Efficacy of clinical and radiological methods to identify second mesiobuccal canals in maxillary first molars.

INTRODUCTION: The success of endodontic treatment depends on the identification of all root canals. Technological advances have facilitated this process as well as the assessment of internal anatomical variations. The aim of this study was to compare the efficacy of clinical and radiological methods in locating second mesiobuccal canals (MB2) in maxillary first molars. METHODS: Fifty patients referred for analysis; access and clinical analysis; cone-beam endodontic treatment of their maxillary first molars were submitted to the following assessments: analysis; access and clinical analysis; cone-beam computed tomography (CBCT); post-CBCT clinical analysis; clinical analysis using an operating microscope; and clinical analysis after Start X ultrasonic inserts in teeth with negative results in all previous analyses. RESULTS: Periapical radiographic analysis revealed the presence of MB2 in four (8%) teeth, clinical analysis in 25 (50%), CBCT analysis in 27 (54%) and clinical analysis following CBCT and using an operating microscope in 27 (54%) and 29 (58%) teeth, respectively. The use of Start X ultrasonic inserts allowed one to detect two additional teeth with MB2 (62%). According to Vertucci's classification 48% of the mesiobuccal canals found were type I, 28% type II, 18% type IV and 6% type V. Statistical analysis showed no significant differences (p > 0.5) in the ability of CBCT to detect MB2 canals when compared with clinical assessment with or without an operating microscope. A significant difference (p < 0.001)was found only between periapical radiography and clinical/CBCT evaluations. CONCLUSION: Combined use of different methods increased the detection ofthe second canal in MB roots, but without statistical difference among CBCT, operating microscope, Start X and clinical analysis.

Fragmented adipose tissue graft for bone healing: histological and histometric study in rabbits' calvaria.

OBJECTIVE: The adipose tissue represents an important reservoir of stem cells. There are few studies in the literature with which to histologically evaluate whether or not the adipose tissue graft is really a safe option to achieve bone repair. This study histologically analyzed the effect of fragmented autogenous adipose tissue grafts on bone healing in surgically created, critical-size defects (CSD) in a rabbit's calvaria. STUDY DESIGN: Forty-two New Zealand rabbits were used in this study. CSD that were 15 mm in diameter were created in the calvarium of each animal. The defects were randomly divided into two groups: in Group C (control), the defect was filled only by a blood clot and, in Group FAT (i.e., fragmented adipose tissue), the defect was filled with fragmented autogenous adipose tissue grafts. The groups were divided into subgroups (n = 7) for euthanasia at 7, 15, and 40 days after the procedure had been conducted. Histologic and histometric analyses were performed. Data were statistically analysed with ANOVA and Tukey's tests (p < 0.05). RESULTS: The amount of bone formation did not show statistically significant differences seven days after the operation, which indicates that the groups had similar amounts of mineral deposition in the earlier period of the repair. Conversely, a significant of amount of bone matrix deposition was identified in the FAT group at 15 and 40 days following the operation, both on the border and in the body of the defect. Such an outcome was not found in the control group. CONCLUSION: In this study, an autologous adipose tissue graft may be considered as likely biomaterial for bone regeneration, since it positively affected the amount of bone formation in surgically created CSD in the rabbits' calvaria 40 days after the procedure had been performed. Further investigations with a longer time evaluation are warranted to determine the effectiveness of autologous adipose tissue graft in the bone healing.

Prosthetic rehabilitation and management of an MTA-treated maxillary central incisor with root perforation and severe internal resorption.

Root canal perforation and root resorption are challenging clinical conditions to correctly diagnose and treat, especially when they occur in anterior teeth. This clinical report describes the computed tomography findings, endodontic treatment, prosthetic rehabilitation, and clinical outcome of an iatrogenic root perforation and internal resorption in a maxillary central incisor. The case management consisted of endodontic retreatment, periodontal surgery, and prosthetic rehabilitation. Gray mineral trioxide aggregate (MTA) was used to fill the resorption space and seal the perforation. The prosthetic treatment was performed with glass fiber-reinforced dowels and all-ceramic crowns. No signs or symptoms, including discomfort, pain, or esthetic defects were observed in 30 months of follow-up.

