Sealing ability of materials used as protective cervical barrier in internal tooth bleaching

The use of a protective cervical barrier (PCB) is very well established to perform a safe internal bleaching; however, there is still no consensus on which material has the best sealing ability. Objective: This in vitro study aimed to evaluate the apical and linear sealing of different PCB materials placed during internalbleaching. Material and methods: This study had two study factors: PCB positioning, divided at two levels (cement-enamel junction [CEJ] and 1mm above the cement enamel junction [CEJ+1]); and PCB material, divided at eight levels (resin composite [RC], glass ionomer cement [GIC], resin-modified glass ionomer cement liner [LRGIC], restorative resin-modified glass ionomer cement [RRGIC], zinc phosphate cement [ZPC], eugenol-free zinc oxide cement [ZOC],provisional filling resin [PFR] and gutta-percha as control [GUT]). Response variables were apical and linear sealing obtained through dye penetration and analyzed with a digital microscope. Data were subjected to two-way analysis of variance followed by Tukey test (p<0.05). Results: The main factor for both apical and linear sealing was the type of material (p<0.01), regardless of their position. RC and ZPC presented the worst sealing values (p<0.05). The Spearmanrank correlation coefficient revealed a positive correlation between the apical and linear leakage. Conclusion: The results suggest that RC and ZPC must be avoided as a PCB during internal bleaching procedures.The use of a protective cervical barrier (PCB) is very well established to perform a safe internal bleaching; however, there is still no consensus on which material has the best sealing ability. Objective: This in vitro study aimed to evaluate the apical and linear sealing of different PCB materials placed during internalbleaching. Material and methods: This study had two study factors: PCB positioning, divided at two levels (cement-enamel junction [CEJ] and 1mm above the cement enamel junction [CEJ+1]); and PCB material, divided at eight levels (resin composite [RC], glass ionomer cement [GIC], resin-modified glass ionomer cement liner [LRGIC], restorative resin-modified glass ionomer cement [RRGIC], zinc phosphate cement [ZPC], eugenol-free zinc oxide cement [ZOC],provisional filling resin [PFR] and gutta-percha as control [GUT]). Response variables were apical and linear sealing obtained through dye penetration and analyzed with a digital microscope. Data were subjected to two-way analysis of variance followed by Tukey test (p<0.05). Results: The main factor for both apical and linear sealing was the type of material (p<0.01), regardless of their position. RC and ZPC presented the worst sealing values (p<0.05). The Spearmanrank correlation coefficient revealed a positive correlation between the apical and linear leakage. Conclusion: The results suggest that RC and ZPC must be avoided as a PCB during internal bleaching procedures

Primary care hypnotic and anxiolytic prescription:Reviewing prescribing practice over 8 years

Introduction: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice. Materials and Methods: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients′ age, gender, name of the prescribed drug(s), and total number of prescriptions in this class over the year were extracted. Results: The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n = 109) in 2007, 70.5% (n = 122) in 2011, and 51.7% (n = 138) in 2015 (P = 0.006). The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n = 39) in 2007, 46.2% (n = 80) in 2011, and 52.4% (n = 140) in 2015 (P = 0.001). There was a significant increase in the number of patients prescribed melatonin (P = 0.020). Discussion: This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall. Conclusion: Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations

Usefulness of aqueous and vitreous humor analysis in infectious uveitis

OBJECTIVE: To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS: Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS: The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION: Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful

Efeito da PDT, e de novas soluções quelantes na inativação do LPS bacteriano

INTRODUCTION: In the necropulpectomies, in addition to the elimination of microorganisms and to neutralization of lipopolysaccharides (LPS), present in root canal system, it is fundamental, since that endotoxin is highly related to unsuccessful cases with painful symptomatology. OBJECTIVE: The present study evaluated the capacity of Photodynamic Therapy (PDT) and the different irrigants, to inactivate the bacterial LPS. MATERIALS AND METHODS: Eighty single-rooted human teeth were used, previously analyzed by radiographic images to confirm the single canal. The coronary portion was removed to obtain 14mm segment of the root, where the canals were properly prepared. The samples were placed vertically in 24-well plates and fixed with acrylic resin. The samples and all the materials used in the study were previously sterilized with Cobalt-60 Gamma radiation. Inside the laminar flow cabinet, 10L of LPS from Escherichia coli were inoculated inside in root canal of each sample and kept for 24 hours in a bacteriological oven. The inoculation procedure was repeated twice more and then the samples were divided into the following groups (n = 10): [G1] sodium hypochlorite at 2.5%; [G2] pyrogen-free water; [G3] trisodium EDTA at 17%; [G4] tetrasodium EDTA at 10%; [G5] Etidronate at 18%; [G6] Methylene blue at 5%; [G7] diode LASER; [G8] PDT (methylene blue + diode LASER). The time for action of the irrigating solutions, dye and irradiation, was 5 minutes for all groups. After the treatment, the canals were cleaned and filled with 5mL of pyrogen-free water, where it was agitated and aspirated by a pyrogen-free needle/syringe. The aspirated content of each specimen was kept under refrigeration at -80ºC until posterior analysis of Limulus Amebocyte Lysate. The obtained data did not pass the Shapiro Wilks normality test, so they were submitted to the Kruskal-Wallis test followed by the Dunns test. RESULTS: The obtained data presented relevant reduction only in the groups G3 (p = 0.0452) and G5 (p = 0.0097), in comparison to the control group G2. The medium percentage (Minimum/Maximum) of remaining endotoxin was: [G1] = 1.005 (0.3100/5.810); [G2] = 2.010 (0.8700/10.33); [G3] = 0.3800 (0.060 /2.150); [G4] = 1.195 (0.110/3,420); [G5] = 0.9000 (0.0/1.540); [G6] = 1.320 (0.1800/9.410); [G7] = 1.210 (0.4700/9.400); [G8] = 3.560 (0.4800/5.460).CONCLUSION: The PDT did not present efficacy in neutralizing the LPS and, among the evaluated solutions, trisodium EDTA at 17% and etidronate at 18% presented efficacy in inactivating the bacterial endotoxin.OBJETIVO: Nas necropulpectomias, além da eliminação de micro-organismos e neutralização de lipopolissacarídeos (LPS), presentes no sistema de canais radiculares, é fundamental, uma vez que esta endotoxina está altamente relacionada aos casos de insucesso e de sintomatologia dolorosa. Este trabalho avaliou a capacidade da Terapia fotodinâmica (PDT) e de diferentes irrigantes, para inativar o LPS bacteriano. MATERIAIS E MÉTODOS: Foram utilizados 80 dentes humanos unirradiculados, analisados previamente por imagens radiográficas para confirmação de canal único. A porção coronária foi removida para a obtenção de 14mm de segmento radicular, cujos canais foram devidamente preparados. As amostras foram posicionadas verticalmente em placas de cultura de 24 poços e fixados com resina acrílica. As amostras e todos os materiais a serem utilizados na pesquisa foram esterilizados, previamente, em radiação Gama cobalto 60. No interior da cabine de fluxo laminar, 10L de LPS de Escherichia coli foram inoculados no canal de cada amostra, e mantidas durante 24 horas em estufa bacteriológica. O procedimento de inoculação foi repetido mais 2 vezes e então as amostras foram divididas nos seguintes grupos (n=10): [G1] hipoclorito de sódio a 2,5%; [G2] água apirogênica; [G3] EDTA trissódico a 17%; [G4] EDTA tetrassódico a 10%; [G5] Etidronato a 18%; [G6] Azul de metileno a 5%; [G7] LASER de diodo e [G8] PDT (azul de metileno + LASER de diodo). O tempo de ação das soluções irrigadoras, do corante e da irradiação, foi de 5 minutos para todos os grupos. Após o tratamento, os canais foram lavados e preenchidos com 5mL de água apirogênica, onde a mesma foi agitada e aspirada por uma agulha/seringa apirogênica. O conteúdo aspirado de cada espécime foi mantido em refrigeração a -80ºC até posterior análise pelo método Limulus Amebocyte Lysate. Os dados obtidos não passaram no teste de normalidade Shapiro Wilks, sendo então submetido ao teste de Kruskal Wallis seguido de Dunn. RESULTADOS: Os dados obtidos apresentaram redução significativa apenas nos grupos G3 (p = 0,0452) e G 5 (p = 0,0097) em comparação ao grupo controle G2. A mediana (Mínima/Máxima) da porcentagem de endotoxina remanescente foram: [G1] = 1.005 (0.3100/5.810); [G2] = 2.010 (0.8700/10.33); [G3] = 0.3800 (0.060 /2.150); [G4] = 1.195 (0.110/3,420); [G5] = 0.9000 (0.0/1.540); [G6] = 1.320 (0.1800/9.410); [G7] = 1.210 (0.4700/9.400); [G8] = 3.560 (0.4800/5.460). CONCLUSÃO: A PDT não apresentou eficácia em neutralizar o LPS, e dentre as soluções avaliadas, o EDTA trissódico a 17% e o etidronato a 18, foram eficazes em inativar a endotoxina bacteriana

