Abstract The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. Objective: To evaluate a new tongue hygiene technique hereby referred to as “the X technique” and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users’ perceptions of their breath.

Abstract Changes in the suboccipital muscles and the hamstrings may interfere with head posture and the biomechanics of the temporomandibular joint, both of which contribute to the severity of temporomandibular disorders (TMD). The objective of this investigation was to evaluate the effects of a global postural exercise program (GPEP) on pain intensity and mouth-opening range of motion (ROM) in women with TMD. The participants were comprised of 30 women with TMD who were divided into two groups: an experimental group (EG) and a control group (CG). A pressure algometer was used for pain assessment and a paquimeter was used to measure ROM. The duration of the GPEP was six weeks. In the EG, there was a reduction in pain intensity and an increase in mouth-opening ROM compared to the CG. Therefore, we concluded that the GPEP was effective in relieving pain in all of the evaluated muscles and regions, and in increasing mouth-opening ROM in women with TMD.

The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG), Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract from Casearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.

Objetivo Avaliar o efeito da dentina sobre o pH e a atividade antimicrobiana de formulações com hidróxido de cálcio. Material e método O pH e a atividade antimicrobiana das formulações (G1- polietilenoglicol, G2- glicerina e paramonoclorofenol canforado ou G3- clorexidina) foram analisados nas formulações puras (G1A, G2A e G3A) ou acrescidas de dentina em pó (G1B, G2B e G3B). Tubos de polietileno foram preenchidos com uma das formulações e imersos em água destilada. O pH foi analisado após 24 horas, 7, 14 e 21 dias. A atividade antimicrobiana foi avaliada sobre Enterococcus faecalis (ATCC 29212), através do teste de difusão em ágar. Os resultados foram submetidos aos testes de ANOVA e Tukey (p=0,05). Resultado A dentina não exerceu efeito sobre o pH das formulações, exceto ocasionando a redução em G1, no período de 24 horas (p<0,05). Nas demais formulações, não houve interferência da dentina sobre o pH (p>0,05). Quando comparados entre os grupos, em 24 horas e 7 dias, G1A e G1B apresentaram menor pH (p<0,05). Em 14 dias, G2A, G2B, G3A e G3B demonstraram similar pH (p>0,05), assim como entre G3B e G1A (p>0,05). Em 21 dias, todas as formulações demonstram semelhante pH (p>0,05). Os resultados em ordem decrescente da atividade antimicrobiana foram G2A=G2B>G3A=G3B>G1A=G1B (p<0,05). Conclusão A dentina não interferiu no pH e na atividade antimicrobiana das diferentes formulações com hidróxido de cálcio, exceto na associação com o polietilenoglicol, em que ocasionou a redução do pH apenas no período de 24 horas. A formulação com paramonoclorofenol canforado apresentou maior atividade antimicrobiana, seguida da clorexidina e do polietilenoglicol.

Objective To evaluate the dentin effect on pH and antimicrobial activity of the calcium hydroxide chemical formulations. Material and method pH and antimicrobial activity of calcium hydroxide formulations were evaluated (G1-polyethyleneglycol, G2-glycerin and camphorated paramonochlorophenol and G3-chlorhexidine). The formulations were evaluated alone (G1A, G2A e G3A) or with dentin powder (G1B, G2B and G3B). Polyethylene tubes were filled with the formulation and immersed in distilled water. After 24 hours, 7, 14 and 21 days, pH was evaluated. The antimicrobial activity was evaluated against Enterococcus faecalis by agar diffusion test. All data were submitted to ANOVA and Tukey tests (p=0.05). Result None effect was observed on pH and antimicrobial activity by dentin on different chemical formulations, except the reduction occurred in G1 at 24 hours (p <0.05). When compared between the groups at 24 hours and 7 days, G1A and G1B had a lower pH (p <0.05). At 14 days, G2A, G2B, G3A and G3B showed similar pH (p <0.05) and between G3B and G1A (p> 0.05). At 21 days, all formulations were similar (p> 0.05). Regarding antimicrobial activity G2B G2A => = G3A G3B> = G1A G1B (p <0.05). Conclusion The dentin did not affect the pH and antimicrobial activity of different formulations containing calcium hydroxide, except in association with polyethylene glycol, which caused the reduction of pH, within 24 hours. The formulation with paramonochlorophenol camphor showed higher antimicrobial activity, followed by chlorhexidine and polyethylene glycol.