Evaluation of Endo 10 mobile application as diagnostic tool in endodontics.

Background: Endodontic diagnosis can be compared to a puzzle, requiring the interpretation of a series of clinical and imaging data. Mobile health, especially mobile application (apps), can assist professionals in endodontic diagnosis. This work aims to evaluate an app - Endo 10 app, designed to assist pulpal and periapical diagnosis based on the patient's signs and symptoms and radiographic data. Material and Methods: A total of 41 dental students and dentists with different levels of expertise (10 multi-specialty clinic professors, 17 residents in endodontics and 14 dental students) were included. The System Usability Scale (SUS) was used to evaluate usability and the Davis' technology acceptance model was used to evaluate usefulness of Endo 10 app. The Mann-Whitney test was performed to compare SUS scores between professors and undergraduate dental students and to compare questions 6 and 7 of the utility test and verify whether participants who understood that the technology was useful also better understood the concepts of endodontic diagnosis. The agreement between professor's diagnosis with the app and professor without the app, and between professor and residents in endodontics with the app were evaluated. Results: The SUS score at the 50th percentile was 77.5, graded as acceptable. No significant difference was observed in the SUS scores when analyzing professors and dental students separately (p = 0.442). Usefulness test showed positive responses ranging between 72% - 100%. No statistically significant difference was observed between questions 6 and 7 of the utility test (p = 0.206), indicating that the group of participants who understood that the technology was useful in endodontic diagnosis was associated with the agreement that the application helped to better understand the concepts related. The diagnosis agreement between professor in the common diagnosis process and professor with app was 100% (31) of cases. The concordance between professor and residents in endodontics with the app was 71% (22) of cases. The differences were associated with resident's misinterpreting the patient's data. Conclusions: The Endo 10 app reached the usability and usefulness requirements. It proved accurate in diagnosing pulpal and periapical pathologies. Key words:Dental education, endodontics, diagnosis, smartphone, dental informatics.

Analysis of 115 mandibular angle fractures.

PURPOSE: This retrospective study reviewed cases of fractures of the mandibular angle to identify personal data, social traits, fracture characteristics, treatment modalities, and postoperative complications. PATIENTS AND METHODS: From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-Unicamp, in Brazil. RESULTS: More angle fractures were observed in Caucasian (55%) men (89%) with some kind of drug addiction (62%). Patient mean age was 27 years. The majority of fractures in this study were sustained in altercations, including gunshot wounds (43%), followed by vehicle accidents, including bicycles and being struck by a car (39%). Open fractures were the most frequent (90%), with prevalence of the left side (57%). Only 1 patient sustained bilateral angle fractures. Ninety-seven patients (85%) underwent open reduction. Complications occurred in 19 patients (17%); 10 (9%) were infections. Of the total number of complications, 3 underwent another surgical intervention for refixation. The factors that contributed to the development of postoperative complications were social risks that included alcohol abuse, smoking, and intravenous and nonintravenous drug abuse. CONCLUSIONS: Angle fracture management outcomes are affected by many factors beyond method of fixation.

