Abstract Vaccinium macrocarpon (cranberry) is a fruit that has an inhibitory effect on matrix metalloproteinases (MMPs) present in dentin and saliva. The inhibition of MMPs has been shown to prevent dentin erosion. The aim of this study was to analyze the effect of cranberry juice on the reduction of dentin erosion in vitro. Specimens of bovine dentin (4×4×2 mm) were randomized and divided into 4 groups (n = 17/group): distilled water (C-control, pH 7.2); green tea extract solution containing 400 µm epigallo-catechin-gallate (EGCg, positive control, pH 4.5); 10% cranberry extract (CrE, pH 3.9), and cranberry juice (CrJ, Cranberry JuxxTM, pH 2.8). Specimens were submitted to erosive pH cycles for 5 days. Each day, four demineralizations were carried out with 0.1% citric acid (90 s). After the acid challenges, specimens were rinsed and kept in treatment solutions for 1 min; afterwards, they were rinsed and stored in artificial saliva for 1 h at 37°C (or overnight at the end of each day). After the experimental period of 5 days, dentin loss was evaluated by contact profilometry. Data were analyzed by ANOVA and Tukey’s test (p < 0.05). Dentin loss (µm ± SD) was significantly lower for all treatments (EGCg = 9.93 ± 2.90; CrE = 12.10 ± 5.44; CrJ = 11.04 ± 5.70) compared to control (21.23 ± 11.96), but it did not significantly differ from each other. These results indicate that the commercial cranberry juice, despite its low pH, is able to reduce dentin erosion, which might be due to the ability of cranberry components to inhibit MMPs.

ABSTRACT The use of gels and mouthrinses with MMP inhibitors (chlorhexidine, and green tea extract) was shown to prevent erosive wear. The aim of this study was to analyze the protective effect of toothpastes containing MMP inhibitors on dentine loss induced by erosion in vitro. Material and Methods Five groups each containing 12 specimens of human root dentine were prepared. The specimens were subjected to 1 min erosion by immersion in a cola drink, 4 times a day, for 5 d. Each day, after the first and last erosive challenges, the specimens were brushed for 15 s with a slurry of dentifrice and water (1:3) containing placebo, 1,100 ppm fluoride, 0.61% green tea extract, 0.12% chlorhexidine or 0.004% chlorhexidine (commercial toothpaste). Between the acid challenges, the specimens were stored in artificial saliva with remineralizing potential until the next treatment. Dentine loss was determined using profilometry. Data were analyzed using one-way ANOVA after log transform (p<0.05). Results The mean wear values (μm) were as follows: placebo 1.83±0.53; 0.61% green tea extract 1.00±0.21; fluoride 1.27±0.43; 0.12% chlorhexidine 1.19±0.30; and 0.004% chlorhexidine 1.22±0.46. There was a significant difference in wear between placebo and all the treatment toothpastes, which did not differ from each other. Conclusion The results suggest that toothpastes containing MMP inhibitors are as effective as those based on NaF in preventing dentine erosion and abrasion.

OBJECTIVE: The aim of this study was to evaluate the effect of the addition of metallic ions to carbonated drinks on their erosive potential. MATERIAL AND METHODS: Powdered enamel was added to carbonated beverages (Coca-ColaTM or Sprite ZeroTM and shaken for 30 s. The samples were then immediately centrifuged and the supernatant removed. This procedure was repeated 5 times with the beverages containing Cu2+, Mg2+, Mn2+ or Zn2+ (1.25-60 mmol/L). For Coca-ColaTM, the concentration of each ion that exhibited the highest protection was also evaluated in combination with Fe2+. The phosphate or calcium released were analyzed spectrophotometrically. Data were analyzed using ANOVA and Tukey's test (p<0.05). RESULTS: For Coca-ColaTM, the best protective effect was observed for Zn2+ alone (10 mmol/L) or in combination (1 mmol/L) with other ions (12% and 27%, respectively, when compared with the control). Regarding Sprite ZeroTM, the best protective effect was observed for Cu2+ at 15 and 30 mmol/L, which decreased the dissolution by 22-23%. Zn2+ at 2.5 mmol/L also reduced the dissolution of powdered enamel by 8%. CONCLUSIONS: The results suggest that the combination of metallic ions can be an alternative to reduce the erosive potential of Coca-ColaTM. Regarding Sprite ZeroTM, the addition of Cu2+ seems to be the best alternative.

