Daily Toothbrushing Frequency and the Association with Parental Report of Dental Pain and Discomfort in Preschool Children

Abstract Objective: To evaluate the impact of daily toothbrushing frequency on parental reports of dental pain and discomfort in preschoolers. Material and Methods: An observational cross-sectional study was conducted involving 376 children between four and five years of age at public preschools in the city of Campo Magro, Brazil. Parents/guardians answered a socioeconomic questionnaire that contained a single question on the child's daily toothbrushing frequency and the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B). Statistical analysis involved bivariate and multivariate Poisson regression analyses (α=0.05). Results: After the adjustments in the multivariate analysis, the prevalence of dental pain and discomfort was lower among children whose last visit to the dentist was for prevention (PR = 4.42; 95% CI: 1.75- 11.14; p=0.002) and those with a higher daily toothbrushing frequency (PR = 2.13; 95% CI: 1.12-4.05; p=0.021). Conclusion: A lower toothbrushing frequency is associated with parental reports of dental pain and discomfort in preschoolers. Educational and preventive measures that stimulate an increase in daily toothbrushing frequency can contribute to a better oral health status in preschoolers, consequently, less prevalence of dental pain and discomfort.

Community pharmacy staff oral health training, training needs and professional self-efficacy related to managing children's dental problems.

OBJECTIVES: Few studies have explored the oral health training needs and professional self-efficacy (PSE) in both pharmacy support staff and pharmacists related to managing children's dental problems. This study assessed community pharmacy staff perceptions of their (i) training experiences and interests; (ii) PSE; and (iii) whether this was influenced by the pharmacy being part of a minor ailment scheme (MAS), where staff could directly offer advice and issue prescription medications without patients seeing a doctor. METHODS: All of the 1851 community pharmacies across London, UK, were invited to participate in an online questionnaire. Staff rated their prior training, perceived need for further training and confidence in giving parents advice related to three dental problems in children (dental pain, mouth ulcers and dental trauma). Information was collected about staff roles and whether the pharmacy was a MAS. KEY FINDINGS: From 752 community pharmacies, 846 community pharmacy staff participated. Positive experiences of training were variable but interest in further training for all three dental problems was high. Pharmacy support staff had significantly lower PSE scores than pharmacy professionals (P = 0.009). A significant interaction showed that pharmacy staff who had poorly rated prior training on advising parents about managing their child's dental pain and who did not work in a MAS had lower PSE scores than staff who had highly rated training and who worked in a MAS (P = 0.02). CONCLUSIONS: Minor ailment scheme pharmacies may be an optimal environment for frontline pharmacy support staff to develop higher PSE when combined with good quality oral health training.

A program review of a community-based oral health care program for socially vulnerable and underserved citizens in Denmark.

OBJECTIVES: To describe the oral health and oral health-related quality of life among social vulnerable adults enrolled in a special oral care program, and to evaluate the effect of oral care on their oral health-related quality of life. METHOD: Social workers identified social vulnerable persons in social centres and referred them to the program. Dental clinics were arranged including a well-motivated staff to be special responsive to these clients. The participants, (n = 235, mean age 43.5 years) with drug abuse, being homeless, permanently unemployed, or with mental problems were offered low-cost treatment services. Data collection was made by clinical registration and questionnaires. Oral health-related quality of life was measured by means of the Oral Health Impact Profile-14 index (OHIP-14). RESULTS: 94% of the participants had actual decayed teeth (mean 9.5). Forty-four per cent had not visited a dentist within 5 years and less than one-third reported tooth brushing twice a day, 17% even less frequent. One hundred and forty-six completed the dental program within the program period. Mean OHIP-14 score was 28.6 at baseline. Among those who fulfilled the program, the OHIP-14 score was reduced to 9.9 (p < .001). CONCLUSION: Oral health among the study population was very poor. However, oral problems in this group can be solved, and their oral health-related quality of life can be increased although it requires special arrangements and special clinical environment.