Calcium hydroxide diffusion after agitation of endodontic irrigants: an ex vivo study

Aim: To compare the influence of two methods of agitation of endodontics irrigants, by diffusion of calcium hydroxide [Ca(OH)2] through the dentinal tubules, measuring the pH of the medium where they were kept. Methods: Twenty mandibular incisors were prepared using a WaveOne Gold Large file, in a reciprocating movement, and then divided into (n = 10): gutta-percha cone (GPC) or Easy Clean system (ECS) agitation of 1% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The specimens were filled with Ca(OH)2 paste, placed in flasks with 4 mL of deionized water, and stored in an incubator. The pH was read using a digital pH meter immediately after storage (T0), after 7 (T1), 14 (T2), 21 (T3), and 35 (T4) days. Results: Statistical difference between groups was observed regardless of the day pH was measured (p < 0.01). From T2 on, ECS presented higher pH values in comparison with GPC, with significant difference (p < 0.01). Conclusion: Agitation of endodontic irrigants with ECS enhances the Ca(OH)2 diffusion, providing higher pH values, from the 14th day on, when compared with GPC

Cerebrospinal fluid rhinorrhoea: diagnosis and management.

A cerebrospinal fluid (CSF) rhinorrhoea occurs when there is a fistula between the dura and the skull base and discharge of CSF from the nose. CSF rhinorrhea or liquorrhoea commonly occurs following head trauma (fronto-basal skull fractures), as a result of intracranial surgery, or destruction lesions. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis. This article reviewed the causes, diagnosis and treatment of CSF leakage. A PUBMED search of the National Library of Medicine was conducted. CSF leak most commonly occurs following trauma and the majority of cases presenting within the first three months. CSF rhinorrhoea have significantly greater incidence of periorbital haematoma. This suggests that patients with head injuries and features of periorbital haematoma are at greater risk of unobserved dural tear and delayed CSF leakage. In the presence of a skull base fracture on computed tomography and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. A greater proportion of the CSF leaks in the patients resolved spontaneously. CSF fistulae persisting for > 7 days had a significantly increased risk of developing meningitis. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The timing for surgery and CSF drainage procedures must be decided with great care and with a clear strategy.

Biomechanical aspects of external root resorption in orthodontic therapy.

External apical root resorption is a common phenomenon associated with orthodontic treatment. The factors relevant to root resorption can be divided into biological and mechanical factors. Some mechanical and biological factors might be associated with an increased or decreased risk of root resorption during orthodontic treatment. For mechanical factors, the extensive tooth movement, root torque and intrusive forces, movement type, orthodontic force magnitude, duration and type of force are involved. For biological factors, a genetic susceptibility, systemic disease, gender and medication intake have been demonstrated influence root resorption. Orthodontic therapy of patients with increased risk of root resorption should be carefully planned. Medical history, medication intake, family history, tooth agenesis, root morphology, oral health and habits must be considerate if we do not want jeopardize our patients by severe root resorption. To monitor apical root resorption the standard procedure is a radiographic examination after 6 months of treatment. In teeth with enhanced risk, a 3-month radiographic follow-up is recommended. The administration of anti-inflammatory drugs might suppress root resorption induced by orthodontic therapy, although none study was enough conclusive to indicate a protocol for patients with enhanced risk. In the event of multiple external root resorption, the diagnostic procedure should focus on the exclusion of the local factors and its associations (such as magnitude, duration and type of orthodontic force; periodontal disease; root form) that might lead to external root resorption. Systemic disorders associated with phosphorus-calcium metabolic alterations shall be suspected. This review searched the current knowledge of the mechanical and biological aspects of root resorption in orthodontic tooth movement.

Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study.

CONTEXT AND OBJECTIVE:: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING:: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS:: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS:: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION:: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.

Conhecimento dos estudantes da área da saúde sobre as condutas de biossegurança e prevençãoda transmissão da COVID-19 / Healthcare students' knowledge about biosafety and prevention of COVID-19