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear. Objective: This review discusses the role of salivary factors on the development of dental erosion. Material and Methods: A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. Results: Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion. Conclusions: Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.

OBJECTIVE: This in vitro study evaluated the effect of calcium glycerophosphate (CaGP) supplemented to soft drinks on bovine enamel erosion. MATERIAL AND METHODS: Four pH-cycles were performed, alternating demineralization by the beverage and remineralization in artificial saliva. RESULTS: Mean wear (±SD, µm) was 7.91±1.13, 7.39±1.01, 7.50±0.91 and 5.21±1.08 for Coca-Cola® without CaGP or containing CaGP at 0.1, 1.0 or 2.0 mM, respectively, while no wear was detected for CaGP at 5.0 and 10.0 mM. Corresponding figures for Sprite Zero® without CaGP or containing CaGP at 0.1, 1.0, 2.0, 5.0 or 10.0 mM were 8.04±1.30, 7.84±0.71, 7.47±0.80, 4.96±0.81, 3.99±0.10 and 1.87±0.12, respectively. CONCLUSION: Supplementation of both beverages with CaGP seems to be an alternative to reduce their erosive potential.

Iron has been suggested to reduce the erosive potential of cola drinks in vitro.OBJECTIVE: The aim of this study was to evaluate in situ the effect of ferrous sulfate supplementation on the inhibition of the erosion caused by a cola drink. MATERIAL AND METHODS: Ten adult volunteers participated in a crossover protocol conducted in two phases of 5 days, separated by a washout period of 7 days. In each phase, they wore palatal devices containing two human enamel and two human dentin blocks. The volunteers immersed the devices for 5 min in 150 mL of cola drink (Coca-ColaTM, pH 2.6), containing ferrous sulfate (10 mmol/L) or not (control), 4 times per day. The effect of ferrous sulfate on the inhibition of erosion was evaluated by profilometry (wear). Data were analyzed by paired t tests (p<0.05). RESULTS: The mean wear (±se) was significantly reduced in the presence of ferrous sulfate, both for enamel (control: 5.8±1.0 µm; ferrous sulfate: 2.8±0.6 µm) and dentin (control: 4.8±0.8 µm; ferrous sulfate: 1.7±0.7 µm). CONCLUSIONS: The supplementation of cola drinks with ferrous sulfate can be a good alternative for the reduction of their erosive potential. Additional studies should be done to test if lower ferrous sulfate concentrations can also have a protective effect as well as the combination of ferrous sulfate with other ions.

OBJECTIVE: This in situ study evaluated the protective effect of green tea on dentin erosion (ERO) and erosion-abrasion (ABR). MATERIAL AND METHODS: Ten volunteers wore intraoral palatal appliances with bovine dentin specimens subjected to ERO or ERO + toothbrushing abrasion performed immediately (ERO+I-ABR) or 30 min after erosion (ERO+30-min-ABR). During 2 experimental 5-day crossover phases, the volunteers rinsed with green tea or water (control, 1 min) between each erosive (5 min, cola drink) and abrasive challenge (30 s, toothbrushing), 4x/day. Dentin wear was measured by profilometry. RESULTS: The green tea reduced the dentin wear significantly for all conditions compared to control. ERO+I-ABR led to significantly higher wear than ERO, but it was not significantly different from ERO+30-min-ABR. ERO+30-min-ABR provoked significant higher wear than ERO, only for the placebo treatment. CONCLUSIONS: From the results of the present study, it may be concluded that green tea reduces the dentin wear under erosive/abrasive conditions.