Lesões cervicais não cariosas: uma abordagem no controle da dor e tratamento

Objetivo: o objetivo deste trabalho é relatar um caso clínico de hipersensibilidade severa associada a múltiplas lesões cervicais não cariosas, entender o mecanismo de ação e a eficácia dos agentes dessensibilizantes. Relato de caso: paciente do gênero masculino, 38 anos de idade, compareceu à clínica da Faculdade Morgana Potrich com um quadro de hipersensibilidade em vários elementos, bem como, a presença de lesão cervical não cariosa em alguns desses elementos. Durante a anamnese o paciente relatou o hábito de escovar os dentes várias vezes ao dia logo após se alimentar, exercendo muita força durante o ato, relatou também fazer consumo diário de cerveja que possui um pH ácido. Ao realizar análise da oclusão notou-se um desequilíbrio oclusal e contato prematuro nos dentes 24 e 34. O tratamento de escolha para esse caso foi o ajuste oclusal seguido do uso de dessensibilizantes e restaurações em resina composta nos dentes que havia a presença de lesões cervicais não cariosas com perda de estrutura dentária. Considerações finais: após esse tratamento, realizado em várias sessões, foi possível devolver ao paciente a função e eliminar a dor provocada pela hipersensibilidade, proporcionando uma melhor qualidade de vida para esse paciente.

Objective: This study aims to report a clinical case of severe hypersensitivity associated with multiple non-carious cervical lesions and to understand the mechanism of action and the efficacy of desensitizing agents. Case report: A 38-year-old male patient attended the clinic at Faculdade Morgana Potrich with the hypersensitivity of several elements and the presence of non-carious cervical lesion in some of these elements. During anamnesis, the patient reported the habit of toothbrushing several times a day soon after eating, exerting a lot of force in such activity; he also reported the daily consumption of beer, which has an acidic pH. The occlusal analysis showed occlusal disorder and premature contact in teeth 24 and 34. The treatment of choice for this case was the occlusal adjustment followed by the use of desensitizers and composite resin restorations on the teeth with non-carious cervical lesions with loss of dental structure. Final considerations: After this treatment, which was performed in several sessions, it was possible to return function to the patient and eliminate the pain caused by hypersensitivity, providing a better quality of life for this patient.(au)

Oral health awareness in school-going children and its significance to parent's education level.

BACKGROUND: The oral health imparts a major impact on one's quality of life. Since last decades, there is an increase in the prevalence of dental afflictions which can be avoided by the knowledge of simple preventive measures. AIM: The aim of this study was to assess the oral health status of children and to analyze its association with the education level of their parents. MATERIALS AND METHODS: Two randomly schools were selected and all the children from 5-15 years willing to participate in the present cross-sectional study were assessed for oral health status using the World Health Organization for the oral health awareness in children, 2004. Both child and parents were directly interviewed to avoid any bias in understanding the questionnaire. Statistical Package for the Social Sciences (16.0) was used for data analysis. Chi-square/Fisher's exact test was used to compare the dichotomous variables. RESULTS: A total of 210 (133 males and 77 females) children were assessed along with their parents for the awareness of child's oral health condition. Totally 134 (63.3%) children were of age group 5-10 years, while 76 (36.7%) children were of age group 11-15 years. Children with uneducated parents have often experienced toothache, brushes once a daily and frequently visits the dentist for toothache compared to children of educated parents, and this association was observed to be statistically significant (<0.001). CONCLUSION: The oral health status of children was average. However, education level and awareness of parents regarding oral health preventive measures play a key role in determining the oral health of children.

Supplementary techniques for pain control during root canal treatment of lower posterior teeth with irreversible pulpitis: A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate utilisation of supplementary techniques for pain control during root canal treatment of lower molars with irreversible pulpitis. The literature was searched using electronic databases up to year 2012. Seventeen studies with 1504 participants were included and each study compared experimental interventions with a standard treatment, i.e. the inferior alveolar nerve block. Changing the injection techniques or supplemental injection had no significant effect on pulp anaesthesia compared to the standard treatment (P = 1.00 or P = 0.14), whereas changing anaesthetic features and increasing anaesthetic volumes resulted in significantly higher rates of anaesthesia than those of the standard treatment (P = 0.03 and P = 0.007, respectively). Premedication with non-steroidal anti-inflammatory drugs (NSAIDs) also significantly increased the success rate of anaesthesia (P = 0.001). Taken together, increased anaesthetic volumes and premedication with NSAIDs provide predictable anaesthesia and more pain control during endodontic treatment of lower molars with irreversible pulpitis.

