Resumen El objetivo de este estudio fue observar la eficacia anestésica del bloqueo del nervio alveolar en nueve pacientes que CBCT diagnosticó canal retromolar unilateral en un abordaje de boca dividida doble ciego. Las evaluaciones de la respuesta del paciente a los estímulos térmicos (prueba de vitalidad pulpar) y de presión (compresión de los tejidos blandos) se realizaron antes y 5 minutos después del procedimiento de bloqueo del nervio alveolar inferior, utilizando tanto la escala analógica visual (VAS) como los cuestionarios de dolor de Mc Gill ( McG). El porcentaje medio de respuesta de los pacientes disminuyó tras el bloqueo del nervio alveolar, según EVA y McG, y fue estadísticamente similar entre hemimandíbulas con y sin canal retromolar (Wilcoxon>0,05); sin embargo, aquellos sin canal retromolar presentaron mayor reducción en la respuesta del paciente en 6 de 9 casos. Por lo tanto, el canal retromolar no es un factor determinante del fracaso del bloqueo del nervio alveolar inferior.

Abstract The aim of this study was to observed the anesthetic efficacy of the alveolar nerve block on nine patients that CBCT diagnosed unilateral retromolar canal on a double-blind, split-mouth approach. The assessments of patient response to thermal (pulp vitality test) and pressure (compression of soft tissue) stimuli were carried out before and 5 minutes after the inferior alveolar nerve block procedure, using both visual analog scale (VAS) and Mc Gill pain questionnaires (McG). The mean percentage of patient response decreased after alveolar nerve block, according to both VAS and McG, and was statistically similar among hemi mandibles with and without retromolar canal (Wilcoxon>0.05); however, those without retromolar canal presented greater reduction in patient response in 6 out of 9 cases. Therefore, the retromolar canal is not a determinant factor of inferior alveolar nerve block failure.

O objetivo deste estudo foi comparar o teor residual de pirofosfato de tetrasodio liberado por dois tipos diferentes de fio dental anti-cálculo (Reach PP(r) - polipropileno entrelaçado e Reach NT(r) - nylon texturizado) na cavidade oral. Dez indivíduos saudáveis (com idade entre 18 e 30 anos) foram selecionados para este estudo clínico em modelo crossover. Os participantes receberam instruções sobre como utilizarem os fios dentais e as intervenções foram randomicamente realizadas em 2 grupos de 5 participantes de acordo com o tipo de fio avaliado. O participantes foram instruídos a passarem cada fio dental em um total de 6 passadas ao redor dos 2 espaços interproximais dos dentes selecionados (3 passadas em cada face interproximal). Um período de washout de 1 semana foi utilizado antes do início do estudo e após cada intervenção com o objetivo de prevenir a ocorrência de viés relacionado à exposição de algum agente terapêutico. Amostras do fluido interdental após as intervenções foram avaliadas por meio de cromatografia de íons. A porcentagem residual de pirofosfato tetrassódico foi verificada empregando-se o método da cromatografia de íons, pela colheita do fluido interdental com cones de papel absorvente esterilizados. Os teores de pirofosfato tetrassódico residual foram comparados para cada fio dental e para cada tempo de colheita do fluido interdental. Não foram observadas diferenças significantes entre os grupos avaliados (p>0,05). Conclui-se que a composição do material e a estrutura física dos fios dentais não exerceram influência na liberação e na permanência do agente anti-tártaro, que permaneceu em níveis terapêuticos por um período de até 2 h após o uso único.

The aim of this study was to compare the residual content of tetrasodium pyrophosphate released by two different anticalculus dental flosses (Reach PP(r) - entangled polypropylene floss and Reach NT(r) - texturized nylon) in the oral cavity. Ten healthy individuals (aged between 18 and 30 years) were enrolled in this randomized crossover clinical investigation. Participants received instructions on daily dental flossing and the interventions were randomly performed in 2 different groups (NT or PP) of five individuals each according to the dental flosses. Individuals were instructed to use each dental floss with a total of six slides on the two interproximal aspects of target teeth (3 slides on each interproximal aspect). A washout period of one week was used before start flossing interventions and after each type of dental floss to prevent any bias related to the exposure to any product that contained the active ingredient. Samples were collected by #35 sterilized absorbent paper points from interdental fluid after flossing and assessed by ion chromatography. The levels of residual tetrasodium pyrophosphate were evaluated by means of binomial generalized linear model proportions and canonical link function. Both dental flosses were effective in tetrasodium pyrophosphate release at therapeutic levels in the interdental gingival crevicular fluid for a period of up to 2 h after use. No significant differences were found between both groups (p>0.05). It may be concluded that both material composition and physical structure of the new dental floss did not affect the release or the maintenance of anticalculus agent at therapeutic levels for a period of up to 2 h after single use.