OBJECTIVE: To evaluate the prevalence of dental fluorosis in scholars aging 12 to 15 years old, residents in the city of Bauru, State of São Paulo, Brazil. METHODS: 1318 volunteers were enrolled in this study and examined in 18 public schools of the State of São Paulo. The examinations were performed in the schools' court by three dentists (with a Master's degree in Public Health), after toothbrushing supervised by another dentist. The teeth were dried with cotton pellets and examined under natural light by visual inspection, using an explorer as recommended by the WHO, a plane mirror and a tongue depressor. The Thylstrup-Fejerskov (TF) index was used for rating fluorosis. Intra and inter-examiner reproducibility was calculated and data were submitted to descriptive analysis. RESULTS: Approximately 36% of the children presented dental fluorosis, of which 28% was diagnosed as TF1 while the remaining received scores between TF2 and TF4. CONCLUSION: The prevalence of dental fluorosis in Bauru is within the expected range, based on previous studies. Although fluoride is an important resource for caries control, its use must be adequate to the needs of each specific population.

This study evaluated, in vitro, the effect of iron (previously exposed with enamel powder or added directly to the beverage) on the erosive potential of carbonated or decarbonated beverage. Four sets of experiments were done. For groups E1 and E3, a solution containing 30 mmol/L FeSO4 was added to bovine enamel powder (particles between 75-106 mm) before exposure to the carbonated or decarbonated beverage (Sprite Zero®), respectively. For groups E2 and E4, 15 mmol/L FeSO4 was added directly to the carbonated or decarbonated beverage, respectively. Control groups were included for comparison. In controls C1 and C3, the experiments E1 and E3 were repeated, but the iron solution was replaced by deionized water. For controls C2 and C4, the carbonated and decarbonated beverage, respectively, was used, without addition of iron. After addition of the beverage to the powdered enamel (40 mg enamel powder/400 mL of final volume), the sample was vortexed for 30 s and immediately centrifuged for 30 s (11,000 rpm). The supernatant was removed after 1 min 40 s. This procedure was repeated in quintuplicate and the phosphate released was analyzed spectrophotometrically. The results were analyzed by Student's t-test (p<0.05). E2 presented the best results with a significant inhibition (around 36%) of phosphate released. For E3 and E4 a non-significant inhibition (around 4 and 12%, respectively), was observed. For E1 an increase in phosphate loss was detected. Thus, the protective effect of iron seems to be better when this ion is directly added to the carbonated beverage.

O tratamento das Disfunções Temporomandibulares (DTM) objetiva ser conservador e reversível para alívio da dor e restauração da função normal. Sendo assim, tratamentos como a estimulação neural elétrica transcutânea (TENS) e o laser de baixa freqüência têm sido utilizados. Portanto, foi premissa deste trabalho a comparação do TENS com o a terapia com laser de baixa freqüência no tratamento de pacientes com DTM. Foram selecionados dezoito pacientes com sinais e sintomas de DTM crônica de origem muscular. O grupo LASER recebeu aplicação de laser e o grupo TENS, estimulação elétrica, totalizando 10 sessões, três vezes por semana, durante um mês. A avaliação foi feita imediatamente antes e 5 minutos após cada sessão terapêutica, por meio da escala de análise visual (EAV) para o registro da sensação de dor mensuração de abertura máxima e palpação muscular ( masseter e temporal anterior). Para análise estatística foram utilizados o teste de Friedman e ANOVA para mensurações repetidas. Os resultados demonstraram decréscimo na EAV e aumento da abertura bucal máxima de ambos os grupos (p<0,05). A palpação muscular apresentou diferença significante para o grupo LASER (p<0,05). Baseado na análise da EAV e movimentação ativa, concluiu-se que ambas as terapias propostas foram efetivas no tratamento das DTM, sendo que o efeito acumulativo pode ser o responsável pela melhora obtida. Porém, é sugerida cautela quando se analisa o presente resultado, devido ao aspecto auto-limitante das condições músculo-esqueletais como as DTMs.

Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (p<0.05), and improvement in muscle tenderness for the LASER group. Authors concluded that both therapies are effective as part of TMD management and a cumulative effect may be responsible for the improvement. Caution is suggested when analyzing these results because of the self-limiting feature of musculoskeletal conditions like TMD.

OBJETIVO: Avaliar a efetividade do laser de baixa freqüência e do estímulo muscular microelétrico (MENS) no tratamento de pacientes com disfunções temporomandibulares (DTM). MATERIAL E MÉTODOS: Uma amostra de 19 indivíduos com sinais e sintomas de DTM de origem muscular, foi dividida em dois grupos (I -laser e II - MENS). O tratamento consistiu de 10 sessões, três vezes por semana, durante um mês. Os critérios de avaliação dos pacientes foram: escala de análise visual (EAV), mensuração de abertura máxima bucal e palpação muscular, estes foram avaliados imediatamente antes e 5 minutos após cada sessão terapêutica, num estudo do tipo controlado. Para análise estatística, foram aplicados ANOVA para mensurações repetidas e Mann-Whitney. RESULTADOS: Os resultados demonstraram aumento da abertura bucal máxima e diminuição na sensibilidade à palpação em ambos os grupos e, em relação à EAV, ambos os grupos demonstraram decréscimo, mas houve uma diferença estatisticamente significante entre os grupos, já que o grupo laser apresentou os melhores resultados p<0,05. CONCLUSÃO: Os autores concluíram que as duas terapias foram efetivas como parte do tratamento das DTM, e o efeito cumulativo podem ter sido responsável pela melhora. Porém sugere-se cautela quando se analisam os resultados devido ao aspecto autolimitante das condições músculo-esqueletais como as DTM.

OBJECTIVE: The aim of the present study was to evaluate the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of patients with temporomandibular disorders (TMD). MATERIAL AND METHODS: A sample of 19 individuals presenting with signs and symptoms of myogenic TMD was randomly divided into two groups (I - LLLT and II - MENS). Therapy was done in 10 sessions, three times a week, for one month. Patients were evaluated by the Visual Analogue Scale (VAS), measurement of active range of motion (AROM) and muscle palpation, performed immediately before and 5 minutes after each therapeutic session by a blinded TMD specialist. The ANOVA for repeated measurements and Mann-Whitney tests were used for the statistical analysis. RESULTS: The results showed an increase in maximum mouth opening and a decrease in tenderness to palpation for both groups. The VAS reduced for both groups, although more evident for the laser group (p<0.05). CONCLUSION: Authors concluded that both therapies were effective as part of the TMD treatment, and the cumulative effect may have been responsible for this fact. However, caution is recommended when judging the results due to the self-limiting aspect of musculoskeletal conditions such as TMD.

A fim de avaliar a opinião da classe odontológica sobre a utilização das coroas metalo-cerâmicas na prática odontológica, aplicou-se um questionário de 20 questões a cirurgiões-dentistas da cidade de Aracaju - SE, e a cirurgiões-dentistas e estudantes de pós-graduação em odontologia, na área de prótese dental, da cidade de Bauru-SP. Concluiu-se que: 1. As coroas metalo-cerâmicas são o tipo de restauração protética mais empregado em Odontologia. 2. A maioria dos dentistas refere-se às coroas metalo-cerâmicas como restaurações bem sucedidas, indicando superfícies oclusais metálicas para a maioria dos pacientes. 3. Apesar da maior parte dos profissionais utilizar as ligas de níquel-cromo nas coroas metalo-cerâmicas de seus pacientes, os mesmos prefeririam que ligas nobres ou semi-nobres fossem empregadas em suas próprias restaurações. 4. A maioria dos entrevistados emprega as coroas metalo-cerâmicas na restauração de dentes anteriores (57,23%). Entretanto, esse valor se deve à preferência dos dentistas de Aracaju (78%) por esse tipo de restauração, ao passo que, em Bauru, prevaleceu o número de respostas favoráveis às coroas de porcelana pura. 5. O cimento de fosfato de zinco foi o cimento de escolha da maioria dos profissionais. 6. A preferência da maior parte dos entrevistados, com relação à porcelana utilizada foi pela porcelana Vita (34,34%), em comparação às porcelanas Noritake e Dulceram Plus (13,86%). 6. Ficou evidente o desejo dos entrevistados quanto ao desenvolvimento de mecanismos que facilitem o reparo das coroas metalo-cerâmicas.

