The maintenance of adequate fluoride (F) concentration in the public water supply is fundamental for ensuring that the community use of F can reach the maximum benefit for caries control and minimum risk for dental fluorosis. Thus, surveillance systems must use accurate and valid analytical methods to determine F concentration and, according to the literature, give preference to the ion-specific electrode (F- ISE) analysis. Aim The objective of this study was to compare the accuracy of the ISE and SPADNS methods in the determination of the F concentration in the same water sample. Methods Duplicate water samples were taken from 30 sampling sites in the municipality of Maringá, state of Paraná, monthly for 12 months, totaling 276 samples. An aliquot was analyzed by the FOP-UNICAMP Oral Biochemistry laboratory, using the F- ISE method, and the other one, by the SANEPAR laboratory in Maringá/PR, using the SPADNS method. Descriptive analysis and Pearson’s correlation test were applied, with a significant level of p<0.05. Results Results were expressed as ppm F (mg F/L), and a very strong positive correlation (r= 0.91; p<0.001) was detected between the two methods of analysis. Conclusion Our findings suggest that the determination of fluoride concentration in water can be made with accuracy by the SPADNS method, a standardized analysis protocol.

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy (FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil.

Resumo O artigo tem por objetivo monitorar a produção ambulatorial em Odontologia e avaliar a associação de indicadores de ação coletiva e exodontia com o número de Equipes de Saúde Bucal (ESB) entre 2006 e 2015, no Paraná. Neste estudo ecológico longitudinal foram analisados dados secundários consolidados (ações coletivas de escovação supervisionada-ES, aplicação tópica de flúor-ATF, bochecho fluorado-BF, exame bucal com finalidade epidemiológica-EB e exodontia de dente permanente-EXO) do Sistema de Informação Ambulatorial e números de ESB no Sistema de Cadastro Nacional de Estabelecimentos de Saúde. Foram realizadas análises descritivas e correlação de Pearson, com nível de significância de p<0,05. Verificou-se um aumento de ESB implantadas ao longo do tempo e correlação forte positiva com procedimentos coletivos de ES (r=0,78; p=0,007) e BF (r=0,76; p=0,011) e correlação moderada negativa com EXO (r=-0,53). Conclui-se que os indicadores avaliados demonstraram que a implantação de Equipes de Saúde Bucal pode ter contribuído para mudanças no modelo de atenção, com aumento dos procedimentos coletivos preventivos e redução de perdas dentárias no Paraná.

Abstract This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson’s correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.

Resumo O artigo tem por objetivo monitorar a produção ambulatorial em Odontologia e avaliar a associação de indicadores de ação coletiva e exodontia com o número de Equipes de Saúde Bucal (ESB) entre 2006 e 2015, no Paraná. Neste estudo ecológico longitudinal foram analisados dados secundários consolidados (ações coletivas de escovação supervisionada-ES, aplicação tópica de flúor-ATF, bochecho fluorado-BF, exame bucal com finalidade epidemiológica-EB e exodontia de dente permanente-EXO) do Sistema de Informação Ambulatorial e números de ESB no Sistema de Cadastro Nacional de Estabelecimentos de Saúde. Foram realizadas análises descritivas e correlação de Pearson, com nível de significância de p<0,05. Verificou-se um aumento de ESB implantadas ao longo do tempo e correlação forte positiva com procedimentos coletivos de ES (r=0,78; p=0,007) e BF (r=0,76; p=0,011) e correlação moderada negativa com EXO (r=-0,53). Conclui-se que os indicadores avaliados demonstraram que a implantação de Equipes de Saúde Bucal pode ter contribuído para mudanças no modelo de atenção, com aumento dos procedimentos coletivos preventivos e redução de perdas dentárias no Paraná.

Abstract This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson’s correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.