The aim of this study was to evaluate the shear bond strength between acrylic teeth and heat-activated acrylic denture base resin using five different disinfectants solutions after simple immersion or under ultrasonic cleaner action. A total of 144 acrylic denture resin specimens were produced with both types of acrylic denture tooth (Biolux® and Trilux®). The specimens were randomly divided into subgroups according to the disinfection procedure used (immersion in Listerine®, Cepacol®, Periogard®, Riozyme II® and Cloro Rio® 1%, and/or ultrasonic cleaning action). The shear bond strength between acrylic teeth and denture base was assessed using a universal testing machine and the data obtained were analyzed by means of ANOVA followed by Fisher's LSD Multiple-Comparison test. The two layers teeth presented a bond strength average of 3.43 MPa while the three layer ones had an average of 3.02 MPa. The association of ultrasonic cleaner and the disinfectant solutions studied did not affect negatively the teeth bond resistance to the denture base. The three layer acrylic teeth had a lower shear bond strength compared to those with double pressing when immersed in disinfection solutions, regardless of the ultrasonic cleaner use.

El objetivo de este estudio fue evaluar la resistencia al cizallamiento entre dientes de resina acrílica y bases acrílicas curadas mediante calor, junto al uso de cinco soluciones de desinfectantes diferentes, mediante inmersión simple o bajo ultrasonido. Un total de 144 bases de acrílico fueron confeccionadas con los dos tipos de dientes de resina (Biolux ® y Trilux ®). Los especímenes se dividieron aleatoriamente en subgrupos de acuerdo con el procedimiento de desinfección utilizado (inmersión en Listerine ®, Cepacol ®, Periogard ®, Riozyme II ® y Cloro Río ® 1%, y/o acción de limpieza por ultrasonido). Se evaluó la resistencia al cizallamiento entre los dientes de resina y la base de la prótesis utilizando una máquina de ensayo universal; los datos obtenidos se analizaron mediante ANOVA seguido por el test LSD de Fisher de comparaciones múltiples. Las dos capas de los dientes presentaron una fuerza de adherencia promedio de 3,43 MPa, mientras que las tres capas tenían un promedio de 3,02 MPa. La asociación de limpiador ultrasónico y las soluciones desinfectantes estudiados no afectaron negativamente la resistencia de los dientes a la base de la prótesis. Las tres capas de acrílico de los dientes tuvieron una resistencia al cizallamiento menor en comparación con aquellos con doble prensado cuando se sumergen en soluciones desinfectantes, independientemente del uso de limpiador ultrasónico.

Dental implants have increased the use of titanium and titanium alloys in prosthetic applications. Whitening toothpastes with peroxides are available for patients with high aesthetic requirements, but the effect of whitening toothpastes on titanium surfaces is not yet known, although titanium is prone to fluoride ion attack. Thus, the aim of the present study was to compare Ti-5Ta alloy to cp Ti after toothbrushing with whitening and conventional toothpastes. Ti-5Ta (%wt) alloy was melted in an arc melting furnace and compared with cp Ti. Disks and toothbrush heads were embedded in PVC rings to be mounted onto a toothbrushing test apparatus. A total of 260,000 cycles were carried out at 250 cycles/minute under a load of 5 N on samples immersed in toothpaste slurries. Surface roughness and Vickers microhardness were evaluated before and after toothbrushing. One sample of each material/toothpaste was analyzed by Scanning Electron Microscopy (SEM) and compared with a sample that had not been submitted to toothbrushing. Surface roughness increased significantly after toothbrushing, but no differences were noted after toothbrushing with different toothpastes. Toothbrushing did not significantly affect sample microhardness. The results suggest that toothpastes that contain and those that do not contain peroxides in their composition have different effects on cp Ti and Ti-5Ta surfaces. Although no significant difference was noted in the microhardness and roughness of the surfaces brushed with different toothpastes, both toothpastes increased roughness after toothbrushing.

