Sedação com midazolam e hidroxizina por via oral em Odontopediatria: ensaio clínico randomizado, controlado e cruzado

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg); MH - midazolam (0,75 mg/kg) associado à hidroxizina (2,0 mg/kg). Os sinais vitais (pressão arterial, freqüência respiratória, pulso e saturação de oxigênio) e os parâmetros comportamentais (consciência, choro, movimento, comportamento geral) foram avaliados a cada 15 minutos. As comparações entre grupos e entre momentos de atendimento num mesmo grupo foram estabelecidas estatisticamente através dos testes Friedman e Wilcoxon. Os grupos P, M e MH não diferiram quanto aos sinais vitais, os quais se mantiveram dentro de valores aceitáveis. A freqüência cardíaca aumentou nos grupos P e M com o transcorrer da sessão. O grupo M esteve associado a menos choro e movimento nos primeiros 15 minutos de tratamento. O grupo MH apresentou mais sonolência no início da sessão. O comportamento geral foi melhor em M do que em P e MH. M produziu sedação efetiva em 77% dos casos, e MH em 30,8%. Concluiu-se que o midazolam foi efetivo e seguro, e que sua associação à hidroxizina não repercutiu em vantagens adicionais na sedação odontopediátrica

Odontopediatria no alojamento conjunto: avaliação de um projeto inovador em promoção de saúde bucal

According to the current paradigm for promoting health, dental care should be a consideration from the first months of life, or even before birth. The aim of this paper is to evaluate mothers' knowledge of and attitude toward their babies' oral health after receiving guidance during the neonatal period. Forty-six mothers were contacted and asked about the advice they had received and how they felt about the information provided. The mothers recruited for the study were divided into two groups, A (n=25) and B (n=21), according to the time elapsed since their participation in the project, that is, less than or equal to three months and more than three months, respectively. A Wilcoxom rank sum test did not show any statistically significant difference between the two groups (p>;0.05). Guidance on the baby's oral hygiene, breastfeeding the baby exclusively until the sixth month, as well as the restrictions imposed on sugar intake were what the mothers remembered most. Recommendations concerning good arch development and the use of bottles were what mothers remembered least. Regarding infant oral health, it would be advisable to schedule prenatal and neonatal visits, with the second post-natal consultation no later than four months after childbirth.Segundo o paradigma atual de promoção de saúde, a atenção odontológica deve se iniciar ainda nos primeiros meses de vida ou então anteriormente ao nascimento, já que hábitos alimentares e de higiene bucal se estabelecem muito cedo. Avaliou-se o grau de conhecimento e as atitudes das mães com relação à saúde bucal do bebê, após as mesmas terem recebido orientações no período neonatal (projeto "Odontopediatria no alojamento conjunto"/ UFG). Quarenta e seis mães com idades de 15 a 38 anos foram questionadas a respeito das orientações recebidas, bem como seu comportamento em relação às mesmas. Dividiu-se a casuística em dois grupos, A (n=25) e B (n=21), de acordo com o tempo decorrido após a implementação do projeto, ou seja, menor ou igual a três meses e maior que três meses, respectivamente. Frente às orientações recebidas (transmissibilidade da cárie dentária, hábitos alimentares, desenvolvimento das arcadas e higiene bucal), a análise de variância não mostrou diferenças estatisticamente significantes entre os dois grupos (p >; 0,05), no que diz respeito ao conhecimento e atitudes das mães. As orientações de higiene bucal do bebê, de aleitamento materno exclusivo até seis meses e a restrição na ingestão de açúcar foram as mais lembradas pelas mães. Recomendações referentes à contribuição ao bom desenvolvimento das arcadas e às precauções quanto ao uso de mamadeiras foram menos recordadas. Considerando a saúde bucal do lactente, seria aconselhável que cuidadores sejam orientados nos períodos pré- e neonatal, sendo que a segunda consulta odontológica pós-nascimento deve idealmente ocorrer por volta do quarto mês de vida da criança

Percepção de cirurgiões-dentistas, acadêmicos de odontologia e público leigo sobre sedação em odontologia

