Abstract Laboratory evidence has demonstrated the antimicrobial effect of Melaleuca alternifolia (MEL) against oral microorganisms. This randomized, double-blind, crossover clinical trial, compared the anti-biofilm and anti-inflammatory effects of MEL nanoparticles with 0.12% chlorhexidine gluconate (CHX) on biofilm-free (BF) and biofilm-covered (BC) surfaces. Before each experimental period, the participants refrained from all oral hygiene practices for 72 hours. The 60 participants were randomly assigned to professional prophylaxis in two quadrants (Q1–Q3 or Q2–Q4), and rinsed with MEL or CHX for four days. The Quigley & Hein plaque index (QHPI), gingival crevicular fluid (GCF) volume, and participants’ perceptions were assessed. CHX showed significantly lower mean QHPI on BF (2.65 ± 0.34 vs. 3.34 ± 0.33, p < 0.05) and BC surfaces (2.84 ± 0.37 vs. 3.37 ± 0.33, p < 0.05). Intragroup comparisons indicated reductions in GCF in all the groups, with significant differences only for CHX on BF surfaces (p < 0.05). Intergroup comparisons revealed no significant differences (p > 0.05). Based on individual perceptions, CHX had better taste and biofilm control, but resulted in a greater change in taste. Nevertheless, MEL demonstrated anti-inflammatory effects similar to those of CHX. Further clinical trials testing different protocols, concentrations and follow-up periods are required to establish its clinical application.

ABSTRACT OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O’Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

ABSTRACT OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O’Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Resumo Objetivo Comparar a eficácia antimicrobiana de clorexidina 0,12% (CHX) e solução de chá verde (CV) (Camellia sinensis) em biofilmes formados em diferentes tensões de oxigênio em um modelo in situ. Método Vinte e cinco estudantes de odontologia foram elegíveis. Um dispositivo com espécimes de esmalte (EE) padronizados, voltado para o palato e para vestibular foram inseridos nos voluntários por 7 dias. Durante os primeiros quatro dias nenhum agente foi aplicado. A partir do quinto dia, ambos os agentes foram aplicados nos EEs no grupo teste e nenhum agente foi aplicado no grupo EE controle. Após 7 dias, os fragmentos EEs foram removidos dos dispositivos, sonicados, plaqueados em ágar, e incubado durante 24 h a 37 °C para determinar unidades formadoras de colonias (UFCs). Resultado CHX teve significativamente melhor eficácia em comparação com CV nos EEs para vestibular (1.330 vs. 2.170 UFC/mL) e EEs voltados para o palatal (2.250 vs. 2.520 UFC/mL). Comparações intragrupos mostraram maior eficácia em EEs vestibulares do que as EEs voltadas para o palato (1.330 vs. 2.250 UFC/mL para CHX e 2170 vs, 2520 UFC/mL para CV) em ambas as soluções. Análise dos controles, mostrou a formação de biofilme significativamente maior em comparação com EEs palatinas e bucais. Conclusão CHX tem uma eficácia maior do que o chá verde em biofilmes formados por 4 dias. A eficácia dos agentes foi reduzida para os biofilmes em ambiente com baixa tensão de oxigênio. A tensão de oxigênio parece influenciar na eficácia dos agentes testados.

Abstract Objective To compare the antimicrobial efficacy of a 0.12% chlorhexidine (CHX) and herbal green tea (Camellia sinensis) solution on established biofilms formed at different oxygen tensions in an in situ model. Method Twenty-five dental students were eligible for the study. In situ devices with standardized enamel specimens (ES) facing the palatal and buccal sides were inserted in the mouths of volunteers for a 7 day period. No agent was applied during the first four days. From the fifth day onward, both agents were applied to the test ES group and no agent was applied to the control ES group. After 7 days the ES fragments were removed from the devices, sonicated, plated on agar, and incubated for 24 h at 37 °C to determine and quantify the colony forming units (CFUs). Result CHX had significantly higher efficacy compared to green tea on the buccal (1330 vs. 2170 CFU/µL) and palatal (2250 vs. 2520 CFU/µL) ES. In addition, intragroup comparisons showed significantly higher efficacy in buccal ES over palatal ES (1330 vs. 2250 CFU/µL for CHX and 2170 vs, 2520 CFU/µL for CV) for both solutions. Analysis of the ES controls showed significantly higher biofilm formation in palatal ES compared to buccal ES. Conclusion CHX has higher efficacy than green tea on 4-day biofilms. The efficacy of both agents was reduced for biofilms grown in a low oxygen tension environment. Therefore, the oxygen tension environment seems to influence the efficacy of the tested agents.