This study evaluate spontaneous pain after and before administration of sodium diclofenac, isolated or associated to carisoprodol, acetaminophen and caffeine, in chronic temporomandibular disorders (TMD) patients. Were selected eighteen volunteers, both men and women, between 35-70 years of age (mean age 50 years). The inclusion criteria was masticatory muscle pain, and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used on the diagnose. The selection of treatment for each individual was done by a triple-blind full-randomized crossover methodology. Thus, all patients were submitted to all treatment at different moments, in a non standardized sequence, avoiding tendentious results. The treatments were: A (sodium diclofenac + carisoprodol + acetaminophen + caffeine), B (sodium diclofenac) and C (placebo), all associated with an occlusal splint. Each treatment period was followed by an eleven-day washout. There weren't observed differences between initial and final values of treatments. However, there were statistically significant differences in evaluative and miscellaneous sensorial groups after B treatment; and in sensorial, affective, and total score groups after B and C treatments. Within the limitations of this investigation, we conclude that treatment of muscular TMD patients with sodium diclofenac isolated promoted higher analgesia than treatment with sodium diclofenac more associations or placebo, when associated to an occlusal splint.

Este estudio evaluó el dolor espontáneo antes y después de la administración de diclofenaco sódico, aislado o asociado a carisoprodol, paracetamol y cafeína, en pacientes con trastornos temporomandibulares crónicos (TTM). Se seleccionaron dieciocho voluntarios, hombres y mujeres, entre 35-70 años de edad (edad media 50 años). Los criterios de inclusión fueron dolor muscular masticatorio, y los criterios diagnósticos para trastornos temporomandibulares (RDC / TMD) como diagnóstico. La selección del tratamiento para cada individuo se llevó a cabo mediante una metodología de cruce triple ciego completo al azar. Por lo tanto, todos los pacientes fueron sometidos a todos los tratamientos en diferentes momentos, en una secuencia no estandarizada, evitando los resultados tendenciosos. Los tratamientos fueron: A (diclofenaco sódico + carisoprodol + acetaminofen + cafeína), B (diclofenaco sódico) y C (placebo), todos asociados a una férula oclusal. Cada período de tratamiento fue seguido por once días. No se encontraron diferencias entre los valores inicial y final de los tratamientos. Sin embargo, hubo diferencias estadísticamente significativas en los grupos de evaluación sensorial y después del tratamiento B, y en los grupos de calificación sensorial, afectivo, y el total después de los tratamientos B y C. Dentro de las limitaciones de esta investigación, se concluye que el tratamiento con diclofenaco sódico aislado en pacientes con TTM musculares promueve una mayor analgesia que el tratamiento con diclofenaco sódico más asociaciones o placebo, cuando se asocia a una férula oclusal.

Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. MATERIAL AND METHODS: The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CENTRAL) (12), MEDLINE (192), EMBASE (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently. RESULTS: Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confdence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identifed. CONCLUSIONS: This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.

The intra-buccal polymeric bioadhesive systems that can stay adhered to the oral soft tissues for drug programmed release, with the preventive and/or therapeutic purpose has been employed for large clinical situations. A system based on hydroxypropyl methyl cellulose/Carbopol 934'/magnesium stearate (HPMC/Cp/StMg) was developed having the sodium fluoride as active principle. This kind of system was evaluated according to its resistance to the removal by means of physical test of tensile strength. Swine buccal mucosa extracted immediately after animals' sacrifice was employed as substrate for the physical trials, to obtain 16 test bodies. Artificial saliva with or without mucin was used to involve the substrate/bioadhesive system sets during the trials. Artificial salivas viscosity was determined by means of Brookfield viscometer, showing the artificial saliva with mucin 10.0 cP, and the artificial saliva without mucin 7.5 cP. The tensile strength assays showed the following averages: for the group "artificial saliva with mucin" - 12.89 Pa, and for the group "without mucin" - 12.35 Pa. Statistical analysis showed no significant difference between the assays for both artificial salivas, and it was possible to conclude that the variable mucin did not interfered with the bioadhesion process for the polymeric devices. The device was able to release fluoride in a safe, efficient and constant way up to 8 hours.