Apandemia de COVID-19impôs ainterrupção deatividades presenciais coletivaseos profissionais de saúde foram os mais afetados, por estarem na linha de frente no combate desta doença. Medidas de biossegurança tiveram que ser redobradas para evitar a propagação do vírus e assim ajudar a controlar apandemia. Procedimentos que geram aerossóis na Odontologia foram evitados, pois é de conhecimento que um dos meios de transmissão é a saliva. Alguns Equipamentos de Proteção Individual(EPs) foram adicionados para garantir a proteção, e protocolos de desinfecção do ambiente foram modificados. O objetivo deste estudo foi avaliar o grau de conhecimento sobre biossegurança entre estudantes da área da saúde. Foiaplicado um questionário eletrônicopara a comunidade relacionada aos cursos da área da saúde na cidade de Curitiba/PR. Cento e cinquenta e novealunos responderam ao questionário, sendo 107 (67,3%) estudantesdaOdontologia, 28 (17,6%) da Medicina, 17 (10,7%) da Biomedicina e 7 (4,4%) daEnfermagem. Entre os participantes, 63,55% dos alunos de Odontologia, 100% de Medicina, 64,71% de Biomedicina e 85,71% de Enfermagem acreditam que os alunos da graduação não estão preparados para fazer atendimentos de urgência em pacientes com COVID-19. Apesar de toda a orientação sobre biossegurança, os alunos da área da saúde ainda devem desenvolver habilidades quanto aoscorretos procedimentos para atendimento de pacientes portadores ou não de doenças transmissíveis (AU).

Because of the COVID-19 pandemic, people all over the world had to interrupt their face-to-face interactions. Health professionals were most affected, as they were at the forefront of combating this disease. Biosecurity measures had to be re-doubled to prevent the spread of the virus and thus help control the pandemic. Procedures in dentistry that generated aerosols were avoided, as saliva is one of the means ofCOVID-19transmission. Complementary Personal Protective Equipment (PPE) was required to ensure protection, and environmental disinfection protocols had been modified. Thus, to assess the level of knowledge about biosafety and these new changes, particularly regarding COVID-19, a questionnaire was published for the community related to health courses in the city of Curitiba (PR, Brazil). This study included 159 students (dentistry, 107 (67.3%); medicine, 28 (17.6%); biomedicine, 17 (10.7%); and nursing, seven (4.4%)). Approximately 63.55% of dentistry, 100% of medicine, 64.71% of biomedical, and 85.71% of nursing students believe that undergraduate students are unprepared to provide urgent care to COVID-19 patients. Despite all the guidance on biosafety, students in healthcaremust still develop skills incorrect procedures for caring forpatients with or without communicable diseases (AU).

Conhecimento dos estudantes da área da saúde sobre as condutas de biossegurança e prevençãoda transmissão da COVID-19 / Healthcare students' knowledge about biosafety and prevention of COVID-19

Apandemia de COVID-19impôs ainterrupção deatividades presenciais coletivaseos profissionais de saúde foram os mais afetados, por estarem na linha de frente no combate desta doença. Medidas de biossegurança tiveram que ser redobradas para evitar a propagação do vírus e assim ajudar a controlar apandemia. Procedimentos que geram aerossóis na Odontologia foram evitados, pois é de conhecimento que um dos meios de transmissão é a saliva. Alguns Equipamentos de Proteção Individual(EPs) foram adicionados para garantir a proteção, e protocolos de desinfecção do ambiente foram modificados. O objetivo deste estudo foi avaliar o grau de conhecimento sobre biossegurança entre estudantes da área da saúde. Foiaplicado um questionário eletrônicopara a comunidade relacionada aos cursos da área da saúde na cidade de Curitiba/PR. Cento e cinquenta e novealunos responderam ao questionário, sendo 107 (67,3%) estudantesdaOdontologia, 28 (17,6%) da Medicina, 17 (10,7%) da Biomedicina e 7 (4,4%) daEnfermagem. Entre os participantes, 63,55% dos alunos de Odontologia, 100% de Medicina, 64,71% de Biomedicina e 85,71% de Enfermagem acreditam que os alunos da graduação não estão preparados para fazer atendimentos de urgência em pacientes com COVID-19. Apesar de toda a orientação sobre biossegurança, os alunos da área da saúde ainda devem desenvolver habilidades quanto aoscorretos procedimentos para atendimento de pacientes portadores ou não de doenças transmissíveis (AU).

