ABSTRACT Introduction: Primary health care solves most of the health problems of the population, provides primary access to the service, ensures the continuity and comprehensiveness of health care, and coordinates its different forms. Objective: Evaluate the relationship between primary health care quality and dental caries in preschoolers. Methods: A cross-sectional descriptive study was conducted of a sample of 515 preschoolers. Participant schools were selected by stratified random sampling, followed by simple random sampling for the selection of participant children. Oral examination was performed to evaluate dental caries, and parents / guardians were given a questionnaire about the quality of the primary services attended by their children. Data were estimated with the chi-squared test, the Wilcoxon test and Spearman's coefficient (95% confidence). Results: A relationship was found between primary health care quality and the ceod index of preschoolers (ρ = -0.19; p < 0.05). Significant differences were observed in the prevalence of dental caries when quality services (ceod = 0.50) were compared with the low quality group (ceod = 1.13). Quality was also associated to the service mode (p < 0.001). Private services and the family health strategy obtained higher quality scores (55.31% and 69.48%, respectively). Conclusions: Primary health care quality is closely related to oral health, in such a way that when the quality of primary health care services is not good, a higher dental caries rate is observed among preschoolers.

RESUMEN Introducción: La atención primaria de salud aporta la resolución de la mayoría de los problemas de salud de la población, proporciona el acceso primario al servicio, la continuidad e integralidad de la atención y la coordinación de los cuidados. Objetivo: Evaluar la relación entre la calidad de los cuidados primarios y la caries dental en preescolares. Métodos: Se realizó un estudio descriptivo de corte transversal en una muestra de 515 preescolares. La selección de las escuelas tuvo lugar a partir de un muestreo aleatorio estratificado, seguido por muestreo aleatorio simple para la selección de los participantes. Se realizó un examen bucal para evaluar caries dental y se aplicó a los padres/responsables un cuestionario de calidad de los servicios primarios utilizados por los niños. Se emplearon chi cuadrado, Wilcoxon y el coeficiente de Spearman (95 % de confianza) para el cálculo de los datos. Resultados: La calidad de la atención primaria tuvo relación con el índice ceod de preescolares (ρ = -0,19; p < 0,05). Se observó diferencias significativas entre la prevalencia de caries dental cuando comparados servicios de calidad (ceod = 0,50) con el grupo baja calidad (ceod = 1,13). También, la calidad fue asociada con la modalidad del servicio (p < 0,001), obteniéndose en los servicios privado y la estrategia de salud de la familia puntajes mayores (55,31 % y 69,48 % de calidad, respectivamente). Conclusiones: La calidad de la atención primaria está estrechamente relacionada con salud bucal, de esta forma, cuando la calidad de los servicios de atención primaria no es buena, repercute en un mayor índice de caries dental en los preescolares.

RESUMO Objetivo Objetivou-se avaliar prevalência de cárie, doença periodontal e edentulismo em pacientes obesos mórbidos e bariátricos e verificar o impacto da saúde bucal na qualidade de vida. Métodos Avaliou-se 33 pacientes obesos mórbidos (G1) e 50 pacientes submetidos à cirurgia bariátrica (G2). Os índices CPOD, IPC, uso e necessidade de prótese foram utilizados para analisar as condições bucais. O impacto da saúde bucal na qualidade de vida foi avaliado através do questionário OIDP. Resultados CPOD foi G1:9,0±7,0 e G2:13,3±8,0 (p=0,020). O cálculo dentário foi a pior condição periodontal G1:72,7% e G2:80.,0% (p=0,752). A maioria dos pacientes do G1 e G2 não usavam (p=0,878) e não necessitavam (p=0,132) de prótese dentária. A média do OIDP foi G1:11,2±23,8 e G2:14,16±23,8 (p=0,089). Conclusão Conclui-se que os pacientes bariátricos apresentam maior prevalência de cárie dentária e a necessidade de prótese dentária está relacionada com impacto da saúde bucal na qualidade de vida dos pacientes obesos.