Los sistemas bioadhesivos poliméricos intra-bucales pueden permanecer adheridos a los tejidos blandos orales para una liberación programada de fármacos, con finalidad preventiva y/o propósito terapéutico han sido empleados en diversas situaciones clínicas. Un sistema basado en Hidroxipropilmetilcelulosa/Carbopol934Ô/ estearato de magnesio (HPMC/Cp/StMg) fue desarrollado con fluorato de sodio como principio activo. Este tipo de sistema fue evaluado de acuerdo a su resistencia a la eliminación física por medio de pruebas de resistencia a la tracción. Mucosas bucales de cerdos fueron tomadas inmediatamente después del sacrificio de los animales y se utilizaron como sustrato para las pruebas físicas, obteniendo 16 cuerpos de prueba. Saliva artificial con o sin mucina fue utilizada para participar como parte del sistema sustrato/bioadesivo durante los ensayos. La viscosidad de la saliva artificial, se determinó mediante un viscosímetro Brookfield, mostrando la saliva artificial con mucina 10,0 cP y saliva artificial sin mucina 7,5 cP. Las pruebas de resistencia a la tracción mostraron los siguientes promedios: para la "saliva artificial con mucina" - 12,89 Pa, y para el grupo "sin mucina" - 12,35 Pa. El análisis estadístico no mostró diferencias significativas entre las pruebas de saliva artificial, y es posible concluir que la variable de mucina no interfiere con el proceso de bioadhesión del dispositivo polimérico. El dispositivo fue capaz de liberar fluor de forma segura, eficiente y constante durante un máximo de hasta 8 horas.

The aim of this study was to evaluate some biological characteristics and toxicity of basic formulations of dentifrices containing such substances, and to compare them with two existing products in market which also contains silic in their formulations. In this way, it was evaluated some biological parameters: weight of the animals, oral toxicity, hematological parameters, urinary analysis, and histological evaluation. The thrombocytes were also statistically at normal levels. The glutamate-pyruvate transaminase (TGP) showed normal aspect in 5 of the tested groups, as in control. Meanwhile, the oxalacetic transaminase (AST) in one group had a small increase in the control group. Regarding urine, in exception the rats of one group, the rats of the 4 other experimental groups showed leukocytosis urinary statistically higher than the control group. The histological evaluation of the animals showed that specimens from liver, stomach, kidney and submandibular gland presented normal aspects for these organs, without significant characteristics related to inflammatory infiltrates in any of the 6 samples tested in their respective groups.

El objetivo del estudio fue evaluar algunas características biológicas y de toxicidad provenientes de las formulaciones básicas de dentífricos que contienen sílice en su composición y compararlos con dos dentífricos disponibles comercialmente que también presentan sílice. El análisis hematológico no mostró diferencias entre los grupos evaluados. Los niveles de trombocitos presentados por los grupos fueron también normales. La transaminasa gluámico pirúbica se mostró un aspecto normal en 5 de los grupos estudiados, así como en el grupo control. La transaminasa glutámico oxaloacética en uno de los grupos tuvo un pequeño incremento. En relación a la orina, 4 grupos presentaron leucocitosis urinaria significativamente mayor que el grupo de control. La evaluación histológica del hígado, estómago, riñones y glándulas submandibulares se presentó con aspecto normal, sin presencia de infiltrado inflamatorio.

The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

The aim of this investigation was to monitor metronidazole concentrations in the gingival crevicular fluid (GCF) collected from periodontal pockets of dogs after treatment with an experimental 15% metronidazole gel. Five dogs had periodontitis induced by cotton ligatures placed subgingivally and maintained for a 30-day period. After the induction period, only pockets with 4 mm or deeper received the gel. Each pocket was filled up to the gingival margin by means of a syringe with a blunt-end needle. GCF was collected in paper strips and quantified in an electronic device before and after 15 minutes, 1 h, 6 h, 24 h and 48 h of gel administration. The GCF samples were assayed for metronidazole content by means of a high performance liquid chromatography method. Concentrations of metronidazole in the GCF of the 5 dogs (mean ± SD, in µg/mL) were 0 ± 0 before gel application and 47,185.75 ± 24,874.35 after 15 minutes, 26,457.34 ± 25,516.91 after 1 h, 24.18 ± 23.11 after 6 h, 3.78 ± 3.45 after 24 h and 3.34 ± 5.54 after 48 h. A single administration of the 15% metronidazole gel released the drug in the GCF of dogs in levels several-fold higher than the minimum inhibitory concentration for some periodontopathogens grown in subgingival biofilms for up to one hour, but metronidazole could be detected in the GCF at least 48 hours after the gel application.