Because of the COVID-19 pandemic, people all over the world had to interrupt their face-to-face interactions. Health professionals were most affected, as they were at the forefront of combating this disease. Biosecurity measures had to be re-doubled to prevent the spread of the virus and thus help control the pandemic. Procedures in dentistry that generated aerosols were avoided, as saliva is one of the means ofCOVID-19transmission. Complementary Personal Protective Equipment (PPE) was required to ensure protection, and environmental disinfection protocols had been modified. Thus, to assess the level of knowledge about biosafety and these new changes, particularly regarding COVID-19, a questionnaire was published for the community related to health courses in the city of Curitiba (PR, Brazil). This study included 159 students (dentistry, 107 (67.3%); medicine, 28 (17.6%); biomedicine, 17 (10.7%); and nursing, seven (4.4%)). Approximately 63.55% of dentistry, 100% of medicine, 64.71% of biomedical, and 85.71% of nursing students believe that undergraduate students are unprepared to provide urgent care to COVID-19 patients. Despite all the guidance on biosafety, students in healthcaremust still develop skills incorrect procedures for caring forpatients with or without communicable diseases (AU).

A review of facial injuries due to dog bites.

Bite injuries to the head and neck region can result in facial disfigurement with distressing physical and psychological consequences. This article reviewed the causes and management of facial bite wounds due to dog bites. A PUBMED search of the National Library of Medicine from 1995 to December 2005 was conducted. Keywords used in the search were facial wound, bite wound, dog bite. The results showed that the risk factors for dog attacks include: school-aged children, male, households with dogs, male dogs and certain breeds (german shepherds, bull terriers, blue/red heelers, dobermans and rottwellers). Early management of such complex injuries usually guarantees satisfactory outcome. Most of the cases involve a known dog (friends, neighbors) and family pet. Although animal bites are not the most accounted children injuries, deaths may a result of these attacks. Antibiotic therapy is indicated for infected bite wounds and fresh wounds considered at risk for infection, such as extremely large wounds, large hematoma, and cat bites, that appear be more infected than dog bites. Tetanus immunization status and the risk of rabies infection should be routinely addressed in bite wound management. Prevention strategies should be considered for preventing dog bites.

Introduction of nickel titanium rotary instruments to undergraduate students: afour-yearclinical experience / Introdução de instrumentos rotários de níquel titânio para alunos de graduação: quatro anos de experiência clínica

Many studies address the quality of root canal treatments, but few refer to endodontics usingrotatory techniques performed by noviceoperators. This study evaluatedthe performance of undergraduates in their first contact with rotary root canal instrumentation concerningthe findings of the final periapical radiograph, and thepostendodontic treatment pain.A longitudinal observational studywas performed on periapical radiographs of 491teethfrom 450 patientssubmitted toroot canal treatmentby undergraduate students from 2015 to 2018. The analysis of the length of root canal filling followed the criteria: (i) acceptable, ifperiapical radiograph presentsroot filling ending 0 -1 mm short of radiographic apex; (ii) over, if periapical radiograph presentsroot filling ending beyond the radiographic apex; and (iii) under, ifperiapical radiograph presentsroot filling ending > 1 mm short of radiographic apex. Evaluation of postendodontic treatment painwas categorized into either absence or presenceof pain. Adequate length root canal filling was observed in 65.9% of the cases (324 teeth). Periapical lesions presenceand dimensions did not interfere to the obturation quality.Statistical relation was found between the pulp condition and postendodontic treatment pain. Thepresence of pain was observed in 4.7% of the vital teeth and 0.3% of non-vital teeth. The presence of periapical lesion did not influence postoperative pain.AdequatelengthrootcanalfillingwasobservedinmostcasesandNitTi rotary instrumentation hadapplicability in undergraduate programs, even with novice operators. Besides that, pulp condition had an effect on post endodontic pain (AU).