Prevention of tooth loss and dental pain for reducing the global burden of oral diseases.

Population ageing is a global phenomenon and is predicted to become one of the most significant social transformations of the 21st century. The anticipated demographic shift provides governments the opportunity to proactively align policies with the estimated demands for housing, transportation, social protection, and health and well-being. Oral health is a fundamental component of health and physical and mental well-being, and is influenced by the individual's changing experience, perceptions, expectations and ability to adapt to circumstances. As such, prevention of oral disease and maintenance of oral health contributes to the systemic health, well-being, and quality of life of older adults. Dental caries, periodontal disease, and tooth loss in older adults are global health concerns because they are highly prevalent worldwide, socio-economic inequalities contribute to these diseases, many of the risk factors are modifiable, and these diseases result in compromised oral health-related quality of life. Oral care must be tailored to the needs and level of dependency of older adults through the use of evidence-based approaches and inter-professional collaboration. The persistence of between countries and within countries oral health disparities indicate that population-based policies are also needed to address the underlying social, environmental, and economic causes of oral diseases.

Evaluation of low-level laser at auriculotherapy points to reduce postoperative pain in inferior third molar surgery: study protocol for a randomized controlled trial.

BACKGROUND: A comfortable postoperative return to daily activities has increased the need to control inflammation after third molar surgery. Anti-inflammatory drugs and analgesics are not exempt from adverse effects such as allergies and chronic gastritis, and they are not without cost. The association between low-level laser and auricular acupuncture can be an alternative when conventional drugs are contraindicated. Among its advantages, we can mention the low risk of side effects, low cost and simplicity of application. The objective of this study is to evaluate the efficiency of low-level laser at auriculotherapy points in reducing postoperative pain in lower third molar surgery. METHODS/DESIGN: Ninety bilateral, symmetrical lower third molar surgeries will be performed in 45 healthy patients. Each patient will be their own control, through a split-mouth crossover study. One side of the mouth will be randomly chosen and, immediately after surgery, will be treated with low-level laser. After 21 days, the contralateral side will be operated on with low-level laser simulation used postoperatively. This regimen (laser application or not) will be repeated at 24 and 48 h after surgery. All patients will be requested to take analgesics (acetaminophen) if they have pain, i.e. in case of pain. Neither the surgeon nor the patients will know the assigned treatment. The primary variable will be postoperative pain assessed using a Visual Analog Scale, and the secondary variables will be trismus, edema, local temperature, dysphagia, presence of infection and painkiller ingestion. These variables will be assessed at baseline, 24 h, 48 h and 7 days after surgery. Blood samples for systemic inflammatory cytokine (TNF-α, IL-1, IL-6 and IL-8) analysis will be assessed at baseline and 24 h after surgery. DISCUSSION: Some authors believe that using a wavelength of 633 to 670 nm is a good option for laser therapy in the field of acupuncture. This wavelength can penetrate biological tissue to a depth of about 3 mm. However, for auriculotherapy points, the stimulus (mustard seeds, needles 1 to 2.5 mm) does not penetrate so deeply. For this reason, we chose a laser wavelength of 660 nm (red wavelength). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02657174 , registered on 11 January 2016.