ABSTRACT Objective The aim was to evaluate the prevalence of dental caries, periodontal disease and edentulism in morbidly obese and bariatric patients, and to verify the oral health impact on quality of life. Methods We evaluated 33 morbidly obese patients (G1) and 50 patients submitted to bariatric surgery (G2). The DMFT, CPI, prosthetic status and prosthetic need for edentulism were used to analyze oral conditions. The impact of oral health on quality of life was assessed using the OIDP questionnaire. Results CPOD were G1: 9.0±7.0 and G2: 13.3±8.0 (p= 0.020). The dental calculus was the worst periodontal condition G1: 72.7% and G2: 80.0% (p= 0.752). The majority of G1 and G2 patients did not use (p = 0.878) and did not need (p= 0.132) dental prosthesis. The mean of OIDP was G1: 11.2±23.8 and G2: 14.16±23.8 (p= 0.089). Conclusion It concluded that bariatric patients have a higher prevalence of dental caries and the need for dental prostheses is related to the impact of oral health on the quality of life of obese patients.

RESUMO Este estudo teve por objetivo avaliar a influência do pré-aquecimento de compósitos bulk-fill, em relação a resistência à flexão, módulo de elasticidade e resistência coesiva. Cinco compósitos foram testados: Tetric N-Ceram Bulk-fill (TBF), X-tra fill (XTF), Filtek Bulk-fill (FBF), Aura Bulk-fill (ABF) e Filtek Z250 (FZ, controle). As amostras foram condicionadas em 37ºC por 24 horas antes de serem testadas. Os resultados foram analisados estatisticamente por ANOVA e teste de Tukey. Os compósitos FBF, XTF E FZ apresentaram as maiores resistências coesivas, e o pré-aquecimento influenciou positivamente esta propriedade. Os materiais XTF e FBF sem pré-aquecimento apresentaram os maiores valores de resistência à flexão e de módulo de elasticidade. Para estas propriedades, o pré-aquecimento causou redução nos compósitos XBF, FBF e ABF, não teve efeito em TBF e causou aumento em FZ. O pré-aquecimento influenciou positivamente a resistência coesiva dos materiais estudados, melhorando o desempenho de todas os materiais do tipo bulk-fill. A Tetric N-Ceram Bulk Fill/Ivoclar não obteve variação de módulo de elasticidade e resistência flexural quando pré-aquecida, tendo os demais compósitos do tipo bulk-fill apresentado resultados inferiores quanto a essas duas propriedades após o aquecimento.

ABSTRACT The purpose of this study was to evaluate the influence of pre-heating of bulk-fill composites on flexural strength, modulus of elasticity and cohesive strength. Five composites were tested: Tetric N-Ceram Bulk-fill (TBF). X-tra Fill (XTF), Filtek Bulk-fill (FBF), Aura Bulk-fill (ABF) and Filtek Z250 (FZ, control). The samples were conditioned at 37ºC for 24 hours before being tested. Results were statistically analyzed by ANOVA and Tukey test. FBF, XTF and FZ composites had the highest cohesive strengths, and preheating positively influenced this property. XTF and FBF materials without preheating showed the highest values of flexural strength and modulus of elasticity. For these properties, preheating caused a reduction in XBF, FBF and ABF resins, had no effect on TBF resin and caused an increase in FZ resin. The preheating positively influenced the cohesive strength of the studied materials, improving the performance of all bulk-fill resins. Tetric N-Ceram Bulk Fill/ Ivoclar did not show changes on modulus of elasticity and flexural strength when preheated, while the other bulk-fill composites presented lower results for these two properties after heating.

RESUMO Objetivo O objetivo deste estudo foi verificar a prevalência da cárie dentária em pré-escolares de escola pública e privada, avaliando sua associação a fatores socioeconômicos e impactos projeto de extensão universitária. Métodos Foram examinados pré-escolares de 5 anos, alocados em 3 grupos: G1 - crianças de colégio privado, sem projeto preventivo em saúde bucal; G2 - crianças de ensino público também sem cuidados preventivos regulares; G3 - pré-escolares de ensino público que recebem cuidados preventivos através de projeto de extensão universitária. As crianças foram examinadas para aferição do índice ceo-d e seus responsáveis foram entrevistados para verificação de fatores socioeconômicos. Para análise dos dados foi utilizado o teste de Fisher e o teste Qui-quadrado Resultados A escola referente ao G1 mostrou melhores condições socioeconômicas e bucais, comparada com os grupos G2 e G3. A escolaridade dos pais esteve associada à presença de doença nos filhos, porém, a renda não demonstrou associação. Conclusão A cárie dentária foi mais prevalente no grupo com piores indicadores socioeconômicos, e apesar do projeto de extensão universitária em saúde bucal estar presente em uma das situações ele não foi capaz de superar as desigualdades em saúde.