Sedation is an option for controlling fear and anxiety related to a visit to the dentist. The goal of this study was to capture, by means of a questionnaire, the perceptions of twenty dentists, twenty dental students and twenty lay people concerning the use of sedatives in a dental environment. The responses were evaluated using the quantitative-interpretative method. Dentists: 75% had knowledge of sedatives in a dental setting, but their actual use was mentioned by only three. As far as the use of sedatives by dentists is concerned, one considered it "risky" and 19 were favorable. Two affirmed that sedation does not present risks. Eighteen said they would be able to react to a medical emergency. Dental students: 60% said they were aware of the topic, in theory. Nineteen expressed interest in the topic. Fifteen claimed there were risks associated with the technique. Twelve (60%) have the theoretical knowledge to deal with a medical emergency in the dental office. Lay public: Seven (35%) responded that they felt some discomfort during dental treatment, because of fear (n=6) and equipment noise (n=2). Five said they would go to the dentist more often if there was a way to reduce the discomfort. Half of those interviewed indicated that they knew what sedation was. Sixteen favored using it for dental treatment. Seven thought that there were no risks when sedation is carried out. It was concluded that few participants in any of the three categories felt confident about the topic, though they demonstrated interest. The population in general felt optimistic, while practicing dentists and dental students complained of a lack of exposure to the subject at dental school.A sedação constitui-se em opção no controle do medo e da ansiedade relacionados à visita ao dentista. Propôs-se captar a percepção de 20 cirurgiões-dentistas, 20 acadêmicos de odontologia e 20 leigos sobre a utilização de recursos sedativos em ambiente odontológico, através da aplicação de formulários. As respostas foram avaliadas através de método quantitativo-interpretativo. Cirurgiões-dentistas: 75% tinham conhecimento do uso de sedativos em consultório odontológico, sendo que sua prática efetiva foi mencionada por apenas três. Quanto ao uso de sedativos por dentistas, um considerou "arriscado" e 19 manifestaram-se favoráveis. Dois afirmaram que a sedação não oferece riscos. Dezoito disseram saber reagir frente a emergência médica. Acadêmicos de odontologia: 60% admitiam conhecer o tema, em teoria. Dezenove expressaram interesse no assunto. Quinze afirmaram haver riscos associados à técnica. Doze (60%) tinham o conhecimento teórico para conduta frente a uma emergência médica no consultório. Público leigo: Sete (35%) responderam que sentiam algum desconforto no tratamento odontológico, representado pelo medo (n=6) e o ruído dos equipamentos (n=2). Cinco disseram que iriam mais freqüentemente ao consultório odontológico se houvesse algum meio para reduzir o desconforto. Metade dos entrevistados relatou saber o que é sedação. Dezesseis foram favoráveis à sua realização para tratamento odontológico. Sete julgaram que não há riscos quando se faz sedação. Concluiu-se que poucos participantes, dentro das três categorias, estiveram seguros com relação ao assunto, embora tenham demonstrado interesse. A população em geral sentiu-se otimista, enquanto que CDs e acadêmicos queixaram-se da pouca vivência do tema nas faculdades

Antimicrobial activity of two brazilian commercial propolis extracts

The antimicrobial activity of propolis extracts is well documented, but little is known about the antimicrobial properties of commercial products containing propolis, since these vary according to the geographical region in which the propolis is obtained. This study evaluated the antimicrobial activity of two samples of commercial propolis on 26 species of microorganisms obtained from ATCC and some wild strains: Gram-positive cocci and bacilli, and Gram-negative rods and yeasts. The tested products were two samples of Brazilian commercial propolis from Apis Flora™: 11.0% ethanolic extract of propolis (EEP) and Propomax™ 11.0% extract of propolis without alcohol (EP). Antimicrobial activity was determined by the agar diffusion technique, well method. MIC was determined for Staphylococcus sp. and Staphylococcus mutans using the method of broth dilution with the propolis extract in serial concentrations. EEP and EP showed antimicrobial activity against all tested bacteria and yeasts, having a more pronounced action against Gram-positive bacteria and Candida albicans ATCC 10231, and a less evident activity against Gram-negative and Candida albicans FT2010. For S. mutans, the EEP MIC ranged from 8.8 to 4.4 mL of propolis, and the EP MIC, from 4.4 to <1.1 mL. For Staphylococcus sp., the MIC of both extracts was <1.

Antimicrobial activity of two brazilian commercial propolis extracts

imicrobial activity of propolis extracts is well documented, but little is known about the antimicrobial properties of commercial products containing propolis, since these vary according to the geographical region in which the propolis is obtained. This study evaluated the antimicrobial activity of two samples of commercial propolis on 26 species of microorganisms obtained from ATCC and some wild strains: Gram-positive cocci and bacilli, and Gram-negative rods and yeasts. The tested products were two samples of Brazilian commercial propolis from Apis Flora: 11.0% ethanolic extract of propolis (EEP) and Propomax 11.0% extract of propolis without alcohol (EP). Antimicrobial activity was determined by the agar diffusion technique, well method. MIC was determined for Staphylococcus sp. and Streptococcus mutans using the method of broth dilution with the propolis extract in serial concentrations. EEP and EP showed antimicrobial activity against all tested bacteria and yeasts, having a more pronounced action against Gram-positive bacteria and Candida albicans ATCC 10231, and a less evident activity against Gram-negative and Candida albicans FT2010. For S. mutans, the EEP MIC ranged from 8.8 to 4.4 mL of propolis, and the EP MIC, from 4.4 to <1.1 mL. For Staphylococcus sp., the MIC of both extracts was <1.1