Abstract Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children’s decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Resumo Introdução A cárie dentária ainda é um problema de saúde pública na maioria dos países industrializados, com maior prevalência nas populações mais vulneráveis socioeconomicamente. Objetivo Avaliar a prevalência e a severidade da cárie dentária, e as ações curativas realizadas em escolares de 6 a 14 anos do Ensino Fundamental durante quatro meses de intervenção. Material e método Estudo transversal foi realizado com 130 escolares do município de Sarandi-PR. Para o diagnóstico da cárie dentária, foram utilizados os índices ceo-d, CPO-D e ICDAS II. Os escolares receberam atendimento curativo de acordo com as necessidades apresentadas, associado a atividades educativas preventivas. Resultado A prevalência de cárie dentária foi de 70% e 83%, segundo os índice ceo-d/CPO-D e ICDAS II, respectivamente. Os códigos referentes ao ICDAS II com maior prevalência foram ICDAS 5 e 6 (1,57% e 3,69%, respectivamente), enquanto o código 4 foi o de menor prevalência (0,30%). A maioria dos tratamentos restauradores foi realizada pela técnica de Tratamento Restaurador Atraumático (ART) (150 restaurações). Foram realizadas 90 aplicações de verniz fluoretado em lesões iniciais de cárie. Os tratamentos de maior complexidade foram encaminhados para a Unidade Básica de Saúde do município. Dos 32 escolares referenciados, 21 compareceram e nestes foram realizados tratamentos endodônticos e exodontias de dentes decíduos e permanentes. Conclusão A população estudada apresenta prevalência alta de cárie e, após quatro meses de intervenção, observou-se que o ART foi resolutivo para a maioria das necessidades de tratamento (59,2%), apresentando-se como uma estratégia eficiente que pode ser implementada em locais que não oferecem a estrutura de um consultório odontológico.

Abstract Introduction Dental caries is still a public health problem in most industrialized countries, with a higher prevalence in the most socioeconomically vulnerable populations. Objective The aim of this study was to evaluate the prevalence and severity of dental caries and curative actions performed in students from 6 to 14 years of elementary school during four months of intervention. Material and method Cross-sectional study was conducted with 130 students from Sarandi / PR. To diagnose dental caries, dmft, DMFT and ICDAS II indices were used. The students received curative care according to the needs presented associated with preventive educational activities. Result The prevalence of dental caries was 70% and 83% according to the ceo-d / CPO-D and ICDAS II index, respectively. The codes for ICDAS II with thw highest prevalence were ICDAS 5 and 6 (1.57% and 3.69% respectively), while Code 4 was the least prevalent (0.30%).Most restorative treatments were performed by the ART technique (150 restorations). Ninety applications of fluoride varnish were performed on initial carious lesions. The most complex treatments were referred to the Basic Health Unit of the municipality. Of the 32 students referred, 21 attended and endodontic treatments and primary and permanent teeth extraction were performed. Conclusion The studied population has a high prevalence of caries and after four months of intervention, it was observed that ART was decisive for most treatment needs (59.2%), presenting itself as an efficient strategy that can be implemented in places that do not offer the structure of a dental office.

RESUMO Objetivo: Identificar o perfil epidemiológico dos acidentes com material biológico ocorridos na clínica odontológica de uma universidade na região sul do país Métodos: Foi realizado um estudo descritivo, transversal, retrospectivo, analisando as notificações da Vigilância Epidemiológica (SINAN) ocorridas entre março de 2013 a dezembro de 2016. Foram analisadas as variáveis demográficas e os dados referentes a notificação de acidentes com material biológico contidas na ficha do SINAN, tais como: idade, sexo, raça, ocupação (estudante, professor, técnico em saúde bucal, residentes), momento e local da ocorrência do acidente, agente causador da perfuração, uso total ou parcial de EPI no momento do acidente, contato com material orgânico, agente do contato e vacinação em dia contra hepatite B e abandono do tratamento. Os dados obtidos foram analisados pelo Software EpiInfo. A análise estatística incluiu a análise descritiva e inferencial, com nível de significância de p?0,05 e intervalo de confiança (IC) de 95%. Resultados: No total houve 55 notificações de acidentes com materiais pérfuro-cortantes, sendo doze homens (21,82%) e 43 mulheres (78,18%). A idade média da população amostral era de 24,2 (±6,3) anos. Quanto à ocupação, 80% (n=44) eram estudantes de graduação, 12,72% residentes, 5,45% professores e 1,82% técnico em saúde bucal. A maioria (61,8%) se perfurou durante o procedimento odontológico, 21,82% durante a lavagem dos materiais e 16,36% durante uma cirurgia, porém 20% alegaram que não utilizavam o equipamento de proteção individual. Em relação ao material orgânico, houve grande prevalência do contato com o sangue 70,9%, sendo a agulha o principal agente (n=26; 47,3%). Ainda, 3,7% afirmaram não estavam vacinados contra hepatite B. Na análise bivariada, o local do acidente esteve associado com o uso do equipamento de proteção individual (p=0,01). Conclusão: Os resultados mostraram que o número de incidentes é elevado e podem ser atribuídos a diversos fatores, como a falta de experiência dos estudantes e a não utilização de equipamentos de proteção individual. Em decorrência disso, é necessário estabelecer um programa de educação permanente focado em estratégias de educação e prevenção de acidentes para minimizar esses agravos.