ABSTRACT Objective The aims of this study were to assess the prevalence of dental caries among preschoolers at public and private schools and to evaluate the associations among the prevalence of the disease, socioeconomic factors, and the impact of a university extension project. Methods Five-year-old preschool children were examined and were divided into three groups: children from private schools who were not receiving regular preventive care (group 1), children from public schools who were not receiving regular preventive care (group 2), children from public schools who were receiving preventive care through a university extension project (group 3). The children were examined for decay-missing-filled index, and their caregivers were interviewed to collect data on socioeconomic factors. Fisher’s and Chi-squared tests were used to analyze the data. Results Group 1 showed better socioeconomic and oral conditions compared with groups 2 and 3. Parents’/guardians’ level of education was associated with the presence of disease in their children; however, income showed no association. Conclusion Dental caries were more prevalent in the group with worse socioeconomic indicators, and although the university extension project had been implemented in one of the groups, it was not able to overcome health inequalities.

O objetivo deste estudo foi realizar uma revisão sistemática sobre a associação entre obesidade e periodontite. Os métodos aplicados incluíram uma estratégia de busca na literatura, seleção dos estudos por meio dos critérios de inclusão e exclusão de acordo com as características dos estudos e meta-análise. A busca foi realizada nas bases de dados PubMed, EMBASE e LILACS até 2010. Os artigos selecionados foram sobre estudos em humanos, investigando se a obesidade é um fator de risco para periodontite. Dos 822 estudos identificados inicialmente, 31 atendiam aos critérios de inclusão e foram incluídos na metanálise. O risco da periodontite esteve associado com obesidade (ou teve uma tendência para isso) em 25 estudos, sendo que 6 não encontraram esta associação. A meta-análise mostrou uma associação significativa entre obesidade e periodontite. (OR = 1,30 [95% Intervalo de Confiança (IC); 1,25 - 1,35]) e entre o Índice de Massa Corporal (IMC) médio e doença periodontal (diferença nas médias = 2,75). Obesidade esteve associada à periodontite, entretanto os fatores de risco que agravam essas doenças devem ser melhor esclarecidos para elucidar a direção dessa associação. Trabalhar com amostras pareadas e evitar fatores de confusão podem contribuir para a homogeneidade entre os estudos.

The scope of this study was to conduct a systematic review of the studies on the association between obesity and periodontitis. The methods applied included a literature search strategy and selection of studies using inclusion and exclusion in accordance with the criteria for characteristics of the studies and meta-analysis. The research was conducted in the PubMed, Embase and Lilacs databases through 2010. Selected papers were on studies on humans investigating whether or not obesity is a risk factor for periodontitis. Of the 822 studies identified, 31 studies met the inclusion criteria and were included in this meta-analysis. The risk of periodontitis was associated with obesity (or had a tendency for this) in 25 studies, though it was not associated in 6 studies. The meta-analysis showed a significant association with obesity and periodontitis (OR = 1.30 [95% Confidence Interval (CI), 1.25 - 1.35]) and with mean Body Mass Index (BMI) and periodontal disease (mean difference = 2.75). Obesity was associated with periodontitis, however the risk factors that aggravate these diseases should be better clarified to elucidate the direction of this association. Working with paired samples and avoiding confusion factors may contribute to homogeneity between the studies.

O objetivo deste estudo foi realizar uma revisão sistemática sobre a associação entre obesidade e periodontite. Os métodos aplicados incluíram uma estratégia de busca na literatura, seleção dos estudos por meio dos critérios de inclusão e exclusão de acordo com as características dos estudos e meta-análise. A busca foi realizada nas bases de dados PubMed, EMBASE e LILACS até 2010. Os artigos selecionados foram sobre estudos em humanos, investigando se a obesidade é um fator de risco para periodontite. Dos 822 estudos identificados inicialmente, 31 atendiam aos critérios de inclusão e foram incluídos na metanálise. O risco da periodontite esteve associado com obesidade (ou teve uma tendência para isso) em 25 estudos, sendo que 6 não encontraram esta associação. A meta-análise mostrou uma associação significativa entre obesidade e periodontite. (OR = 1,30 [95% Intervalo de Confiança (IC); 1,25 - 1,35]) e entre o Índice de Massa Corporal (IMC) médio e doença periodontal (diferença nas médias = 2,75). Obesidade esteve associada à periodontite, entretanto os fatores de risco que agravam essas doenças devem ser melhor esclarecidos para elucidar a direção dessa associação. Trabalhar com amostras pareadas e evitar fatores de confusão podem contribuir para a homogeneidade entre os estudos.