Muitos estudos abordam a qualidade dos tratamentos de canal radicular, mas poucos se referem à endodontia por meio de técnicas rotatórias realizada por operadores novatos. Este estudo avaliou o desempenho de graduandos no primeiro contato com a instrumentação endodôntica em relação aos achados da radiografia periapical final e à dor pós-tratamento endodôntico. Um estudo observacional longitudinal foi realizado em radiografias periapicais de 491 dentes de 450pacientes submetidos a tratamento endodôntico por estudantes de graduação no período de 2015 a 2018. A análise do comprimento da obturação de canais radiculares obedeceu aos critérios: (i) aceitável, se a radiografia periapical apresentasse término de obturação 0 -1 mm aquém do ápice radiográfico; (ii) acima, se a radiografia periapical apresentasse obturação que termina além do ápice radiográfico; e (iii) abaixo, se a radiografia periapicalapresentasse obturação, terminando > 1 mm aquém do ápice radiográfico. A avaliação da dor pós-operatória foi categorizada em ausência ou presença de dor. A obturação de canais radiculares de comprimento adequado foi observada em 65,9% dos casos (324 dentes). A presença e as dimensões das lesões periapicais não interferiram na qualidade da obturação. Foi encontrada relação estatística entre a condição pulpar e a dor pós-tratamento endodôntico. Presença de dor foi observada em 4,7% dos dentes vitais e 0,3% dos não vitais. A presença de lesão periapical não influenciou na dor pós-operatória. O comprimento de trabalho adequado foi observado na maioria dos casos e a instrumentação rotatória NitTi teve aplicabilidade em programas de graduação, mesmo com operadores iniciantes. Além disso, a condição pulpar afetou a dor pós-operatória (AU).

Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study / Análise comparativa de morte por suicídio no Brasil e nos Estados Unidos: estudo transversal temporal descritivo

ABSTRACT CONTEXT AND OBJECTIVE: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.

RESUMO CONTEXTO E OBJETIVO: A Organização Mundial da Saúde reconhece o suicídio como uma prioridade de saúde pública. Aumentar o conhecimento dos fatores de risco de suicídio é necessário para se poder adotar estratégias eficazes de prevenção. O objetivo deste estudo foi analisar e comparar a associação do coeficiente de Gini, usado para medir a desigualdade, com as taxas de mortalidade por suicídio em um período de 14 anos (2000-2013) no Brasil e nos Estados Unidos (EUA). Aventou-se a hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio. TIPO DE ESTUDO E LOCAL: Estudo transversal temporal descritivo realizado no Brasil e nos EUA. MÉTODOS: Dados populacionais, de óbitos e mortes por suicídio foram extraídos do banco de dados do DATASUS, no Brasil, e do Centro Nacional para Estatísticas de Saúde dos EUA. Dados do índice de Gini foram obtidos dos Indicadores de Desenvolvimento Mundial. Foi realizada análise de séries temporais de dados oficiais do Brasil e dos EUA sobre o número de mortes por suicídio, de 2000 a 2013, e do coeficiente de Gini. As tendências de morte por suicídio foram analisadas e comparadas. RESULTADOS: Brasil e EUA apresentaram convergência no coeficiente de Gini devida principalmente à redução da desigualdade no Brasil na última década. No entanto, as taxas de suicídio não estão convergindo como foi conjeturado; em verdade, elas estão crescendo em ambos os países. CONCLUSÕES: A hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio não foi verificada.

Dental infection simulating skin lesion.