ABSTRACT Objective: To identify the epidemiological profile of accidents with biological material occurring in the dental clinic of a university in the southern region of the country. Methods: This is a descriptive, cross-sectional, retrospective study, which analyzed the reports of the Epidemiological Surveillance (SINAN) that occurred between March 2013 and December 2016. We analyzed the demographic variables and data related to the notification of accidents with biological material in the SINAN file, such as: age, sex, race, occupation (student, teacher, oral health technician, residents), time and place of occurrence of the accident, agent causing the perforation, total or partial use of PPE (personal protective equipment) at the time of accident, contact with organic material, contact agent and up-to-date vaccination against hepatitis B and treatment withdrawal. The data obtained were analyzed in EpiInfo Software. Statistical analysis included descriptive and inferential analysis, with significance level of p?0.05 and confidence interval (CI) of 95%. Results: In total there were 55 reports of accidents with piercing-cutting materials, of which 12 were men (21.82%) and 43 were women (78.18%). The mean age of the sample population was 24.2 (± 6.3) years. Regarding the occupation, 80% (n = 44) were undergraduate students, 12.72% were residents, 5.45%, teachers and 1.82%, oral health technicians. The majority (61.8%) were perforated during the dental procedure, 21.82% during material washing and 16.36% during surgery, but 20% claimed that they did not use any personal protective equipment. Regarding the organic material, there was a high prevalence of contact with blood, 70.9%, the needle was the main agent (n = 26; 47.3%). Still, 3.7% stated that they were not vaccinated against hepatitis B. In the bivariate analysis, the site of the accident was associated with the use of personal protective equipment (p = 0.01). Conclusion: The results showed that the number of incidents is high and can be attributed to several factors, such as lack of experience of students and the non-use of personal protective equipment. As a result, it is necessary to establish a permanent education program focused on education and accident prevention strategies to minimize these problems.

Resumo Introdução A solubilidade e sorção dos materiais restauradores são considerados fatores críticos, pois podem interferir na qualidade e durabilidade das restaurações. Objetivo Avaliar a solubilidade e sorção de água de alguns materiais restauradores. Material e método Foram confeccionados quatorze espécimes de cada um dos seguintes materiais: Equia® Forte, Z100, Fuji IX/ e Vidrion R, os quais foram levados a uma dessecadora e pesados diariamente até estabilização. Em seguida, foram inseridos em recipientes individuais contendo 40 mL de água destilada cada e divididos em dois grupos de acordo com o tempo de armazenagem: 7 ou 30 dias. Ao final de cada período, os espécimes foram retirados da água, pesados, levados à dessecadora e pesados novamente até estabilização. Os resultados foram analisados estatisticamente utilizando os testes ANOVA 2 critérios e Tukey. Resultado Com exceção do Equia® Forte e Z100, os demais materiais, apresentaram uma variação significativa da solubilidade ao longo do tempo. Quanto à sorção, observa-se que apenas o material Z100 não apresentou diferença significativa em relação ao tempo de armazenagem, mas, na comparação entre os materiais, todos apresentaram diferenças significativas em ambos os períodos. Conclusão Após os períodos de armazenagem de 7 e 30 dias em água, os materiais restauradores Equia® Forte e Z100 não apresentam variação significativa da solubilidade, sendo mais estáveis que os materiais Fuji IX e Vidrion R. Os materiais à base de ionômero de vidro, Equia® Forte, Fuji IX e Vidrion R, sofrem mais sorção em água quando comparados ao material Z100 em ambos os períodos.

