Aim To compare the influence of two methods of agitation of endodontics irrigants, by diffusion of calcium hydroxide [Ca(OH)2] through the dentinal tubules, measuring the pH of the medium where they were kept. Methods Twenty mandibular incisors were prepared using a WaveOne Gold Large file, in a reciprocating movement, and then divided into (n = 10): gutta-percha cone (GPC) or Easy Clean system (ECS) agitation of 1% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The specimens were filled with Ca(OH)2 paste, placed in flasks with 4 mL of deionized water, and stored in an incubator. The pH was read using a digital pH meter immediately after storage (T0), after 7 (T1), 14 (T2), 21 (T3), and 35 (T4) days. Results Statistical difference between groups was observed regardless of the day pH was measured (p < 0.01). From T2 on, ECS presented higher pH values in comparison with GPC, with significant difference (p < 0.01). Conclusion Agitation of endodontic irrigants with ECS enhances the Ca(OH)2 diffusion, providing higher pH values, from the 14th day on, when compared with GPC.

RESUMO CONTEXTO E OBJETIVO: A Organização Mundial da Saúde reconhece o suicídio como uma prioridade de saúde pública. Aumentar o conhecimento dos fatores de risco de suicídio é necessário para se poder adotar estratégias eficazes de prevenção. O objetivo deste estudo foi analisar e comparar a associação do coeficiente de Gini, usado para medir a desigualdade, com as taxas de mortalidade por suicídio em um período de 14 anos (2000-2013) no Brasil e nos Estados Unidos (EUA). Aventou-se a hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio. TIPO DE ESTUDO E LOCAL: Estudo transversal temporal descritivo realizado no Brasil e nos EUA. MÉTODOS: Dados populacionais, de óbitos e mortes por suicídio foram extraídos do banco de dados do DATASUS, no Brasil, e do Centro Nacional para Estatísticas de Saúde dos EUA. Dados do índice de Gini foram obtidos dos Indicadores de Desenvolvimento Mundial. Foi realizada análise de séries temporais de dados oficiais do Brasil e dos EUA sobre o número de mortes por suicídio, de 2000 a 2013, e do coeficiente de Gini. As tendências de morte por suicídio foram analisadas e comparadas. RESULTADOS: Brasil e EUA apresentaram convergência no coeficiente de Gini devida principalmente à redução da desigualdade no Brasil na última década. No entanto, as taxas de suicídio não estão convergindo como foi conjeturado; em verdade, elas estão crescendo em ambos os países. CONCLUSÕES: A hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio não foi verificada.

ABSTRACT CONTEXT AND OBJECTIVE: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.

A fístula orocutânea de origem dentária é uma condição incomum, bem documentada e geralmente requer tratamento de urgência. Esta condição pode ser confundida por médicos e dentistas com lesões ósseas, de pele, nas glândulas salivares, osteomielite, granuloma piogênico, cisto infectado, infecção fúngica, entre outras. Um caso de fístula facial que foi inicialmente diagnosticado por um médico como uma lesão não-odontogênica é apresentado e discutido. O tratamento de escolha foi a endodontia do dente envolvido, sem necessidade de cirurgia. A possibilidade de infecção dentária deve ser considerada em casos de fístula cutânea na região orofacial. O diagnóstico precoce e tratamento imediato podem minimizar o desconforto do paciente e problemas estéticos, além de reduzir a possibilidade de outras complicações, como osteomielite e sepse.

Orocutaneous fistulas or cutaneous sinus, a tract of dental origin, is an uncommon but welldocumented condition that usually requires emergency treatment. Such condition may be misdiagnosed by physicians and dentists and may sometimes be confused with bone and skin tumor, osteomyelitis, congenital fistula, salivary gland fistula, pyogenic granuloma, infected cyst, deep mycotic infection, and other pathologies. A case of facial sinus tract that was initially misdiagnosed by a physician as a nonodontogenic lesion is presented. Nonsurgical endodontic therapy was the treatment of choice for this case. Facial cutaneous sinus tracts must be considered of dental origin. Early diagnosis and prompt treatment minimize patient discomfort and esthetic problems, reducing the possibility of further complications such as sepsis and osteomyelitis.