RESUMO Objetivou-se identificar os fatores associados à violência em alunos de escolas públicas localizadas na região central do Rio Grande do Sul. Estudo observacional, transversal e analítico. Amostra foi constituída por 435 alunos de 10 a 19 anos. Os dados foram coletados por meio de questionário estruturado aplicado em forma de entrevista. Associações entre as variáveis dependentes e independentes foram retiradas do modelo de regressão de Poisson. Os dados analisados evidenciaram maior prevalência entre violência e as variáveis sexo masculino, maior número de irmãos e baixa renda, enquanto que a religião foi associada como indicador de proteção para a violência psicológica. Conclui-se que as abordagens intersetoriais, interdisciplinares e multidimensionais se constituem em importante estratégia para promoção da saúde e redução da violência escolar, sobretudo em comunidades com indicadores de vulnerabilidade. Estratégias específicas de atuação do enfermeiro são indicadas para prevenção de riscos associados a violência.

ABSTRACT This study aimed to identify the factors associated with violence among students of public schools located in the central region of Rio Grande do Sul. It is an observational, transversal and analytical study. The sample was made up of 435 students aged from 10 to 19 years old. The data were collected through a structured questionnaire applied via interview. Associations between the dependent and independent variables were taken from the Poisson regression model. Once analyzed, the data evidenced greater prevalence between violence and the following variables: male sex, larger number of siblings, and a low income; while religion was associated as an indicator of protection for psychological violence. It is concluded that interdepartmental, interdisciplinary and multidimensional approaches constitute an important strategy for promoting health and reducing violence in schools, above all in communities with indicators of vulnerability. Specific strategies for the work of the nurse are indicated for preventing risks associated with violence.

RESUMEN El presente estudio tuvo como objetivo identificar factores asociados a violencia en estudiantes de escuelas públicas de la región central del Río Grande do Sul. Estudio observacional, analítico y transversal. La muestra estuvo conformada por 435 estudiantes de quinto grado de escuela primaria hasta el nivel secundario. Los datos fueron recolectados por medio de entrevistas utilizando cuestionario estructurado. Las asociaciones entre variables dependientes e independientes se tomaron del modelo de regresión de Poisson. El análisis de datos indicó un aumentó en la prevalencia entre violencia y variables de sexo masculino, mayor número de hermanos y bajos ingresos, mientras que la religión se asoció como indicador de protección de violencia psicológica. Se concluye que los enfoques intersectoriales, interdisciplinarios y multidimensionales se revelan como estrategias para acciones de enfrentamiento a la violencia. Algunas estrategias específicas de intervenciones de enfermería son indicadas para prevenir los riesgos asociados a violencia.

ABSTRACT This study aimed to identify the factors associated with violence among students of public schools located in the central region of Rio Grande do Sul. It is an observational, transversal and analytical study. The sample was made up of 435 students aged from 10 to 19 years old. The data were collected through a structured questionnaire applied via interview. Associations between the dependent and independent variables were taken from the Poisson regression model. Once analyzed, the data evidenced greater prevalence between violence and the following variables: male sex, larger number of siblings, and a low income; while religion was associated as an indicator of protection for psychological violence. It is concluded that interdepartmental, interdisciplinary and multidimensional approaches constitute an important strategy for promoting health and reducing violence in schools, above all in communities with indicators of vulnerability. Specific strategies for the work of the nurse are indicated for preventing risks associated with violence.

RESUMEN El presente estudio tuvo como objetivo identificar factores asociados a violencia en estudiantes de escuelas públicas de la región central del Río Grande do Sul. Estudio observacional, analítico y transversal. La muestra estuvo conformada por 435 estudiantes de quinto grado de escuela primaria hasta el nivel secundario. Los datos fueron recolectados por medio de entrevistas utilizando cuestionario estructurado. Las asociaciones entre variables dependientes e independientes se tomaron del modelo de regresión de Poisson. El análisis de datos indicó un aumentó en la prevalencia entre violencia y variables de sexo masculino, mayor número de hermanos y bajos ingresos, mientras que la religión se asoció como indicador de protección de violencia psicológica. Se concluye que los enfoques intersectoriales, interdisciplinarios y multidimensionales se revelan como estrategias para acciones de enfrentamiento a la violencia. Algunas estrategias específicas de intervenciones de enfermería son indicadas para prevenir los riesgos asociados a violencia.

RESUMO Objetivou-se identificar os fatores associados à violência em alunos de escolas públicas localizadas na região central do Rio Grande do Sul. Estudo observacional, transversal e analítico. Amostra foi constituída por 435 alunos de 10 a 19 anos. Os dados foram coletados por meio de questionário estruturado aplicado em forma de entrevista. Associações entre as variáveis dependentes e independentes foram retiradas do modelo de regressão de Poisson. Os dados analisados evidenciaram maior prevalência entre violência e as variáveis sexo masculino, maior número de irmãos e baixa renda, enquanto que a religião foi associada como indicador de proteção para a violência psicológica. Conclui-se que as abordagens intersetoriais, interdisciplinares e multidimensionais se constituem em importante estratégia para promoção da saúde e redução da violência escolar, sobretudo em comunidades com indicadores de vulnerabilidade. Estratégias específicas de atuação do enfermeiro são indicadas para prevenção de riscos associados a violência.