Orocutaneous fistulas or cutaneous sinus, a tract of dental origin, is an uncommon but well-documented condition that usually requires emergency treatment. Such condition may be misdiagnosed by physicians and dentists and may sometimes be confused with bone and skin tumor, osteomyelitis, congenital fistula, salivary gland fistula, pyogenic granuloma, infected cyst, deep mycotic infection, and other pathologies. A case of facial sinus tract that was initially misdiagnosed by a physician as a nonodontogenic lesion is presented. Nonsurgical endodontic therapy was the treatment of choice for this case. Facial cutaneous sinus tracts must be considered of dental origin. Early diagnosis and prompt treatment minimize patient discomfort and esthetic problems, reducing the possibility of further complications such as sepsis and osteomyelitis.

Avaliação dos óbitos por suicídio em Joinville/SC, 2004-2013 / Evaluation of deaths by suicide in Joinville/SC, 2004-2013

O objetivo deste trabalho foi analisar as causas de óbito por suicídio em Joinville-SC, no Estado de Santa Catarina e no Brasil no período de 2004 a 2013.Trata-se de um estudo exploratório, descritivo e retrospectivo de abordagem quantitativa, desenvolvido a partir do banco de dados do Departamento de Informática do SUS nesse período. Verificou-se a distribuição por faixa etária e gênero. As taxas de suicídio por cem mil habitantes variaram entre 4,42 a 5,24 no Brasil, 6,44 a 8,56 em Santa Catarina e 3,63 a 8,59 em Joinville. Em 2012 houve um importante aumento nas taxas de suicídio em Joinville, mantendo-se em 2013. A proporção homens/mulheres foi 3,7:1, 3,8:1 e 4,3:1 no Brasil, em Santa Catarina e em Joinville, respectivamente. Enforcamento, estrangulamento e sufocação foram os métodos mais usados em todas as regiões estudadas. Os suicídios concentraram-se de forma parecida em adultos e adultos jovens em todas as regiões analisadas. Verificou-se um importante aumento na taxa de óbito por suicídio em Joinville nos últimos anos, o que demanda ações efetivas do setor público e da sociedade para mudar esta realidade.

This study aimed to evaluate the causes of death by suicide in Joinville-SC, in the State of Santa Catarina (SC) and Brazil in the period from 2004 to 2013. This is an exploratory, descriptive and retrospective quantitative research, developed with a database from the SUS Department of Information (DATASUS) in this period. It was analyzed the distribution by age and gender. Suicide rates per hundred thousand inhabitants varied from 4.42 to 5.24 in Brazil, 6.44 to 8.56 in Santa Catarina and 3.63 to 8.59 in Joinville. In 2012 there was a significant increase in suicide rates in Joinville, kept in 2013. The male:female ratio was 3.7:1, 3.8:1 and 4.3:1 in Brazil, State of Santa Catarina and Joinville, respectively. Hanging, strangulation and suffocation were the methods most used in all studied regions. Suicides concentrated similarly in adults and young adults in all regions analyzed. It was found a considerable increase in deaths caused by suicide in Joinville in the last years that demands effective actions from the health services and society to change this reality.

Bisphosphonate-related osteonecrosis of the jaws.

Bisphosphonates are potent inhibitors of bone resorption, and are used in the treatment of osteoporosis and other diseases that cause bone mass loss, such as Paget's disease, bone metastases, and multiple myeloma, to prevent pathological fractures. Since 2003, avascular osteonecrosis of the jaw has been associated with the use of bisphosphonates, mainly intravenous. According to the literature, the occurrence of osteonecrosis of the jaw has ranged from 0.8% to 12% of the patients on bisphosphonates, most of them on prolonged use. Physicians and odontologists should be aware of that potential complication in dental treatment.

Scrotal hematoma as a sign of adrenal hemorrhage in newborns.

CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

Multiple taurodontism: the challenge of endodontic treatment.

This article describe a rare case of multiple taurodontism involving all molars in a 17-year-old male. Volumetric cone-beam computed tomography was used to investigate internal and external root morphology, including that of a maxillary first molar which required endodontic treatment and retreatment. Medical history was not contributory; however, Klinefelter syndrome was the diagnostic hypothesis in this case.