Abstract Introduction The solubility and sorption parameters of restorative materials are considered critical factors since they may interfere with the quality and durability of restorations. Objective The aim of this study was to evaluate the solubility and water sorption of some restorative materials. Material and method Fourteen specimens were made (10.0 mm x 2.0 mm) of each of the following material: Equia® Forte, Z100, Fuji IX/ e Vidrion R, then taken to a desiccator and weighed daily until stabilized. They were then placed in individual containers with 40mL of distilled water each and divided into two groups according to the storage time: 7 or 30 days. At the end of each period, the specimens were removed from the water, weighed, taken to the desiccator and weighed again until stabilized. The results were analyzed statistically with two-way ANOVA and Tukey. Result Except for Equia® Forte and Z100, the other materials presented a significant variation of solubility over time. As for sorption, it was noticed that only Z100 presented no significant difference in relation to the storage time, but in comparison of the materials, all had significant differences in both 7 and 30 days periods. Conclusion After storage periods of 7 and 30 days in water, the restorative materials Equia® Forte and Z100 do not present significant variation of solubility, being more stable than the materials Fuji IX and Vidrion R. The glass ionomer-based materials, Equia® Forte, Fuji IX and Vidrion R, suffer more sorption in water when compared to Z100 material in both periods.

Resumo A amamentação é uma prática diretamente relacionada com a saúde da mãe e, principalmente, do bebê. Apesar de ser um processo natural, muitas mães relatam dificuldades. Este estudo objetivou buscar evidências científicas sobre a questão: “Mãe com mais confiança consegue amamentar exclusivamente por 6 meses?”. Foi realizada uma revisão sistemática com busca em 5 bancos de dados eletrônicos, que resultou na inclusão de 4 estudos de coorte para avaliação. Realizou-se uma análise qualitativa dos resultados, porém não foi possível fazer a meta-análise. Autoconfiança em amamentar foi avaliada pela escala “Breastfeeding Self-Efficacy Scale”. Os estudos analisados mostraram que há associação estatística significante entre aleitamento materno exclusivo e autoconfiança em amamentar. A utilização da escala parece ser uma ferramenta confiável para identificar mães em risco para desmame precoce, facilitando o planejamento de ações pelos profissionais em saúde. As evidências obtidas mostraram a associação entre mães com maior confiança em amamentar e a amamentação exclusiva por 6 meses, porém estes resultados não podem ser generalizados devido à heterogeneidade das populações.

Abstract Breastfeeding is a practice directly related to the health of the mother and especially the baby. Despite being a natural process, many mothers report difficulties with breastfeeding. This study aimed to seek scientific evidence on the issue: “Can a mother with more confidence in breastfeeding exclusively breastfeed her baby for 06 months?”. We conducted a systematic review with a search in five electronic databases, and included four cohort studies for evaluation. We conducted a qualitative analysis of the results, considering the methodological differences and lack of data, and were unable to perform meta-analysis. Confidence in breastfeeding was evaluated by using the Breastfeeding Self-Efficacy Scale. The studies analyzed showed statistically significant association between the practice of breastfeed and confidence in breastfeeding. The application of a scale to evaluate trust and identify mothers at risk for early weaning appeared to be a reliable measurement tool, capable of facilitating action planning by health professionals. The evidence showed association between mothers with higher levels of confidence in breastfeeding and exclusive breastfeeding for 6 months, but these results could not be generalized because of the heterogeneity of the population.