This in vitro study aimed to determine the susceptibility of oral specimens and ATCC lineages of Candida albicans for five endodontic sealers, which were pure and associated with two antifungal drugs, and to analyze their effect on the physical properties. For this purpose, 30 lineages of C. albicans, collected from the oral cavity of patients assisted at the endodontics clinic of the Universidade Sagrado Coração, were analyzed. Yeasts susceptibility to the sealers was tested by diffusion on agar plates. Physical properties were evaluated according to the ADA specification no. 57. The pure versions of the Sealer 26, AH Plus, Endofill, Fillapex, and Sealapex demonstrated antifungal activity, with Endofill presenting the greatest inhibition zones. All cements, except for Endofill, had their antifungal actions enhanced by addition of ketoconazole and fluconazole (p < 0.05), and the AH Plus presented the best antifungal activity. The addition of antifungal drugs did not interfere with the setting time and flowability of the sealers. It was concluded that the addition of antifungals to endodontic sealers enhanced the antimicrobial action of most cements tested without altering their physical properties.

Enterococcus faecalis é uma espécie bacteriana frequentemente encontrada em canais radiculares com insucesso do tratamento endodôntico. Pastes alcalinas são amplamente utilizada em Endodontia por causa de sua biocompatibilidade e atividade antimicrobiana, porém esse microrganismo pode ser resistente a alcalinidade. Este estudo avaliou in vitro a resistência do E. faecalis ao pH alcalino por diferentes períodos até 14 dias. Amostras foram obtidas da cavidade oral de 150 pacientes da Clínica de Endodontia. O pH dos tubes experimentais (n=84) foram inicialmente ajustados com NaOH 6M a valores de pH 9.5, 10.5, 11.5 e 12.5 (21 tubes per pH). Vinte isolados clínicos e a cepa ATCC 29212 foram testados. Os 5 controles positivos e os tubos experimentais de cada pH foram inoculados com 10 µL de suspensão bacteriana e incubados a 36 °C por 24, 48 e 72 h, 7 e 14 dias. Para cada período, turvação do meio foi compara visualmente com padrão 0.5 da escala de McFarland. A presença de microorganism foi confirmada por semeadura no meio ágar M-Enterococcus. Quatro tubos contendo caldo BHI ajustado aos pHs testados foram incubados por 14 dias para verificar a ocorrência de alterações de pH. O pH do caldo BHI inoculado também foi medido no 14° dia para determinar se o microrganismo acidificou o meio. O crescimento de todas as cepas de E. faecalis ocorreu com pH entre 9.5 e 11.5 em todos os períodos. Embora não tenha sido observada turvação do meio no pH 12.5, houve crescimento de 13 e 2 cepas às 24 e 48 h, respectivamente, no meio ágar M-Enterococcus. Nenhum tube apresentou crescimento bacteriano no pH 12.5 após 72 h. Concluiu-se que o E. faecalis pode sobreviver em pH altamente alcalino, que alguns isolados clínicos requerem 72 h em pH 12.5 para serem eliminados.

Enterococcus faecalis is a bacterial species often found in root canals with failed endodontic treatment. Alkaline pastes are widely used in Endodontics because of their biocompatibility and antimicrobial activity, but this microorganism can resist alkalinity. The purpose of this study was to evaluate in vitro the alkaline pH resistance of E. faecalis for different periods up to 14 days. Samples were obtained from the oral cavity of 150 patients from the Endodontic clinic. The pH of the experimental tubes (n=84) was first adjusted with 6M NaOH to pH values of 9.5, 10.5, 11.5 and 12.5 (21 tubes per pH). Twenty clinical isolates and the ATCC 29212 strain were tested. The 5 positive controls and experimental tubes of each pH were inoculated with 10 µL of bacterial suspension and incubated at 36 °C for 24, 48 and 72 h, 7 and 14 days. For each period, the turbidity of the medium was visually compared with a 0.5 McFarland standard. The presence of the microorganism was confirmed by seeding on M-Enterococcus agar. Four tubes containing BHI broth adjusted to the tested pHs were incubated for 14 days to verify if pH changes occurred. The pH of inoculated BHI broth was also measured on day 14 to determine if the microorganism acidified the medium. The growth of all E. faecalis strains occurred at pH 9.5 to 11.5 in all periods. Although turbidity was not observed at pH 12.5, there was growth of 13 and 2 strains at 24 and 48 h, respectively, on M-Enterococcus agar. No tube showed growth at pH 12.5 after 72 h. It was concluded that E. faecalis can survive in highly alkaline pH, and some clinical isolates require 72 h at pH 12.5 to be killed.