O objetivo deste estudo foi traduzir e adaptar o McGill Pain Questionnaire para a Língua Portuguesa falada no Brasil, visando sua validação científica. Inicialmente o questionário original foi traduzido por três tradutores juramentados, fluentes em Inglês e Português falado no Brasil. Estas três traduções foram meticulosamente analisadas por cinco profissionais da saúde (três cirurgiões-dentistas, um médico e um estudante de medicina), que selecionaram para cada descritor de dor, a tradução que melhor correspondia com o termo original em Inglês. O questionário resultante foi então aplicado a 80 sujeitos (20 professores, 20 graduandos, 20 funcionários e 20 pacientes, todos ligados à Faculdade de Odontologia de Ribeirão Preto - USP). Após adaptações visando um melhor entendimento dos descritores de dor, uma adaptação dos valores de intensidade de cada descritor de dor foi feita por 20 pós-graduandos e 20 graduandos em Odontologia, os quais foram solicitados a registrar a intensidade da dor para cada um dos descritores, com base na sua opinião pessoal. Além disso, eles preencheram a versão final do questionário traduzido a fim de identificar a persistência de possíveis dúvidas. O McGill Pain Questionnaire se mostrou um instrumento bastante útil na mensuração da dor, e a sua tradução e adaptação o tornou válido para sua utilização como instrumento de mensuração da dor em Português.

The purpose of this study was to the present a translated version of the McGill Pain Questionnaire to Brazilian Portuguese that adapted the original pain descriptors according to the Brazilian culture, aiming at its scientific validation. Initially, the original questionnaire was translated by 3 legally recognized translators fluent in English and in Brazilian Portuguese. The translations were meticulously assessed by 5 health professionals (3 dentists, 1 physician and 1 medical student) who were asked to choose the best translation for each pain descriptor of the original questionnaire in English. The resulting questionnaire was applied to 80 subjects (20 professors, 20 dental students, 20 employees and 20 patients, all related to the School of Dentistry of Ribeirão Preto, University of São Paulo). After some adjustments to improve the understanding of the pain descriptors, an adaptation of the intensity values of each pain descriptor was done by 20 postgraduate dental students and 20 undergraduate dental students, who were asked to record, for each word, the pain intensity value based on their personal opinion. In addition, they were asked to fill out the final version of the questionnaire to identify any doubts. The McGill Pain Questionnaire proved to be a very useful tool for measuring pain, and its version in Brazilian Portuguese was validated to be used as an important diagnostic resource.

O propósito deste estudo foi avaliar a taxa de sobrevivência bacteriana em escovas dentais após a escovação e a eficácia na sua descontaminação pelo borrifamento de soluções antimicrobianas. Trinta indivíduos foram instruídos a borrifar as soluções nas cerdas das escovas após a escovação. Cada voluntário testou três sprays, uma solução por semana; os sprays foram rotulados spray 1 (cloreto de cetilpiridínio - CCP - e formulação básica), 2 (formulação básica apenas) e 3 (controle - água de torneira esterilizada). Ao final de cada semana, as escovas eram recolhidas e introduzidas no caldo Letheen®, submetidas a ultra-som, à diluição decimal seriada e as suspensões semeadas em vários meios de cultura. As bactérias anaeróbias, avaliadas pela contagem de colônias de microrganismos produtores de pigmento negro no meio Ask, foram recuperadas em 83,3% das amostras, estreptococos em 80% e bacilos aeróbios Gram-negativos em 46,7% das amostras nos testes controle. Houve uma significante redução na contaminação das escovas dentais com os sprays antimicrobianos 1 e 2, o primeiro mostrando maior redução nas contagens de bactérias.

The purpose of this study was to evaluate bacterial survival rate on toothbrushes after brushing and the efficacy of their decontamination by spraying antimicrobial solutions. Thirty subjects were instructed to spray the solutions on toothbrush bristles after brushing. Each volunteer tested three sprays, one solution per week; the sprays were labeled spray 1 (cetylpyridinium chloride - CPC - and basic formulation), 2 (basic formulation only) and 3 (control - sterile tap water). At the end of each week, the brushes were collected and sonicated in Letheen Broth®; the suspensions were ten-fold diluted and the dilutions were plated on various culture media. Anaerobic bacteria, evaluated by colony count of black pigment producing organisms on Ask medium, were recovered from 83.3% of the samples, Streptococci from 80% and aerobic Gram-negative bacilli from 46.7% of them in the control tests. There was a significant decrease in toothbrush contamination with antimicrobial sprays 1 and 2, the first showing the greatest decrease on bacterial counts.