Resumo Dentre as abordagens minimamente invasivas atualmente disponíveis, o tratamento restaurador atraumático (ART) demonstra resultados promissores tanto na dentadura decídua quanto permanente. Objetivo Avaliar a sobrevivência de restaurações ART Classe I, em pré-escolares, com duas marcas brasileiras de cimentos de ionômeros de vidro (CIV) em comparação com um CIV de referência. Material e método Cavidades de 49 crianças pré-escolares (três a cinco anos de idade) com lesões cariosas nos dentes posteriores (N = 81) foram preenchidas por dois odontopediatras experientes, de acordo com a técnica ART. Os CIV brasileiros Maxxion-R (MR) e Vitro-Fil LC (VF) e o CIV de referência, Ketac-Molar (KM), foram inseridos em uma sequência pré-estabelecida aleatoriamente. As restaurações foram avaliadas após 6 e 12 meses por outro pesquisador. As pontuações 0 e 1 foram consideradas bem-sucedidas, enquanto as pontuações 3-9 foram classificadas como falhas. Foram aplicadas a análise de sobrevivência de Kaplan-Meier e o teste log-rank (p <0,05). Resultado Não foram observadas diferenças estatisticamente significativas nas taxas de sobrevivência dos CIV testados após 12 meses. Conclusão O desempenho clínico dos CIV brasileiros MR e VF, observado após 12 meses, sugere que estes podem ser uma alternativa para restaurações ART Classe I para proteger a esfoliação natural dos dentes decíduos. No entanto, até que sejam realizados estudos adicionais envolvendo um maior número de restaurações e períodos de acompanhamento mais longos, os CIV de referência, como o KM, devem continuar sendo o material de escolha para as restaurações ART.

Abstract Among the minimally invasive approaches available today, the atraumatic restorative treatment (ART) has demonstrated promising results both in the primary and permanent dentition. Objective To evaluate the survival of Class I ART restorations in preschoolers with two Brazilian brands of glass ionomer cements (GIC) in comparison with a reference GIC. Material and method The cavities of 49 preschool children (three to five years) with carious lesions in the posterior teeth (N=81) were filled by two experienced pediatric dentists according to the ART technique. The Brazilian GICs Maxxion-R (MR) and Vitro-Fil LC (VF), and the reference GIC Ketac-Molar (KM) were placed in a randomly pre-established sequence. Restorations were evaluated after 6 and 12 months by another investigator. Scores 0 and 1 were considered successful, while scores 3-9 were classified as failures. Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05). Result No statistically significant differences in survival rates of the tested GIC were observed after 12 months. Conclusion The clinical performance the low-cost Brazilian GICs MR and VF observed after 12 months suggests that they may be an alternative for Class I ART restorations to safeguard the natural exfoliation of primary teeth. However, until further studies involving a larger number of restorations and longer follow-up periods are conducted, reference GIC such as KM should continue to be the material of choice for ART restorations.

Resumo Introdução O potencial erosivo das bebidas energéticas (BE) devido ao baixo pH e à presença de ácido cítrico pode estar relacionado ao aumento dos índices de erosão dental da população em geral e especialmente, nos jovens. Objetivo Verificar o pH e a titulação ácida de BE e a influência de uma marca de BE na microdureza superficial do esmalte. Material e método Dez amostras de BE de diferentes marcas comerciais foram selecionadas. O pH de dois lotes de cada BE foi analisado, com e sem gás. A titulação ácida foi realizada com a adição de alíquotas de NaOH, até atingir pH 7,0. Dezoito amostras de esmalte dental humano foram distribuídas aleatoriamente em três grupos (n = 6), Red Bull (RB), Red Light Bull (RBL) e água destilada (C), submetidas a um desafio ácido com a BE, seis vezes consecutivas, com intervalos de 12 horas, durante três dias. A microdureza Knoop foi medida antes e depois do desafio ácido. Resultado Todas as marcas de BE testadas apresentaram baixos níveis de pH, variando de 2,1 a 3,2. Em relação à titulação ácida, verificou-se que a quantidade de base necessária para promover a neutralização das soluções variou de 1200 μL a 3750 μL. Amostras de esmalte humano nos grupos RB e RBL submetidos ao desafio ácido apresentaram diminuição significativa da microdureza Knoop. Conclusão Todas as BE examinadas apresentaram baixo pH e alta titulação ácida e, portanto, potencial para promover perda mineral. As BE analisadas promoveram perdas minerais significativas na superfície do esmalte dental.