[TEAS for prevention and treatment of orthodontic toothache and oral dysfunction: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of transcutanclus electrical acupoint stimulation (TEAS) on prevention and treatment of orthodontic toothache and oral dysfunction. METHODS: A total of 85 patients of malocclusions in the preliminary diagnosis were randomly divided into a control group (20 cases), a psychological intervention group (22 cases), a medication group (20 cases) and a TEAS group (23 cases). Orthodontics treatment was given in all the groups. Patients in the control group received no further treatment; patients in the psychological intervention group received comprehensive psychological intervention, including cognitive education and music therapy; patients in the medication group received oral administration of ibuprofen; patients in the TEAS group received TEAS at Juliao (ST 3), Jiachengjiang (Extra) and auricular point Ya (LO1). The treatment was given twice a day, one in morning and one at night, for 7 days. The pain scores of orthodontic toothache and changes of oral dysfunction were observed in all groups. RESULTS: (1) At 5 time points from the 12th hour to the 4th day, the scores of spontaneous pain in TEAS group were lower than those in the control group (all P < 0.01); during the time points, the scores in TEAS group were lower than those in the psychological intervention group (P < 0.05, P < 0.01), which were similar to those in the medication group (all P > 0.05). (2) During the peak cycle of spontaneous toothache, the scores of irritation pain in TEAS group were significantly lower than those in the control group (all P < O.01), regardless of time-point statistics or general statistics; the scores of irritation pain in the TEAS group were also significantly lower than those in the psychological intervention group (all P < 0.01), which were similar to those in the medication group (all P > 0. 05). (3) Compared with control group, the grading of talking disorder in the remaining groups did not change significantly (P > 0.05). (4) Compared with control group, the grading of moderate-severe eating disorder in TEAS group was significantly reduced (P < O.05), which was not different from that in the medication group (P > 0.05). The differences of the grading of moderate-severe eating disorder were not significantly different between the psychological intervention group and control group (P > 0.05). (5) There were 3 cases of digestive system adverse reactions in the medication group. CONCLUSION: TEAS can efficiently prevent orthodontic toothache and oral dysfunction, which is superior to psychological intervention and similar to medication. In addition, it can avoid possible side-effect of medication.

Development of an ANN optimized mucoadhesive buccal tablet containing flurbiprofen and lidocaine for dental pain.

A novel mucoadhesive buccal tablet containing flurbiprofen (FLB) and lidocaine HCl (LID) was prepared to relieve dental pain. Tablet formulations (F1-F9) were prepared using variable quantities of mucoadhesive agents, hydroxypropyl methyl cellulose (HPMC) and sodium alginate (SA). The formulations were evaluated for their physicochemical properties, mucoadhesive strength and mucoadhesion time, swellability index and in vitro release of active agents. Release of both drugs depended on the relative ratio of HPMC:SA. However, mucoadhesive strength and mucoadhesion time were better in formulations, containing higher proportions of HPMC compared to SA. An artificial neural network (ANN) approach was applied to optimise formulations based on known effective parameters (i.e., mucoadhesive strength, mucoadhesion time and drug release), which proved valuable. This study indicates that an effective buccal tablet formulation of flurbiprofen and lidocaine can be prepared via an optimized ANN approach.

Escaping the Adverse Impacts of NSAIDs on Tooth Movement During Orthodontics: Current Evidence Based on a Meta-Analysis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain during orthodontic treatments; however, the possible inhibition of orthodontic tooth movement (OTM) by NSAIDs has been debated. The aim of this study was to evaluate the influence of some commonly used NSAIDs on OTM during orthodontic treatments. A review of the literature identified relevant studies up to August 2014. A meta-analysis was performed following the guidelines of the Cochrane review group and the PRISMA statement. Studies were identified by searching PUBMED, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and the WHO Clinical Trials Registry Platform. Meta-analysis was performed in a fixed/random-effect model using Revman 5.1.1.Five studies, including 128 subjects and 3 main NSAIDs (celecoxib, acetaminophen, and aspirin), were included for quantitative synthesis and analysis. Celecoxib did not inhibit OTM except with middle-term use (2-3 weeks) (95% CI [-6.47 to -0.43], P = 0.03). Acetaminophen did not inhibit OTM except with long-term use (>1 month) and low-dose use (∼100 mg/kg per day), (95% CI [-2.96 to -0.78], P = 0.0008; 95%CI [-2.42, -0.46], P = 0.004; respectively). Aspirin was found to inhibit OTM (95%CI [-2.40 to -0.64], P = 0.0008). Our systematic review with meta-analysis suggests that aspirin might inhibit OTM in rat models, whereas the short-term (<1 week) use of celecoxib and acetaminophen for relieving orthodontic pain would not inhibit OTM. Well-designed human research should be completed before a solid conclusion can be reached.

[Preventive and therapeutic effects of TEAS on rabbits with orthodontic toothache].