The current features of ceramic fused to metal crowns were evaluated by means of a questionnaire composed by 20 questions concerning the use of this type of restoration in the daily dental practice of professionals from Aracaju, Bauru and post-graduation students in the area of dental prosthesis. The conclusions were as follows: 1. Ceramic fused to metal crowns are the most employed restorations in Dentistry. 2. Most dentists regard ceramic fused to metal crowns as successful restorations, indicating ceramic occlusal surfaces for most of the patients. 3. Even though most professionals use nickel-chromium alloys in ceramic fused to metal crowns for their patients, they prefer the use of noble and semi-noble alloys for restorations in their own mouths. 4. The majority of the interviewees employ ceramic fused to metal crowns for rehabilitation of anterior teeth (57.23%). Nevertheless, this was due to the fact that 78% of the dentists from Aracaju preferred this type of restoration, whereas in Bauru most professionals and students make use of ceramic crowns. 5. Most professionals apply zinc phosphate cement for the placement of ceramic fused to metal crowns. Most of them prefer to use Vita porcelain (34.34%), compared to 13.86% for the Noritake and Dulceram Plus porcelains. 6. The most desired improvement for ceramic fused to metal crowns was the possibility of easy repair.

Na tentativa de estabelecer uma posição maxilomandibular reprodutível em pacientes sem dentes suportes posteriores ou portadores de oclusão instável, o conceito de relação cêntrica (RC) foi introduzido. Apesar de ser utilizada como uma posição de referência, existe uma considerável divergência de opiniões sobre a sua reprodutibilidade. Este estudo procurou avaliar se os métodos de treinamento profissional são efetivos na análise e obtenção de RC. Para isso utilizou-se uma amostra de 40 indivíduos, divididos em 20 assintomáticos e 20 portadores de disfunções da ATM. Os indivíduos foram avaliados por 3 examinadores, previamente calibrados. Foram realizados 2 exames: inicial e final (30 dias após o inicial), possibilitando dessa forma, análise da concordância interexaminadores, assim como intra- examinadores. Posteriormente, os resultados foram submetidos à análise estatística, utilizando-se os testes de concordância de Kendall e de Kappa. Os resultados foram considerados bons, sendo os melhores obtidos para a análise do desvio frontal e relato de dor (ou ausência) durante a manipulação. Os autores concluíram que os programas de calibração podem ser efetivos para análise da RC. No entanto, cautela é recomendada quando da análise de alguns itens isolados.

Centric relation (CR) has been considered a maxillomandibular position of choice for some dental and prosthetic procedures. Although regarded as a fully reproducible relation, there is great controversy about its clinical use and recording technique, especially in patients with signs and symptoms of temporomandibular disorders (TMD). This study aimed at evaluating the effectiveness of a training program on intra- and interexaminer agreement when determining the clinical record of the CR position. Forty individuals constituted the sample, divided into symptomatic (TMD) and asymptomatic groups. Three previously calibrated examiners performed the initial assessment and the second evaluation after 30 days in a blind design, using Dawson’s bilateral manipulation technique with and without an anterior stop. The amount of frontal and sagittal deviations in relation to intercuspal position, the presence of pain and discomfort during manipulation, and the first occlusal contact in CR were analyzed. Kendall and Kappa tests with a 5% level of significance were used to determine agreement. Values for both intra- and interexaminer agreement were deemed good. The best results were obtained for frontal deviations and assessment of pain (or absence of it) during manipulation. Sagittal deviations showed the lowest agreement in both examinations. The authors concluded that a calibration program could be effective for intra- and interexaminer agreement when recording centric relation. However, caution is recommended when analyzing some isolated items.