Abstract Introduction Energy drinks (ED) possess low pH and citric acid in their composition, making them potentially erosive beverages that can contribute to the high dental erosion rates found currently in the general population and also in young people. Objective To evaluate the mean pH and titratable acidity of commercial ED and the influence of a brand of ED on the superficial microhardness of human enamel. Material and method Ten commercial ED were selected and the pH of two lots of each ED with and without gas was obtained. Acid titration was conducted with the addition of NaOH aliquots until the pH 7 was reached. Eighteen human enamel specimens were allocated in three groups (N=6), Red Bull (RB), Red Bull Light (RBL) and distilled water (C), submitted to an acid challenge with the ED, six consecutive times, with 12 hours intervals, during three days. Knoop microhardness was measured before and after the acid challenge. Result All ED brands tested presented low pH levels ranging from 2.1 to 3.2. Regarding titratable acidity, it was found that the amount of base required promoting the neutralization of the solutions ranged from 1200μL to 3750μL. Samples of human enamel in the RB and RBL groups submitted to the acid challenge presented significantly decreased Knoop microhardness when compared with the group C. Conclusion All ED examined have potential to promote mineral loss due to the low pH and high titratable acidity. The ED analyzed promoted significant mineral losses on the dental enamel surface.

Resumo A amamentação é uma prática diretamente relacionada com a saúde da mãe e, principalmente, do bebê. Apesar de ser um processo natural, muitas mães relatam dificuldades. Este estudo objetivou buscar evidências científicas sobre a questão: “Mãe com mais confiança consegue amamentar exclusivamente por 6 meses?”. Foi realizada uma revisão sistemática com busca em 5 bancos de dados eletrônicos, que resultou na inclusão de 4 estudos de coorte para avaliação. Realizou-se uma análise qualitativa dos resultados, porém não foi possível fazer a meta-análise. Autoconfiança em amamentar foi avaliada pela escala “Breastfeeding Self-Efficacy Scale”. Os estudos analisados mostraram que há associação estatística significante entre aleitamento materno exclusivo e autoconfiança em amamentar. A utilização da escala parece ser uma ferramenta confiável para identificar mães em risco para desmame precoce, facilitando o planejamento de ações pelos profissionais em saúde. As evidências obtidas mostraram a associação entre mães com maior confiança em amamentar e a amamentação exclusiva por 6 meses, porém estes resultados não podem ser generalizados devido à heterogeneidade das populações.

Abstract Breastfeeding is a practice directly related to the health of the mother and especially the baby. Despite being a natural process, many mothers report difficulties with breastfeeding. This study aimed to seek scientific evidence on the issue: “Can a mother with more confidence in breastfeeding exclusively breastfeed her baby for 06 months?”. We conducted a systematic review with a search in five electronic databases, and included four cohort studies for evaluation. We conducted a qualitative analysis of the results, considering the methodological differences and lack of data, and were unable to perform meta-analysis. Confidence in breastfeeding was evaluated by using the Breastfeeding Self-Efficacy Scale. The studies analyzed showed statistically significant association between the practice of breastfeed and confidence in breastfeeding. The application of a scale to evaluate trust and identify mothers at risk for early weaning appeared to be a reliable measurement tool, capable of facilitating action planning by health professionals. The evidence showed association between mothers with higher levels of confidence in breastfeeding and exclusive breastfeeding for 6 months, but these results could not be generalized because of the heterogeneity of the population.

The objective of this study was to evaluate the association of pacifier-sucking habit with occlusal and oral myofunctional alterations in preschool children. Eighty-four 2- to 5-year-old children participated in the study. Data on duration and frequency of pacifier use were collected from parents or guardians. Occlusal and oral myofunctional characteristics were examined by a dentist and a speech therapist, respectively. Chi-square tests and Poisson regression were used to analyze the data. The occlusal characteristics that were significantly associated with a pacifier-sucking habit were anterior open bite, altered canine relation, posterior crossbite, increased overjet, and malocclusion. The oral myofunctional characteristics that were significantly associated with a pacifier-sucking habit were resting lip position, resting tongue position, shape of the hard palate, and swallowing pattern. The strongest associations were for anterior open bite (prevalence ratio [PR] = 11.33), malocclusion (PR = 2.33), altered shape of the hard palate (PR = 1.29), and altered swallowing pattern (PR = 1.27). Both duration and frequency of pacifier-sucking habit were associated with occlusal and oral myofunctional alterations. These results emphasize the need for pediatric dentists to advise parents and caregivers about the risks of prolonged pacifier use and refer children to professionals for multidisciplinary assistance to minimize these risks whenever necessary.