OBJECTIVE: To explore the action mechanisms of transcutaneous electrical acupoint stimulation (TEAS) on prevention and treatment of orthodontic toothache. METHODS: Twenty-four male New Zealand rabbits were randomly divided into a blank group, an orthodontic group and a TEAS group, 8 rabbits in each one. The orthodontic model of rabbit was made in orthodontic group and TEAS group by bonding brackets and fixing NI-TI screw with ligature wire. After model establishment, the TEAS group was treated with TEAS at ashi points (skin surface corresponding points to the bilateral upper 1st molars) and "Hegu" (LI 4) with dilatational wave, 20 min per treatment, twice a day, totally 2-day consecutive treatment (4 treatments) was provided. The rabbit general behavior, total food intake and threshold of pain were observed; the contents of serum prostaglandin E2 (PGE2), granulocyte macrophage colony stimulating factor (GM-CSF) as well as endorphin (ß-EP) fluid and cholecystokinin-8 (CCK-8) in cerebrospinal fluid (CSF) were detected. RESULTS: Compared with the orthodontic group, the rabbit general behavior, total food intake and threshold of pain in the TEAS group were significantly improved (P<0.05, P<0.01). The serum PGE2 were significantly reduced (P<0.05), while GM-CSF presented reducing trend without statistical significance (P>0.05). The ß-EP in the CSF were increased (P<0.05), while CCK-8 in CSF presented reducing trend without statistical significance (P>0.05). CONCLUSIONS: The preventive and therapeutic effects of TEAS on rabbits with orthodontic toothache are achieved by reducing algogenic substance PGE2 in peripheral nervous system selectively, increasing ß-EP in CSF in central nervous system and keeping the level of anti-opioid pain maintaining substance CCK-8.Both the central and peripheral nervous systems participate in the analgesic effect of TEAS.

Comparação da eficácia clínica do cetoprofeno, associado ou não ao omeprazol, no controle da dor, edema e trismo em exodontias de terceiros molares inferiores / Comparison of the clinical efficacy of ketoprofen, associated or not with omeprazole, in the control of pain, swelling and trismus in lower third molar removal

A prescrição do cetoprofeno pode gerar reações adversas, como por exemplo, problemas gastrintestinais. Devido a este fato há disponível no mercado a associação do cetoprofeno com omeprazol. Porém, a eficácia desta associação no controle agudo da dor ainda não foi estabelecida. Portanto, nos propusemos a avaliar a eficácia clínica da terapia realizada com comprimidos de cetoprofeno 100 mg duas vezes ao dia versus a terapia realizada com o cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, ambos administrados durante 4 dias, por via enteral, no controle da dor, edema e trismo no modelo de extração bilateral de terceiros molares inferiores em posições semelhantes e em dois momentos cirúrgicos distintos. Este estudo randomizado, duplo-cego e cruzado foi composto por 50 voluntários com idade média de 24 ± 5 anos. Foi utilizado o teste t pareado para os dados paramétricos expressos em média ± desvio padrão e o teste de Wilcoxon para os dados não paramétricos expressos em mediana ± intervalo interquartil. O nível de significância adotado foi de 5%. Quando os voluntários utilizaram cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, relataram significativamente menos dor em vários períodos pós-cirúrgicos e consumiram menos medicação de socorro (paracetamol 750 mg) em comparação a quando utilizaram cetoprofeno 100 mg duas vezes ao dia. Além disso, as avaliações dos medicamentos no controle da dor pós-cirúrgica por parte dos voluntários foram significativamente mais favoráveis à combinação cetoprofeno 200 mg + omeprazol 20 mg. Para o controle do edema e trismo, os tratamentos farmacológicos apresentaram resultados semelhantes. Após a análise dos resultados concluímos que cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia apresentou melhores resultados no controle da dor após extrações de terceiros molares inferiores quando comparado ao cetoprofeno de 100 mg duas vezes ao dia.(AU)

In view of the gastrointestinal problems generated by the use of ketoprofen, the association of ketoprofen with omeprazole is available on the market. However, the efficacy of this association in the acute control of pain has not been established. Therefore, the objective of the present study was to evaluate the clinical efficacy of therapy performed with ketoprofen 100 mg twice daily versus therapy performed with ketoprofen 200 mg + omeprazole 20 mg once daily, both administered enterally to control pain, swelling and trismus in the bilateral extraction model of lower third molars in similar positions in two different appointments. The present randomized, double-blind, crossover study consisted of 50 volunteers with a mean age of 24 ± 5 years. The paired t test was used for the parametric data expressed as mean ± standard deviation and the Wilcoxon test for non-parametric data expressed as median ± interquartile range. The level of significance was 5%. When volunteers took ketoprofen 200 mg + omeprazole 20 mg once daily, they reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study compared to ketoprofen 100 mg twice daily. In addition, the evaluations of the drugs in the control of postoperative pain by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg once daily as compared with ketoprofen twice daily. For the control of swelling and trismus, the treatments presented similar results. Therefore, it can be concluded that ketoprofen 200 mg + omeprazole 20 mg once daily presented better results in postoperative pain control after extractions of the lower third molars when compared to ketoprofen 100 mg twice daily.(AU)