ABSTRACT This study evaluated the clinical diagnosis of proximal gingivitis by comparing two methods: dental flossing and the gingival bleeding index (GBI). One hundred subjects (aged at least 18 years, with 15% of positive proximal sites for GBI, without proximal attachment loss) were randomized into five evaluation protocols. Each protocol consisted of two assessments with a 10-minute interval between them: first GBI/second floss, first floss/second GBI, first GBI/second GBI, first tooth floss/second floss, and first gum floss-second floss. The dental floss was slid against the tooth surface (TF) and the gingival tissue (GF). The evaluated proximal sites should present teeth with established point of contact and probing depth ≤ 3mm. One trained and calibrated examiner performed all the assessments. The mean percentages of agreement and disagreement were calculated for the sites with gingival bleeding in both evaluation methods (GBI and flossing). The primary outcome was the percentage of disagreement between the assessments in the different protocols. The data were analyzed by one-way ANOVA, McNemar, chi-square and Tukey’s post hoc tests, with a 5% significance level. When gingivitis was absent in the first assessment (negative GBI), bleeding was detected in the second assessment by TF and GF in 41.7% (p < 0.001) and 50.7% (p < 0.001) of the sites, respectively. In the absence of gingivitis in the second assessment (negative GBI), TF and GF detected bleeding in the first assessment in 38.9% (p = 0.004) and 58.3% (p < 0.001) of the sites, respectively. TF and GF appears to be a better diagnostic indicator of proximal gingivitis than GBI.

Embora a anestesia injetável previamente a raspagem e alisamento subgengival (RASUB) reduza a dor, muitos pacientes relatam medo e amortecimento prolongado dos tecidos adjacentes. O objetivo deste estudo foi comparar o efeito de uma mistura eutética contendo 25mg/g de lidocaína e 25 mg/g de prilocaína, lidocaína 2% injetável, benzocaína 2% tópica e um placebo na redução da dor durante a RASUB. Neste ensaio clínico randomizado, cego de boca dividida, trinta e dois pacientes que apresentavam mais que dois dentes com profundidade de sondagem e nível de inserção clínica ≥ 5 mm, em no mínimo 4 sextantes, foram randomicamente alocados em 4 grupos: EMLA(r), lidocaína 2% injetável, benzocaína 2% tópica ou placebo. Dor e desconforto foram mensurados usando uma Escala Visual Analógica (EVA) e Escala Verbal (EV). A satisfação dos pacientes com a anestesia foi determinada ao final de cada consulta. Análise de variância de medidas repetidas e regressão de Poisson foram usadas para análise. Os escores da EVA e EV não demonstraram diferenças estatisticamente significantes entre lidocaína injetável e EMLA(r) (p > 0,05) e ambas as substâncias demonstraram significativamente melhor controle da dor comparadas a benzocaína 2% e placebo (p<0,05). 93,7% e 81,2% dos indivíduos ficaram satisfeitos com o anestésico injetável e EMLA(r), respectivamente (p=0,158). A insatisfação com a benzocaína e placebo foi aproximadamente 10 vezes maior do que com a anestesia injetável (p=0,001). Em conclusão, o EMLA(r) demonstrou um efeito equivalente no controle da dor quando comparado com a anestesia injetável e melhor do que a benzocaína 2% em RASUB. Assim, o EMLA(r) é uma opção anestésica viável durante a raspagem e alisamento radicular, apesar da necessidade frequente de segunda aplicação.

Although the use of injectable anesthesia prior to subgingival scaling and root planing (SRP) reduces pain, many patients report fear and prolonged numbness of adjacent tissues. The aim of the present study was to compare the effects of a eutectic mixture containing 25 mg/g of lidocaine and 25 mg/g of prilocaine, injectable 2% lidocaine, topical 2% benzocaine and a placebo substance on reducing pain during SRP. In this randomized, split-mouth, masked clinical trial, thirty-two patients presenting more than two teeth with probing depth and clinical attachment level ≥5 mm in at least 4 sextants were randomly allocated to four groups: EMLA(r); injectable 2% lidocaine; topical 2% benzocaine and placebo. Pain and discomfort were measured using a visual analogue scale (VAS) and verbal scale (VS). Repeated-measures analysis of variance and Poisson regression were used for analysis. Patient satisfaction with the anesthesia was determined at the end of each treatment session. VAS and VS scores did not differ between injectable 2% lidocaine and EMLA (p>0.05) and both substances showed significantly better pain control compared to 2% benzocaine and placebo (p<0.05). 93.7% and 81.2% of the individuals were satisfied with the injectable anesthetic and EMLA, respectively (p=0.158). Dissatisfaction with benzocaine and placebo was approximately 10 times greater than injectable anesthesia (p=0.001). In conclusion, EMLA showed an equivalent effect on pain control when compared to the injectable anesthesia and performed better than 2% benzocaine in SRP. Thus, EMLA is a viable anesthetic option during scaling and root planning, despite the frequent need for second application.

OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo.

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment.

Revisões sistemáticas prévias tem demonstrado melhores resultados com proteínas derivadas da matriz de esmalte (PDME) em comparação a retalho de espessura total (RET) para o manejo de defeitos periodontais infraósseos (DPI). O objetivo desse estudo foi determinar se essas diferenças variam de acordo com o tempo de acompanhamento e com a qualidade dos estudos. As bases de dados Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Lilacs, Embase e Web of Science foram pesquisadas sem limitação de tempo ate agosto de 2013 para ensaios clínicos randomizados. Os desfechos elegíveis foram alterações na profundidade de sondagem (PS), nível de inserção clinica (NIC), recessão gengival (RG) e alterações ósseas (AO). Resultados: Estudos com acompanhamento de ate 12 meses mostraram diferenças de 0.97 mm (CI95% 0.52 – 1.43) e 1.19 mm (CI95% 0.77 – 1.60) para PS e NIC, favoráveis a PDME, respectivamente. Estudos com acompanhamento ≥24 meses demonstraram vantagens de 1.11 mm (CI95% 0.74 -1.48) para NIC e 0.83 mm (CI95% 0.19 -1.48) para PS, com o uso de PDME. Considerando a qualidade dos estudos, publicações com baixo risco de viés exibiram menores diferenças entre os grupos apresentando 0.8 mm (CI95% 0.24-1.36) para o NIC, sem diferenças para PS (0.51 mm, CI95% -0.21 – 1.23). Pode-se concluir que o tempo de acompanhamento (< ou > 2anos) e o risco de viés são variáveis que influenciam nos resultados do tratamento com PDME em DPIO.

Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.

There is little material in the literature that compares biological width measurements in periapical and bite-wings radiographs with clinical measurements. The purpose of this study was to compare measurements of biological width taken by three different methods which are frequently used for planning periodontal surgery - periapical radiograph, bite-wing radiograph and transperiodontal probing - with the trans-surgical measurements. Thirty-four sites from twenty-one subjects were analyzed. The intra-class correlation coefficients between measurements obtained trans-surgically (gold standard) and those obtained by transperiodontal probing, periapical radiography and bite-wing radiography were determined. Average measurements were compared using the Wilcoxon test at a significance level of 0.05. Also, the frequency distribution of differences between test measurements and the gold standard was calculated. The results showed that transperiodontal probing (mean 2.05 mm) was the most accurate measurement, as compared to the gold standard (mean 1.97 mm), with no statistically significant difference observed. On the other hand, periapical and bite-wing radiographic mean values (1.56 mm and 1.72 mm, respectively) were smaller than the gold standard, with statistically significant differences (p < 0.05). It was concluded that transperiodontal probing was the most accurate measurement, as compared to the gold standard, followed by that obtained with the bite-wing radiograph. The clinical relevance of these results could be that planning for crown lengthening surgery should, preferably, include transperiodontal probing.

When dealing with patients with periodontal disease of variable severities, dentists must often choose between treating and restoring the involved tooth or indicating its extraction. Different criteria have been adopted in this decision-making process. The purpose of this study was to evaluate the criteria adopted by dentists to indicate the extraction of teeth with periodontitis. Dentists were interviewed at their private practices in three cities of the state of Rio Grande do Sul, Brazil. The evaluated criteria included severity of attachment loss, tooth mobility, furcation involvement, prosthetic planning, periodontal-endodontic lesion, possible systemic involvement due to the presence of periodontitis, referral to a periodontist for evaluation, radiographic bone loss greater than 50%, presence of extensive caries, socio-economic and cultural status of the patient, among others. The most often adopted criteria to indicate the extraction of periodontally affected teeth were the presence of mobility (37.5%), severity of attachment loss (24.3%) and radiographic bone loss greater than 50% (21.2%). The results of the present study demonstrated the difficulties faced by dentists to indicate the extraction of teeth with severe attachment loss, in addition to the establishment of an adequate prognosis. Aspects associated with the past disease were still the most often reported to indicate the extraction of teeth for periodontal reasons.