Antimicrobial activity of the combination of LED curing light and curcumin on Enterococcus faecalis in photodynamic therapy

Este trabalho avaliou a ação antimicrobiana da terapia fotodinâmica (TFD) realizada pela combinação do aparelho fotopolimerizador (LED 430-480nm) e curcumina 20M, além de sua associação com Gel Carbopol 2%. Fotos padronizadas, na ausência e presença do gel Carbopol no interior do conduto, previamente preparado, foram analisadas no software OriginLab para verificar a manutenção da intensidade de luz ao longo do canal. Na análise antimicrobiana, uma linhagem de ATCC 4083 do Enterococcus faecalis foi utilizada para formação de biofilme sobre a superfície de discos de dentina (4mm de diâmetro) e para contaminação intratubular de segmentos radiculares (15mm), ambos obtidos de raízes bovinas. A ação sobre o biofilme foi avaliada de acordo com os grupos (n=20): [BST]: sem tratamento (controle); [BC]: Curcumina; [BL]: LED; [BCL]: Curcumina + LED e [BAL]: Azul de metileno 0.05% + LASER (660nm). A ação intratubular foi avaliada nos grupos (n=8): [IST]: sem tratamento (controle); [ICL]: Curcumina + LED; [ICGL]: Curcumina + Gel Carbopol + LED e [IAL]: Azul de metileno 0.05% + LASER (660nm). Discos e segmentos foram analisados em Microscópio Confocal de Varredura a LASER para detectar a porcentagem de bactérias viáveis. Os dados obtidos, que apresentaram distribuição normal, foram analisados estatisticamente pelo teste ANOVA, a 1 critério, e para distribuição não normal, Kruskall- Wallis. Os resultados mostraram que a presença do gel Carbopol no conduto não contribuiu na manutenção da intensidade da luz LED. Sobre o biofilme, os grupos BAL e BCL apresentaram maior redução microbiana, sem diferença entre eles, enquanto que, na ação intratubular, o IAL apresentou a melhor ação antimicrobiana, com diferença estatística com os demais. Concluiuse que a TFD realizada com o fotopolimerizador e curcumina é tão eficaz quanto a realizada com LASER e azul de metileno. Entretanto, é necessário investigar meios que permitam a sua utilização no interior do conduto radicular, já que o Gel Carbopol não manteve a intensidade da luz ao longo do trajeto.This work aimed to evaluate the antimicrobial action of photodynamic therapy (PDT) by the combination of light curing device (LED 430-480nm) and Curcumin 20 M, and its in association with Carbopol Gel 2%. Standard photos in the absence and presence of Carbopol gel inside of the root canal previously prepared, were analyzed in OriginLab software to check the light intensity maintenance along the canal. In microbial analysis, a strain of Enterococcus faecalis ATCC 4083 was used to make biofilm on the surface of dentin disks (4 mm in diameter), and intratubular contamination of root segments (15 mm), both obtained from bovine roots. The action on the biofilm was evaluated according to groups (n = 20): [BNT]: no treatment (control); [BC]: Curcumin; [BL]: LED; [BCL]: Curcumin + LED and [BML]: methylene blue 0.05% + LASER (660nm). Intratubular action was evaluated in groups (n = 8): [INT]: no treatment (control); [ICL]: Curcumin + LED; [ICGL]: Curcumin Carbopol Gel + LED + and [IML]: methylene blue 0.05% + LASER (660nm). Disks and segments were analyzed in LASER Scanning Confocal Microscope to detect the percentage of viable bacteria. The data, which showed normal distribution, were statistically analyzed by ANOVA 1 WAY test, and for no normal distribution, Kruskall-Wallis. The results showed that presence of Carbopol gel in the root canal did not increase the maintenance of intensity of LED light. About the biofilm, BML and BCL had higher microbial reduction, no difference between them, while in action intratubular, IML presented the higher antimicrobial action, with statistical difference with the other. It was concluded that the PDT realized with curing light and Curcumin is as effective as LASER and methylene blue. However, it is necessary to investigate ways that allow its use inside the root canal, because the Carbopol gel did not maintain the intensity of light until apex

Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders

<div><p>Study Objectives</p><p>To investigate the efficacy of melatonin compared to placebo in improving sleep parameters in patients with primary sleep disorders.</p><p>Design</p><p>PubMed was searched for randomized, placebo-controlled trials examining the effects of melatonin for the treatment of primary sleep disorders. Primary outcomes examined were improvement in sleep latency, sleep quality and total sleep time. Meta-regression was performed to examine the influence of dose and duration of melatonin on reported efficacy.</p><p>Participants</p><p>Adults and children diagnosed with primary sleep disorders.</p><p>Interventions</p><p>Melatonin compared to placebo.</p><p>Results</p><p>Nineteen studies involving 1683 subjects were included in this meta-analysis. Melatonin demonstrated significant efficacy in reducing sleep latency (weighted mean difference (WMD) = 7.06 minutes [95% CI 4.37 to 9.75], Z = 5.15, p<0.001) and increasing total sleep time (WMD = 8.25 minutes [95% CI 1.74 to 14.75], Z = 2.48, p = 0.013). Trials with longer duration and using higher doses of melatonin demonstrated greater effects on decreasing sleep latency and increasing total sleep time. Overall sleep quality was significantly improved in subjects taking melatonin (standardized mean difference = 0.22 [95% CI: 0.12 to 0.32], Z = 4.52, p<0.001) compared to placebo. No significant effects of trial duration and melatonin dose were observed on sleep quality.</p><p>Conclusion</p><p>This meta-analysis demonstrates that melatonin decreases sleep onset latency, increases total sleep time and improves overall sleep quality. The effects of melatonin on sleep are modest but do not appear to dissipate with continued melatonin use. Although the absolute benefit of melatonin compared to placebo is smaller than other pharmacological treatments for insomnia, melatonin may have a role in the treatment of insomnia given its relatively benign side-effect profile compared to these agents.</p></div

Effect of Melatonin on Sleep quality.

<p>Forest plot depicts sleep quality with melatonin compared to placebo. Meta-analysis demonstrated a significant benefit of melatonin in improving sleep quality. SMD = standardized mean difference; CI = confidence interval.</p

Efficacy of Melatonin in Increasing Total sleep Time.

<p>Forest plot depicting change in total sleep time with melatonin compared to placebo treatment. Meta-analysis demonstrated a significant benefit of melatonin in increasing total sleep time. WMD = weighted mean difference; CI = confidence interval.</p