The scope of this study was to conduct a systematic review of the studies on the association between obesity and periodontitis. The methods applied included a literature search strategy and selection of studies using inclusion and exclusion in accordance with the criteria for characteristics of the studies and meta-analysis. The research was conducted in the PubMed, Embase and Lilacs databases through 2010. Selected papers were on studies on humans investigating whether or not obesity is a risk factor for periodontitis. Of the 822 studies identified, 31 studies met the inclusion criteria and were included in this meta-analysis. The risk of periodontitis was associated with obesity (or had a tendency for this) in 25 studies, though it was not associated in 6 studies. The meta-analysis showed a significant association with obesity and periodontitis (OR = 1.30 [95% Confidence Interval (CI), 1.25 - 1.35]) and with mean Body Mass Index (BMI) and periodontal disease (mean difference = 2.75). Obesity was associated with periodontitis, however the risk factors that aggravate these diseases should be better clarified to elucidate the direction of this association. Working with paired samples and avoiding confusion factors may contribute to homogeneity between the studies.

Objective: To evaluate the efficacy of Neem (Azadirachta indica) experimental gel for the prevention of erosive wear on bovine dentin, in vitro. Material and Methods: One hundred dentin blocks were allocated into 5 experimental groups (20 samples each): C (control group, without gel); CG (control group, only base gel); F (fluoride gel, 1.23% NaF; pH 4.1, Dentsply; Brazil); N (Neem gel, 10% neem extract; pH 4.1, manipulation); NF (Neem+fluoride gel, 10% Neem extract and 1.23% NaF; pH 4.1, manipulation). The blocks were stored in artificial saliva for 24 hours. After this, they were submitted to six alternating re- and demineralization cycles. The blocks were analyzed for wear (profilometry). The results were submitted to statistical analysis by ANOVA and Tukey tests (P<0.05). Results: The mean wear (±SD, µm) was shown as follows in groups: C (13.09±0.99), CG (10.60±1.99), F (10.90±1.44), N (12.68±1.13) and NF (10.84±1.65). All gels showed some preventive action when compared with control group. However, significant differences were found only between Neem+fluoride gel and fluoride gel. Conclusion: A single application of a neem-containing fluoride gel reduced dentin erosion, thus it is a possible alternative in reducing dental wear. Further research should investigate the action mechanism and the synergism between them.

OBJECTIVE: The aim of this study was to evaluate the capacity of potassium oxalate, fluoride gel and two kinds of propolis gel to reduce the hydraulic conductance of dentin, in vitro. MATERIAL AND METHODS: The methodology used for the measurement of hydraulic conductance of dentin in the present study was based on a model proposed in literature. Thirty-six 1-mm-thick dentin discs, obtained from extracted human third molars were divided into 4 groups (n=9). The groups corresponded to the following experimental materials: GI-10% propolis gel, pH 4.1; GII-30% propolis gel; GIII-3% potassium oxalate gel, pH 4,1; and GIV-1.23% fluoride gel, pH 4.1, applied to the dentin under the following surface conditions: after 37% phosphoric acid and before 6% citric acid application. The occluding capacity of the dentin tubules was evaluated using scanning electron microscopy (SEM) at ×500, ×1,000 and ×2,000 magnifications. Data were analyzed statistically by two-way ANOVA and Tukey's test at 5% significance level. RESULTS: Groups I, II, III, IV did not differ significantly from the others in any conditions by reducing in hydraulic conductance. The active agents reduced dentin permeability; however they produced the smallest reduction in hydraulic conductance when compared to the presence of smear layer (P<0.05). The effectiveness in reducing dentin permeability did not differ significantly from 10% or 30% propolis gels. SEM micrographs revealed that dentin tubules were partially occluded after treatment with propolis. CONCLUSIONS: Under the conditions of this study, the application of 10% and 30% propolis gels did not seem to reduce the hydraulic conductance of dentin in vitro, but it showed capacity of partially obliterating the dentin tubules. Propolis is used in the treatment of different oral problems without causing significant great collateral effects, and can be a good option in the treatment of patients with dentin sensitivity.