Current Brazilian law regarding water fluoridation classification is dichotomous with respect to the risks of and benefits for oral diseases, and fluoride (F) concentrations less than 0.6 or above 0.8 mg F/L are considered outside the normal limits. Thus, the law does not consider that both caries and fluorosis are dependent on the dosage and duration of fluoride exposure because they are both chronic diseases. Therefore, this study evaluated the quality of water fluoridation in Maringá, PR, Brazil, considering a new classification for the concentration of F in water the supply, based on the anticaries benefit and risk of fluorosis (CECOL/USP, 2011). Water samples (n = 325) were collected monthly over one year from 28 distribution water networks: 20 from treatment plants and 8 from artesian wells. F concentrations were determined using a specific ion electrode. The average F concentration was 0.77 mg F/L (ppm F), ranging from 0.44 to 1.22 mg F/L. Considering all of the water samples analyzed, 83.7% of them presented from 0.55 to 0.84 mg F/L, and according to the new classification used, they would provide maximum anticaries benefit with a low risk of fluorosis. This percentage was lower (75.4%) in the water samples supplied from artesian wells than from those distributed by the treatment plant (86%). In conclusion, based on the new classification of water F concentrations, the quality of water fluoridation in Maringá is adequate and is within the range of the best balance between risk and benefit.

OBJETIVO: Diagnosticar a prevalência de restaurações de amálgama e resina composta realizadas por profissionais no serviço público e estudantes universitários de um município do noroeste do estado do Paraná. MÉTODOS: Foram selecionadas aleatoriamente dez unidades básicas de saúde, das quais foram consultados 500 prontuários de pacientes com 18 a 50 anos, de ambos os sexos. Para analisar a prevalência das restaurações realizadas pelos estudantes, aplicou-se um questionário aos estudantes do quarto e quinto ano contendo perguntas relativas ao número de restaurações e tipo de material utilizado nas atividades clínicas intramuros. RESULTADOS: Nas unidades básicas de saúde, 66% das restaurações foram feitas com amálgama e 34% com resina composta. Na escola, os estudantes do quarto ano responderam que quando estavam no terceiro ano, de um total de 367 restaurações, 21,5% foram feitas com amálgama e 78,5% com resina. Para o grupo de estudantes do quinto ano, a porcentagem de dentes restaurados com amálgama foi de 14,3%, 12,0% e 10,2%, respectivamente, para quando estavam no 3º, 4º e 5º ano do curso. Os resultados obtidos revelaram que a indicação do material restaurador nos dois cenários é divergente. CONCLUSÃO: Nas unidades básicas de saúde a maioria das restaurações realizadas foi de amálgama enquanto na escola, a maior prevalência foi de resina composta. Deve-se refletir se a formação profissional tem desenvolvido adequadamente as competências necessárias para a tomada de decisão e o atendimento às necessidades da população.

OBJECTIVE: To diagnose the prevalence of amalgam and resin composite restorations performed by professionals in public service and university students in a municipality in the Northeast of the State of Paraná. METHODS: Ten basic health units were randomly selected, at which 500 clinical record charts of patients of both sexes aged from 18 to 50 years were consulted. To analyze the prevalence of restorations performed by students, a questionnaire was applied to 4th and 5th year students, containing questions relative to the number of restorations and type of material using in intramural clinical activities. RESULTS: In the basic health units, 66% of restorations were performed with amalgam, and 34% with resin composite. At the dental school, 4th year students responded that when they were in the 3rd year, out of a total of 367 restorations, 21.5% were performed with amalgam and 78.5% with resin composite. For the 5th year group of students, the percentage of teeth restored with amalgam was 14.3%, 12.0% and10.2%, when they were in the 3rd, 4the and 5th years of the course, respectively. The results obtained revealed that the indication of the restoration material differed in the two scenarios. CONCLUSION: In the basic health units, the majority of restorations were performed with amalgam, whereas at the dental school there was higher prevalence of resin composite restorations. One must reflect whether professional education has adequately developed the necessary competencies for decision making and meeting the needs of this population.