OBJETIVO: O estudo avaliou, em diversos períodos de análise, o pH e liberação de cálcio e a atividade antibacteriana proporcionada pelo MTA Fillapex, em relação ao Sealapex e AH Plus. MATERIAL E MÉTODO: Tubos de polietilenos foram preenchidos com um dos cimentos e imersos em água destilada. Após de 24 horas, 14 e 28 dias, o valor do pH e o cálcio liberado pelos cimentos foram avaliados diretamente na água destilada em que os espécimes permaneceram imersos. A atividade antibacteriana dos cimentos foi avaliada em culturas de Enterococcus faecalis ou Staphylococcus aureus, por meio do teste de difusão em ágar. Os dados obtidos foram submetidos aos testes de ANOVA e Tukey (α=0.05). RESULTADO: Em todos os períodos analizados, o Sealapex proporcionou os maiores valores de pH (p<0,05) em relação aos demais cimentos e o MTA Fillapex proporcionou maiores valores que o dos AH Plus (p<0,05). Em 14 dias, o MTA Fillapex promoveu maior liberação de cálcio que o proporcionado pelo Sealapex (p<0,05). Em 28 dias, o Sealapex proporcionou maior liberação de cálcio que o MTA Fillapex (p<0,05). Em todos os períodos, o AH Plus apresentou a menor liberação de cálcio em relação aos outros cimentos (p<0,05). Em relação ao E. faecalis, não foram observadas diferenças (p>0,05) entre as zonas de inibição de crescimento bacteriano produzidas pelos diveros cimentos. Em relação ao S. aureus, o Sealapex apresentou maior atividade antibacteriana que o MTA Fillapex e o AH Plus (p<0,05), que por sua vez foram semelhantes entre si (p>0,05). CONCLUSÃO: Após o período final de avaliação, o pH e a liberação de cálcio proporcionado pelo MTA Fillapex foram menores que os do Sealapex e maiores que os do AH Plus. A atividade antimicrobiana do MTA Fillapex não diferiu dos demais cimentos endodônticos.

OBJECTIVE: This study evaluated, in several analysis periods, pH and calcium release and antibacterial activity provided by MTA Fillapex sealer compared to Sealapex and AH Plus sealers. MATERIAL AND METHOD: Polyethylene tubes were filled with a sealer and immersed in distilled water. After 24 hours, 14 and 28 days, pH and calcium release by endodontic sealers were evaluated directly in water which the tubes were stored. Sealers antibacterial activity was evaluated against Enterococcus faecalis and Staphylococcus aureus by means of agar diffusion test. All data were submitted to ANOVA and Tukey tests (α=0.05). RESULT: In all periods evaluated, Sealapex had the highest pH value (p<0.05) in comparison to other sealers and MTA Fillapex provided higher pH values than AH Plus (p<0.05). In 14-days period, MTA Fillapex had greater calcium release value than Sealapex (p<0.05). In 28-days period, Sealapex provided higher calcium release than MTA Fillapex (p<0.05). In all periods, AH Plus provided lower calcium release than other sealers (p<0.05). In relation to E. faecalis, there were no differences among the sealers, in relation to antibacterial activity (p>0.05). In relation to S. aureus, Sealapex presented better antibacterial effectiveness than the MTA Fillapex and AH Plus (p<0.05), which were similar each other (p>0.05). CONCLUSION: In final evaluation period, pH values and calcium release provided by MTA Fillapex were lower than provided by Sealapex and higher than provided by AH Plus. The MTA Fillapex antimicrobial action was similar to other endodontic sealers.

The aim of this study was to evaluate the interference of the radiopacifiers bismuth oxide (BO), bismuth carbonate (BC), bismuth subnitrate (BS), and zirconiun oxide (ZO) on the solubility, alkalinity and antimicrobial properties of white Portland cement (WPC). The substances were incorporated to PC, at a ratio of 1:4 (v/v) and subjected to a solubility test. To evaluate the pH, the cements were inserted into retrograde cavities prepared in simulated acrylic teeth and immediately immersed in deionized water. The pH of the solution was measured at 3, 24, 72 and 168 h. The antimicrobial activity was evaluated by a radial diffusion method against the microorganisms S. aureus (ATCC 25923), P. aeruginosa (ATCC 27853), E. faecalis (ATCC 29212) and C. albicans (ATCC 10231). The zone of microbial growth inhibition was measured after 24 h. The addition of BS and BC increased the solubility of the cement. The pH values demonstrated that all materials produced alkaline levels. At 3 h, BS showed lower pH than WPC (p<0.05). At 168 h, all materials showed similar pHs (p>0.05). The materials did not present antimicrobial activity for S. aureus, P. aeruginosas and E. faecalis (p>0.05). With regards to C. albicans, all materials formed an inhibition zone, mainly the mixture of WPC with ZO (p<0.05). The type of radiopacifier incorporated into WPC interfered with its physical and antimicrobial properties. ZO was found to be a viable radiopacifier that can be used with WPC.

Candida albicans está presente na cavidade oral e em todo trato digestivo de humanos e outros animais, podendo estar relacionada a fracassos do tratamento endodôntico. O presente trabalho determinou a incidência de C. albicans na cavidade oral e a susceptibilidade das amostras isoladas frente a diferentes valores de pH e à solução aquosa saturada de hidróxido de cálcio em pH 12,5. Sessenta e cinco pacientes atendidos na Clínica de Endodontia da Universidade Sagrado Coração participaram da pesquisa. As amostras coletadas foram cultivadas em meios seletivos para C. albicans. As cepas isoladas foram testadas quanto a resistência ao pH alcalino e à solução saturada de hidróxido de cálcio. Frente às variáveis de tempo, a viabilidade das leveduras foi avaliada pelos métodos da cultura sobre ágar Sabouraud e de fluorescência pela técnica do diacetato de fluoresceína e brometo de etídio. Foram isoladas 30 linhagens de C. albicans coletadas da cavidade oral dos pacientes. Quando em contato com a solução de hidróxido de cálcio as leveduras foram totalmente inviabilizadas após 48 h de exposição. Quando expostas ao caldo de cultura alcalinizado as leveduras mantiveram-se viáveis em pH 9,5 e 10,5 por até 7 dias. Em conclusão, C. albicans pode ser completamente inibida pelo contato direto com solução aquosa saturada de hidróxido de cálcio após 48 h de exposição.

Candida albicans is present in the oral cavity and in the whole digestive tract of humans and other animals, being frequently related to endodontic treatment failure. The present study determined the incidence of C. albicans in the oral cavity and the susceptibility of isolates to different pH values and saturated calcium hydroxide aqueous solution at pH 12.5. Sixty-five patients attending the Endodontic Clinic at the Sagrado Coração University participated in the study. The collected samples were cultivated in selective media for C. albicans and the isolates were tested in terms of resistance to both alkaline pH and saturated aqueous solution of calcium hydroxide. In relation to time variables, yeast viability was assessed by the Sabouraud's agar culture and fluorescein diacetate and ethidium bromide fluorescent staining method. Results from the different pHs and experimental times, including those from different techniques measuring fungal viability, were compared using the chi-square and Fisher's exact tests (α=0.05). The yeasts became completely inviable after 48 h of contact with the calcium hydroxide solution. On the other hand, when exposed to the alkaline culture broth, the yeasts were found to be viable at pHs 9.5 and 10.5 for up to 7 days. In conclusion, C. albicans can only be completely inhibited by direct contact with saturated calcium hydroxide aqueous solution after 48 h of exposure.

Foi avaliado o poder antimicrobiano dos cimentos Endomethasone, AH26, Sealer 26, Sealer 26 acrescido de 5% de hexametilenotetramina, Sealer 26 acrescido de 10% de hexametilenotetramina, Sealapex e pasta aquosa de hidróxido de cálcio. Foram utilizados o método de difusão radial em placas ágar escavadas e cepas puras de microorganismos, sendo que as leituras foram efetuadas após 24 e 48 horas de incubação em aerobiose e microaerofilia. Os resultados mostraram que o Endomethasone apresentou os maiores halos de inibição do crescimento bacteriano e que o acréscimo de hexametilenotetramina acarretou um aumento nos halos proporcionados pelo Sealer 26. O cimento Sealapex e a pasta de hidróxido de cálcio não inibiram os microorganismos testados

An evaluation of the antimicrobial action of the sealers Endomethasone, AH26, Sealapex, Sealer 26, Sealer 26 with 5% hexametilenotetramine, Sealer 26 with 10% hexametilenotetramine and aqueous calcium hydroxide paste was carried out. Microorganisms were spread over hollowed agar plates, by means of the radial diffusion method. Halo measurements were done after 24 and 48 hours of incubation under aerobic and microaerophilia conditions. The results showed bigger halos when Endomethasone was used, and the increment of hexametilenotetramine in the Sealer 26 increased the inhibition halos of this sealer. The Sealapex and the calcium hydroxide paste did not inhibit bacterial growth