Os bisfosfonatos são potentes inibidores da reabsorção óssea e são utilizados no tratamento da osteoporose e de outras doenças que causam a perda de massa óssea, como doença de Paget, metástases ósseas e mieloma múltiplo, prevenindo fraturas patológicas. Desde 2003, estudos associam osteonecrose avascular dos ossos maxilares a seu uso, principalmente intravenoso. Na literatura, há relatos de ocorrência variando de 0,8% a 12%, dos pacientes, na sua maioria em uso prolongado. Médicos e dentistas devem estar cientes dessa potencial complicação no tratamento odontológico.

Bisphosphonates are potent inhibitors of bone resorption, and are used in the treatment of osteoporosis and other diseases that cause bone mass loss, such as Paget's disease, bone metastases, and multiple myeloma, to prevent pathological fractures. Since 2003, avascular osteonecrosis of the jaw has been associated with the use of bisphosphonates, mainly intravenous. According to the literature, the occurrence of osteonecrosis of the jaw has ranged from 0.8% to 12% of the patients on bisphosphonates, most of them on prolonged use. Physicians and odontologists should be aware of that potential complication in dental treatment.

CONTEXTO: Edema e coloração azulada do escroto do recém-nascido podem sugerir uma série de doenças, incluindo torção dos testículos, orquite, edema escrotal e testicular, hidrocele, hérnia inguinal, peritonite meconial, hematocele, tumor testicular e hematoma traumático. Quarenta e dois casos de alterações escrotais como sinal de hemorragia da glândula adrenal foram encontrados na literatura. RELATO DE CASO: Apresentamos um caso de hematoma escrotal devido a hemorragia da glândula adrenal em um recém-nascido. O tratamento adotado foi conservador, com acompanhamento clínico, com resolução completa em 10 dias. Os possíveis diagnósticos diferenciais são revisados e discutidos.

CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

External apical root resorption is a common phenomenon associated with orthodontic treatment. The factors relevant to root resorption can be divided into biological and mechanical factors. Some mechanical and biological factors might be associated with an increased or decreased risk of root resorption during orthodontic treatment. For mechanical factors, the extensive tooth movement, root torque and intrusive forces, movement type, orthodontic force magnitude, duration and type of force are involved. For biological factors, a genetic susceptibility, systemic disease, gender and medication intake have been demonstrated influence root resorption. Orthodontic therapy of patients with increased risk of root resorption should be carefully planned. Medical history, medication intake, family history, tooth agenesis, root morphology, oral health and habits must be considerate if we do not want jeopardize our patients by severe root resorption. To monitor apical root resorption the standard procedure is a radiographic examination after 6 months of treatment. In teeth with enhanced risk, a 3-month radiographic follow-up is recommended. The administration of anti-inflammatory drugs might suppress root resorption induced by orthodontic therapy, although none study was enough conclusive to indicate a protocol for patients with enhanced risk. In the event of multiple external root resorption, the diagnostic procedure should focus on the exclusion of the local factors and its associations (such as magnitude, duration and type of orthodontic force; periodontal disease; root form) that might lead to external root resorption. Systemic disorders associated with phosphorus-calcium metabolic alterations shall be suspected. This review searched the current knowledge of the mechanical and biological aspects of root resorption in orthodontic tooth movement.

A cerebrospinal fluid (CSF) rhinorrhoea occurs when there is a fistula between the dura and the skull base and discharge of CSF from the nose. CSF rhinorrhea or liquorrhoea commonly occurs following head trauma (fronto-basal skull fractures), as a result of intracranial surgery, or destruction lesions. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis. This article reviewed the causes, diagnosis and treatment of CSF leakage. A PUBMED search of the National Library of Medicine was conducted. CSF leak most commonly occurs following trauma and the majority of cases presenting within the first three months. CSF rhinorrhoea have significantly greater incidence of periorbital haematoma. This suggests that patients with head injuries and features of periorbital haematoma are at greater risk of unobserved dural tear and delayed CSF leakage. In the presence of a skull base fracture on computed tomography and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. A greater proportion of the CSF leaks in the patients resolved spontaneously. CSF fistulae persisting for > 7 days had a significantly increased risk of developing meningitis. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The timing for surgery and CSF drainage procedures must be decided with great care and with a clear strategy.