Este estudo objetivou avaliar in vitro o efeito do gel experimental contendo ferro na redução da condutividade hidráulica na dentina. Trinta e seis discos de dentina humana de 1 mm de espessura, foram obtidos de terceiros molares extraídos divididos em 3 grupos de 10 espécimes cada. Os grupos foram divididos nos seguintes grupos experimentais: F- flúor gel a 1,23%, pH 4,1; O- gel de oxalato de potássio a 3%, pH 4,1; I- gel de sulfato ferroso FeSO4 a 10 mmol/L, pH 4,1. Os géis foram aplicados na dentina sob as diferentes condições: após o ácido fosfórico a 37% a antes do ácido cítrico a 6%. Os resultados foram analisados por ANOVA e teste de Tukey, com nível de significância de 5%. Todos os grupos (gel de flúor, oxalato de potássio e gel de ferro) não apresentaram diferenças significativas entre si para todas as condições testadas, exceto na presença da smear layer (p<0,05). Os produtos utilizados reduziram a permeabilidade dentinária, entretanto apresentaram baixa redução quando comparados à smear layer (p<0,05). Não houve diferença significativa na efetividade dos géis testados para reduzir a permeabilidade dentinária (p<0,05). Este estudo sugere que o gel de ferro promoveu redução na permeabilidade dentinária comparável à dos outros agentes e, portanto, pode ser considerada uma boa alternativa clínica para o tratamento da hipersensibilidade dentinária.

This study evaluated in vitro the effect of an experimental gel containing iron on the reduction of hydraulic conductance of dentin. Thirty-six 1-mm-thick dentin discs obtained from extracted human third molars were divided into 3 groups of 10 specimens each. The groups corresponded to the following experimental materials: 1.23% acidulated phosphate fluoride gel, pH 4.1; 3% potassium oxalate gel, pH 4.1 (Oxa-Gel®); and iron sulfate gel (10 mmol/L FeSO4), pH 4.1. The gels were applied to dentin under the following conditions: after 37% phosphoric acid and before 6% citric acid. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. There was no significant differences (p<0.05) among the groups in any of the conditions for hydraulic conductance reduction, except for smear layer presence. The active agents reduced dentin permeability, but they produced significantly lower (p<0.05) reduction in hydraulic conductance when compared to presence of smear layer. The effectiveness in reducing dentin permeability was not significantly different (p>0.05) among the gels. This study suggests that the iron gel promoted reduction in dentin permeability comparable to that of the other agents and thus may be considered a good clinical alternative for the treatment of dentin hypersensitivity.

OBJETIVO: Avaliar alterações bucais, como cárie dentária, doença periodontal, desgaste dentário e fluxo salivar, em pacientes bariátricos. MÉTODOS: Cinquenta e quatro pacientes obesos, submetidos à cirurgia bariátrica, tiveram suas condições bucais avaliadas antes (n=54), aos 3 meses (n=24) e aos 6 meses (n=16) após a cirurgia bariátrica. Os índices para avaliação das condições bucais foram: CPOD, IPC, IDD e o volume de fluxo salivar. O questionário OIDP foi utilizado para verificar o impacto da saúde bucal na qualidade de vida. ANOVA e correlação de Spearman foram utilizados para análise estatística (p<0,05). RESULTADOS: CPOD foi 17,6±5,7, 18,4±4,1 e 18,3±5,5 (p>0,05), bolsa periodontal foi encontrada em 50%, 58% e 50% dos pacientes (p>0,05) e o desgaste dentário em dentina em 81,5%, 87,5% e 87,5% dos pacientes, respectivamente antes, 3 meses e 6 meses após a cirurgia bariátrica. Houve diferença significativa entre os três períodos estudados, quanto à prevalência e à severidade do desgaste dentário (p=0,012). O fluxo salivar foi 0,8±0,5 ml/min antes, 0,9±0,5 ml/min aos 3 e 1,1±0,5 ml/min aos 6 meses após cirurgia (p>0,05). O impacto da saúde bucal na qualidade de vida diminuiu com o tempo decorrido após cirurgia bariátrica (p=0,029). CONCLUSÕES: As mudanças no estilo de vida após a cirurgia bariátrica podem aumentar a gravidade de problemas bucais pré-existentes. Entretanto, esta alteração na condição bucal pode não influenciar a qualidade de vida.

PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p<0.05). RESULTS: DMFT was 17.6±5.7, 18.4±4.1 and 18.3±5.5 (P>0.05), presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05), tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012). Salivary flow was 0.8±0.5 ml/min before surgery, 0.9±0.5 ml/min for 3 months and 1.1±0.5m/min for 6 months (p>0.05). The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029). CONCLUSION: The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.