Eficácia do anti-inflamatório não-esteroidal diclofenaco associado ou não ao opioide codeína para controle da dor, edema e trismo no modelo de extração bilateral de terceiros molares inferiores com alto grau de dificuldade / Efficacy of non-steroidal anti-inflammatory diclofenaco and its association to the opioid codeine for pain, swelling and trismus in in patients after invasive bilateral third molar extractions

Eficácia do anti-inflamatório não-esteroidal diclofenaco associado ou não ao opioide codeína para controle da dor, edema e trismo no modelo de extração bilateral de terceiros molares inferiores com alto grau de dificuldade O controle da dor e inflamação após cirurgias bucais é normalmente realizado através do uso de anti-inflamatórios não-esteroidais (AINEs); no entanto a combinação de opioides aos AINEs pode garantir uma melhor analgesia principalmente após cirurgias mais traumáticas. Apesar disso, poucos estudos têm comparado AINEs associados ou não aos opioides após cirurgias bucais e maxilofaciais. Este estudo cruzado, randomizado e duplo-cego comparou a eficácia clínica no controle da dor, edema e trismo pós-operatório em 46 voluntários que consumiram randomicamente os medicamentos diclofenaco sódico (50 mg) associado à codeína (50 mg) e apenas diclofenaco sódico (50 mg) após extrações dos dois terceiros molares em posições complexas como alto grau de dificuldade cirúrgica. Os voluntários enquanto em uso do diclofenaco associado à codeína relataram dor pós-operatória significativamente menor em vários momentos (90 minutos (p=0,043), 2 horas (p=0,014), 3 horas (p=0,001), 5 horas (p=0,010), 10 horas (p=0,005), 12 horas (p=0,006) e 24 horas (p=0,018)) dentro das primeiras 24 horas após a cirurgia e também consumiram significativamente menos (p=0,003) medicação de resgate (paracetamol) ao longo do estudo, comparados com os valores expressos pelos mesmos voluntários enquanto em uso do diclofenaco apenas. Em conclusão, o diclofenaco sódico associado à codeína foi mais eficaz no controle da dor pós-operatória, enquanto que o trismo e o edema não apresentaram diferenças quando comparado com o diclofenaco sem codeína.

Postoperative pain and inflammation after oral surgery is mostly managed using non steroidal anti-inflammatory drugs (NSAIDs); however, opioids combined with NSAIDs may improve pain management in patients especially after traumatic oral surgery. Despite this, few studies have compared NSAIDs with and without opioids after oral and maxillofacial surgery. This randomized double-blinded crossover study compared the clinical efficacy for managing postoperative pain in 46 volunteers consuming either sodium diclofenac (50 mg) plus codeine (50 mg) or only sodium diclofenac (50 mg) after invasive surgeries for extraction of both lower third molar surgeries in different appointments. Volunteers reported significantly less postoperative pain at various time points (90 minutes (p=0,043), 2 hours (p=0,014), 3 hours (p=0,001), 5 hours (p=0,010), 10 hours (p=0,005), 12 hours (p=0,006) e 24 hours (p=0,018)) within 24 hours after surgery and also consumed significantly less(p=0,003) rescue medication (acetaminophen) throughout the study while consuming diclofenac plus codeine when compared to only taking NSAIDs. In conclusion, despite no difference between inflammation aspects, oral sodium diclofenac with codeine was more effective for managing postoperative pain when compared to diclofenac without codeine.