Bite injuries to the head and neck region can result in facial disfigurement with distressing physical and psychological consequences. This article reviewed the causes and management of facial bite wounds due to dog bites. A PUBMED search of the National Library of Medicine from 1995 to December 2005 was conducted. Keywords used in the search were ‘facial wound’, ‘bite wound’, ‘dog bite’. The results showed that the risk factors for dog attacks include: school-aged children, male, households with dogs, male dogs and certain breeds (german shepherds, bull terriers, blue/red heelers, dobermans and rottwellers). Early management of such complex injuries usually guarantees satisfactory outcome. Most of the cases involve a known dog (friends, neighbors) and family pet. Although animal bites are not the most accounted children injuries, deaths may a result of these attacks. Antibiotic therapy is indicated for infected bite wounds and fresh wounds considered at risk for infection, such as extremely large wounds, large hematoma, and cat bites, that appear be more infected than dog bites. Tetanus immunization status and the risk of rabies infection should be routinely addressed in bite wound management. Prevention strategies should be considered for preventing dog bites.

A adequação de dentes bovinos e suínos na substituição de dentes humanos extraídos tem sido avaliada em vários estudos. O objetivo deste estudo in vitro foi analisar o padrão de infiltração marginal em esmaltes humano, bovino e suíno. Cavidades cúbicas (2 x 2 x 2 mm³) foram realizadas em blocos de esmalte obtidos de dentes molares humanos, incisivos bovinos e molares suínos. As cavidades foram restauradas com compósito resinoso fotopolimerizável e cimento de ionômero de vidro. Os espécimes foram submetidos à termociclagem por 1.000 ciclos entre 5 ± 2°C e 55 ± 2°C e imersos em azul de metileno a 2%, por 12 horas. A concentração de corante infiltrado foi medida, quantitativamente, através de espectrofotometria. Os dados foram transformados em µg/ml e submetidos à análise estatística ANOVA, seguida pelo teste de Tukey. As médias de infiltração marginal (µg/ml ± DP) nos esmaltes bovino e suíno não foram significativamente diferentes (0,0668 ± 0,0246 vs. 0,0674 ± 0,0286), mas foram superiores e estatisticamente diferentes (p < 0,01) das encontradas no esmalte humano (0,0407 ± 0,0195, p < 0,01), e as médias de infiltração marginal foram superiores nas restaurações realizadas com o cimento de iônomero de vidro (0,0695 ± 0,01313 vs. 0,0471 ± 0,0163, p < 0,01). Os resultados permitiram concluir que os substratos bovino e suíno permitem uma maior infiltração marginal que o esmalte humano, indicando que a capacidade de selamento marginal pode ser afetada por diferenças entre esses substratos. Os resultados indicam que se deve ter prudência na substituição do esmalte humano em estudos laboratoriais de microinfiltração.

The suitability of bovine and swine teeth has been evaluated when they are used as substitutes for extracted human teeth in varied researches. This study evaluated in vitro the marginal microleakage in human, bovine and swine enamel. Cubic cavities (2 x 2 x 2 mm³) were prepared in enamel blocks from human, swine and bovine teeth. The cavities were filled with composite resin and conventional glass-ionomer cement. All the samples were thermocycled for 1,000 cycles (5 ± 2°C - 55 ± 2°C) and immersed in 2% methylene blue solution for 12 hours. The microleakage was quantified by a spectrophotometric technique. The results were statistically analyzed using ANOVA and Tukey's test. The glass-ionomer cement presented significantly higher leakage means (µg/ml ± SD) than the composite resin for all substrates (0.0695 ± 0.01313 vs. 0.0471 ± 0.0163, p < 0.01). No significant differences were found between bovine and swine enamel (0.0668 ± 0.0246 vs. 0.0674 ± 0.0286); however, both presented statistically higher leakage means than human enamel (0.0407 ± 0.0195, p < 0.01). It was concluded that the microleakage pattern was affected by substrates, and that bovine and swine substrates allow higher marginal leakage than human substrates. The results indicate there should be precaution in the substitution of human substrate in laboratory studies of microleakage.