Chemically modified tetracyclines (CMTs) can inhibit MMPs, but lack antimicrobial activity. We hypothesize that CMT-3 will decrease the rate of orthodontic tooth movement in the rat. DESIGN: Eighteen Wistar rats received a standardized orthodontic appliance at one side of the maxilla. During 14 days, three groups of six rats received a daily dose of 0, 6 or 30mg/kg CMT-3, and tooth displacement was measured. Thereafter, osteoclasts were counted on histological sections using an ED-1 staining. Multi- and mononuclear ED-1-positive cells in the PDL were also counted. In addition, sections were stained for MMP-9. RESULTS: CMT-3 significantly inhibited tooth movement (p=0.03) and also decreased the number of osteoclasts at the compression sides in the 30mg/kg group (p<0.05). Significantly more mono- than multinuclear ED-1-positive cells were present in the PDL, but no significant differences were found between the dosage groups. Osteoclasts in the 30mg/kg group seemed to contain less MMP-9 than in the control. CONCLUSIONS: CMT-3 inhibits tooth movement in the rat, probably by reducing the number of osteoclasts at the compression side. This might be due to induction of apoptosis in activated osteoclasts or reduced osteoclast migration. Reduced MMP activity by CMT-3 might also directly inhibit degradation of the organic bone matrix.


Assuntos
Processo Alveolar/efeitos dos fármacos , Inibidores de Metaloproteinases de Matriz , Ligamento Periodontal/efeitos dos fármacos , Tetraciclinas/farmacologia , Técnicas de Movimentação Dentária , Processo Alveolar/patologia , Animais , Contagem de Células , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Masculino , Metaloproteinase 9 da Matriz/análise , Metaloproteinases da Matriz/análise , Glicoproteínas de Membrana/análise , Monócitos/efeitos dos fármacos , Monócitos/patologia , Aparelhos Ortodônticos , Osteoclastos/efeitos dos fármacos , Osteoclastos/patologia , Ligamento Periodontal/patologia , Ratos , Ratos Wistar , Técnicas de Movimentação Dentária/instrumentação , Raiz Dentária/efeitos dos fármacos , Raiz Dentária/patologia
9.
J Periodontal Res ; 41(5): 463-70, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16953823

RESUMO

BACKGROUND AND OBJECTIVE: The purpose of this study was to investigate the effects of chemically modified tetracyclines (CMTs) on the production of gelatinases [matrix metalloproteinase (MMP)-2 and -9] by human periodontal ligament (PDL) cells, and on the activity of recombinant gelatinases. MATERIAL AND METHODS: Human PDL cells were cultured with CMT-1, -3, -5, -7 or -8 in concentrations of 0, 1, 5, 10, 20, 50, 100, 200 and 500 microm. Gelatin zymography was used to determine MMP-2 and -9 production of the cells. The amount of DNA present in the cultures was analyzed using a fluorescent assay. The cytotoxicity of the CMTs was also determined. Recombinant human MMP-2 and -9 were incubated with the CMTs (0-500 microm) and their activity was analyzed using an internally quenched fluorogenic substrate. RESULTS: MMP-2 production was stimulated up to sevenfold by CMT-1, -3, -7 and -8 at low concentrations (10-200 microm). No significant amounts of MMP-9 were produced. In contrast, MMP-2 and -9 activity was reduced by approximately 10-40-fold at higher concentrations (200-500 microm). CMT-5 had no effect on the production or on the activity of MMP-2 and -9. Only CMT-3 and -8 had cytotoxic effects on the PDL cells at the highest concentrations. CONCLUSION: Surprisingly, CMTs are able to stimulate MMP-2 production at relatively low concentrations. However, at higher concentrations they exert a much stronger inhibitory effect on gelatinase activity. A possible stimulatory effect of CMTs on MMP production should be considered in their clinical use.


Assuntos
Metaloproteinase 2 da Matriz/biossíntese , Inibidores de Metaloproteinases de Matriz , Ligamento Periodontal/efeitos dos fármacos , Tetraciclinas/farmacologia , Análise de Variância , Western Blotting , Células Cultivadas , DNA/análise , Eletroforese em Gel de Poliacrilamida , Inibidores Enzimáticos/farmacologia , Gelatina/análise , Humanos , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/biossíntese , Metaloproteinase 9 da Matriz/metabolismo , Ligamento Periodontal/metabolismo , Proteínas Recombinantes/antagonistas & inibidores , Proteínas Recombinantes/metabolismo , Estatísticas não Paramétricas , Tetraciclinas/química , Tetraciclinas/toxicidade
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