Autopercepção sobre saúde bucal e sua relação com utilização de serviços e prevalência de dor de dente / Self-perception on oral health and its relationship with use of services and prevalence of tooth ache

Introdução: Autopercepção em saúde abrange a compreensão que o indivíduo possui sobre o seu próprio estado de saúde, baseando-se em experiências anteriores e no contexto social, cultural e histórico em que está inserido. Objetivo: Analisar a autopercepção em saúde bucal de adolescentes e adultos jovens com 17-21 anos no município de Sobral-CE, relacionando-a com a utilização de serviços odontológicos e prevalência de dor de dente. Métodos: Estudo transversal aninhado à terceira onda da coorte de saúde bucal, desenvolvida no ano de 2012, com 482 participantes, a partir de questionário validado pelo Projeto SB Brasil 2010. Resultados: Houve associação entre classificação da saúde bucal autorreferida com mastigação, aparência de dentes e gengiva e necessidade de tratamento. Além disso, autopercepção sobre a mastigação teve associação com dor de dente e a necessidade de tratamento autorreferida com a utilização de serviços e dor de dente. Conclusões: A percepção sobre saúde bucal de adolescentes e adultos jovens está relacionada com a estética, função mastigatória e a necessidade de tratamento. Esse quadro sinaliza a preferência da utilização dos serviços odontológicos em casos de dor em detrimento de procedimentos preventivos. Seria importante que o planejamento em saúde bucal fosse orientado não somente por dados normativos, mas que incluísse a percepção da população para que as ações propostas fossem mais coerentes e aceitáveis pelos usuários (AU).

Introduction: Self-perceived health is related to the health knowledge that individuals have about their own status based on both previous experiences and the social, cultural and historical context in which they are inserted. Objective: To analyze the self-perception of oral health of adolescents and young adults aged between 17-21 years in Sobral-CE and its relation to the use of dental services and prevalence of toothache. Methods: Cross-sectional study nested to the third wave of an oral health cohort, developed in 2012, with 482 participants aged between 17-21 years, with a questionnaire validated by a National Oral Health Survey in Brazil, the Project SB Brasil 2010. Results: There was association between self-reported rating of oral health with chewing, appearance of teeth and gums and treatment need. In addition, mastication perception was directly associated with toothache and self-reported need treatment was associated with the use of services and toothache. Conclusions: The perception about oral health in adolescents and young adults is related to aesthetics, masticatory function and treatment need. This situation indicates the preference by using dental services in cases of toothache instead of preventive procedures. It is important that oral health planning services should not only be guided by normative data, but includes the perception of the population so that the proposed actions would be more consistent and acceptable from patients (AU).

[Choice of local anesthetic volume at the infiltration anesthesia on the upper jaw].

The aim of this study was to investigate the effect of volume and pressure, at which the solution of local anesthetic is injected into the tissue, on the effectiveness of infiltration anesthesia of the periosteum on the upper jaw. We used the technique of tooth pain sensitivity thresholds. According to the rate of development and the duration of the maximum analgesia effect, the optimum volume for different levels of pressure was determined. The influence of the tissue density at the injection site on the effect criteria of analgesia was demonstrated.

Emergencies in orthodontics. Part 1: Management of general orthodontic problems as well as common problems with fixed appliances.

Fixed appliance treatment is a popular treatment modality with a burgeoning increase in the numbers of children and adults realizing the benefits that can be gained. Appliance breakage is an unavoidable nuisance which is at best inconvenient, and at worst may result in significant pain or discomfort for the patient. General dental practitioners (GDPs) should have the practical knowledge of how to provide timely and appropriate orthodontic 'emergency treatment'. This will significantly reduce the sometimes considerable inconvenience and discomfort for both the patient and his/her parents, and the inevitable frustration for the clinician providing ongoing care. This first paper will deal with general orthodontic problems that commonly present, as well as some issues specific to fixed appliances. The second paper will deal with the other orthodontic appliances that may be encountered by GDPs in their daily practice. Clinical Relevance: Appropriate handling of an orthodontic 'emergency' by the general practitioner will, on many occasions, provide immediate relief of pain and distress for the patient. This will in turn allow treatment to continue moving in the right direction, thus allowing more efficient and effective use of valuable resources.

Traumatized immature teeth treated with 2 protocols of pulp revascularization.

INTRODUCTION: Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization. METHODS: Twenty-three teeth of young patients (7-17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9-19 months in 2 dental institutions for evaluation of clinical and radiographic data. RESULTS: Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group. CONCLUSIONS: Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP.