Stability of calcium fluoride deposits on enamel after cariogenic challenge

Orientadores: Lívia Maria Andaló Tenuta, Jaime Aparecido CuryDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Depósitos minerais do tipo fluoreto de cálcio ("CaF2") são formados no esmalte após aplicação tópica profissional de flúor (ATPF). Esses depósitos atuam como um reservatório de íons flúor para o fluido do biofilme, os quais reduzem a desmineralização no esmalte. Neste trabalho, a hipótese de que o "CaF2" seja dissolvido mais rapidamente mediante desafios cariogênicos foi testada, assim como a influência do uso de dentifrício fluoretado nessa dissolução. Para isso, foi conduzido um estudo in situ, cruzado e duplo-cego com duas fases de 14 dias cada, nas quais 12 voluntários utilizaram um dispositivo intrabucal palatino contendo 12 blocos de esmalte tratados com flúor fosfato gel acidulado (12.300 ppm F, pH 3,6-3,9) no primeiro dia de cada fase experimental. Adicionalmente, dois blocos foram fixados com cera na porção anterior do dispositivo e 30 minutos após a ATPF foram retirados para a determinação do "CaF2" formado logo após o tratamento com fluoreto. Durante o período experimental, foi gotejada solução de sacarose a 20% sobre os blocos de esmalte nas freqüências de 2 ou 8X ao dia. Três vezes ao dia, os voluntários utilizaram dentifrício fluoretado (1100 µg F/g, NaF) ou não fluoretado. Após 2, 7 e 14 dias de uso do dispositivo, os blocos de esmalte foram coletados para a determinação do "CaF2" remanescente. A extração do "CaF2" foi feita com solução de KOH M, em duas extrações seqüenciais por 24 e 6 horas. Para análise estatística, os voluntários foram considerados blocos estatísticos (n=12) e o nível de significância adotado foi de 5%. A concentração do "CaF2" formado sobre os blocos de esmalte após a ATPF diminuiu em função do tempo (p<0,0001), embora 2 semanas após a ATPF continuasse mais alta do que blocos de esmalte não tratados com ATPF. Sob uso de dentifrício fluoretado, a dissolução do "CaF2" foi reduzida (p=0,0115), porém a freqüência de consumo de sacarose não parece ter interferido nessa dissolução (p=0,226). Os resultados sugerem que a dissolução do "CaF2" parece não ter sido influenciada pela freqüência de consumo de sacarose e que sua manutenção é favorecida pelo uso concomitante de dentifrício fluoretado.Abstract: Calcium fluoride-like ("CaF2") deposits are formed on enamel after professional topical fluoride application, and they can serve as a reservoir of fluoride ions to the biofilm fluid, to reduce enamel demineralization. In the present study, the hypothesis that "CaF2" is more readily dissolved during a higher cariogenic challenge was tested. Also, the effect of exposure to fluoride dentifrices on "CaF2" dissolution was evaluated. Thus, a crossover, double-blind and in situ study was conducted in 2 phases of 14 days each. In each phase, 12 volunteers used intraoral palatal appliances containing 12 enamel blocks treated with acidulated phosphate fluoride, APF (12,300 ppm F, pH 3,6-3,9) on the first day of each phase. Additionally, two blocks were fixed with wax on the palatal appliance and removed 30 minutes after treatment with APF to determine the concentration of "CaF2" formed. During the experimental period, the enamel blocks were exposed to 20% sucrose solution 2X or 8X/day. Three times a day, the volunteers used fluoride dentifrice (1100 µg F/g, NaF) or non-fluoride dentifrice. On the 2th, 7th e 14th day of each phase, enamel blocks were collected and the remaining "CaF2" concentration was determined. For "CaF2" determination, blocks were immersed in 1.0 M KOH, for 24 and 6 h. Data was statistically analyzed considering the volunteers as statistical blocks (n=12) and the significance limit was set at 5%. "CaF2" concentration decrease with time (p<0.0001), but was still higher than enamel blocks not treated with APF 2 weeks after APF application. Under fluoride dentifrice use, "CaF2" dissolution was reduced (p=0.0115), but the frequency of sucrose exposure did not seem to have affected it (p=0.226). The findings suggest that the frequencies of sucrose exposure did not influence the "CaF2" dissolution; and that its maintenance is facilitated by the concurrent use of fluoride dentifrice.MestradoCariologiaMestre em Odontologi

PROTOCOLO DE ATENDIMENTO DO PACIENTE COM ESTOMATITE PROTÉTICA NA ATENÇÃO BÁSICA / PRIMARY CARE FOR PATIENTS WITH DENTURE STOMATITIS

Introdução: No Brasil, o número de usuários de próteses dentárias é bastante elevado, principalmente entre os idosos. Considerando-se a alta prevalência da estomatite protética nos portadores de próteses removíveis e a alta taxa de mortalidade e morbidade dos pacientes em condição de enfermidade e/ou imunossupressão que apresentam estomatite protética, é importante que o cirurgião-dentista da atenção básica esteja capacitado para diagnosticar, prevenir e tratar essa patologia. Entretanto, as ações desenvolvidas pelo Programa de Saúda da Família (PSF) estão voltadas apenas ao controle da cárie e doença periodontal, ou seja, ao paciente dentado. Em se tratando de um paciente desdentado, este é logo encaminhado a um Centro de Especialidade Odontológica (CEO) para que possa ser atendido por um especialista em prótese, enquanto que, esse encaminhamento só deveria ser realizado após o tratamento da estomatite protética e nos casos em que há necessidade de substituição ou reparo da prótese removível. Objetivo: Diante do exposto, o presente estudo teve como objetivo capacitar o profissional do PSF para o atendimento do paciente com estomatite protética. Conclusão: Considerando-se que a população assistida pelo PSF é de baixa renda, a partir de uma revisão de literatura foi possível estabelecer um protocolo de atendimento que prioriza métodos simples e mais baratos de diagnóstico, prevenção e tratamento da estomatite protética pela atenção básica, mas que têm sua eficácia comprovada por meio de estudos científicos.Palavras-chaves: Saúde da Família. Prótese Total. Estomatite sob Prótese.AbstractIntroduction: In Brazil, the number of dental prosthesis users is very high, mainly among the elderly. Considering the high prevalence of denture stomatitis in patients with removable dentures as well as the high mortality and morbidity rate of ill and/or immunocompromised patients, the Family Health Program (FHP) dentists should be able to diagnose, treat and prevent accurately this disease. However, the actions undertaken by these dentists are directed only to patients presenting periodontal disease or to control dental caries, it means, to dentate patient. Edentulous patients presenting oral disease are sent to the Specialized Dental Clinics (SDC) to be treated by the prosthodontist. Thus, denture stomatitis patients should be sent to these clinics only after they treated the denture stomatitis and in the cases when it is necessary to repair or replace the removable denture. Objective: To enable FHP dentists to treat patients with denture stomatitis. Conclusion: Considering that the population assisted by the FHP falls into a low-income category, this literature review developed an attendance protocol for the patients with denture stomatitis to be adopted by the FHP dentist that prioritizes simple and inexpensive methods of diagnosis, prevention, treatment, and which its effectiveness was tested by scientific studies.Keywords: Family Health Program. Complete Denture. Denture Stomatitis

Effect of chlorhexidine gel containing saccharin or aspartame in deaf children highly infected with mutans streptococci

Aim: Since deaf children are unable to comprehend or cooperate with dental treatment due to lack of communication, preventive measures may be an important way to control the high prevalence of dental caries in these patients. The aim of the this study was to evaluate the effect of an intensive treatment with chlorhexidine (CHX) gel, containing either saccharin or aspartame, in deaf children highly infected with mutans streptococci (MS). Methods: Eighteen children were randomly divided into two groups, according to the sweetener used to improve the CHX gel bitter taste: saccharin or aspartame. Before CHX treatment, saliva samples were collected to establish baseline microbial data for MS. CHX gel was applied on two consecutive days, four times the first day and three times the second day. Saliva samples were then taken after 7, 30, 60, 90 and 120 days to evaluate MS oral recolonization. Results: CHX gel containing saccharin was not effective on the reduction of MS levels, while the gel containing aspartame decreased significantly MS levels after treatment (P<.05). Conclusions: Although a new CHX application may be necessary after 60 days to control caries risk and MS levels, CHX treatment should be individually controlled because of variations in the response of subjects

Effect of chlorhexidine gel containing saccharin or aspartame in deaf children highly infected with mutans streptococci

nce deaf children are unable to comprehend or cooperate with dental treatment due to lack of communication, preventive measures may be an important way to control the high prevalence of dental caries in these patients. The aim of the this study was to evaluate the effect of an intensive treatment with chlorhexidine (CHX) gel, containing either saccharin or aspartame, in deaf children highly infected with mutans streptococci (MS). Methods: Eighteen children were randomly divided into two groups, according to the sweetener used to improve the CHX gel bitter taste: saccharin or aspartame. Before CHX treatment, saliva samples were collected to establish baseline microbial data for MS. CHX gel was applied on two consecutive days, four times the first day and three times the second day. Saliva samples were then taken after 7, 30, 60, 90 and 120 days to evaluate MS oral recolonization. Results: CHX gel containing saccharin was not effective on the reduction of MS levels, while the gel containing aspartame decreased significantly MS levels after treatment (P<.05). Conclusions: Although a new CHX application may be necessary after 60 days to control caries risk and MS levels, CHX treatment should be individually controlled because of variations in the response of subjects

Avaliação dos indicadores de saúde bucal no Brasil: tendência evolutiva pró-equidade?

Resumo Foi testada a hipótese de que os indicadores de saúde bucal, obtidos do Pacto da Atenção Básica de 2006, Pacto pela Saúde do biênio 2010/2011 e indicadores de transição entre o Pacto pela Saúde e Contrato Organizativo da Ação Pública em Saúde de 2012, não diferiam entre as Unidades Federativas (UF) brasileiras com diferentes Índices de Desenvolvimento Humano (IDH). Para isso, foi realizado um estudo longitudinal ecológico comparando as UF do Brasil com extremos de IDH. Os dados foram obtidos dos sistemas de informação do SUS e do Programa das Nações Unidas para o Desenvolvimento, e submetidos à análise de regressão linear de efeitos mistos (alfa = 5%). Todos os indicadores de oportunidade de acesso foram associados negativamente com o IDH. Para os de utilização, a associação ocorreu para apenas dois indicadores. Os resultados evidenciaram uma tendência evolutiva pró-equidade para indicadores de oportunidade de acesso em relação à saúde bucal

Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort

This study aimed to assess the dimensional structure, reliability, convergent validity, discriminant validity, and scalability of the Perceived Stress Scale (PSS). The sample consisted of 1,447 pregnant women in São Luís (Maranhão State) and 1,400 in Ribeirão Preto (São Paulo State), Brazil. The 14 and 10-item versions of the scale were assessed using confirmatory factor analysis, using weighted least squares means and variance (WLSMV). In both cities, the two-factor models (positive factors, measuring resilience to stressful situations, and negative factors, measuring stressful situations) showed better fit than the single-factor models. The two-factor models for the complete (PSS14) and reduced scale (PSS10) showed good internal consistency (Cronbach’s alpha ≥ 0.70). All the factor loadings were ≥ 0.50, except for items 8 and 12 of the negative dimension and item 13 of the positive dimension. The correlations between both dimensions of stress and psychological violence showed the expected magnitude (0.46-0.59), providing evidence of an adequate convergent construct validity. The correlations between the scales’ positive and negative dimensions were around 0.74-0.78, less than 0.85, which suggests adequate discriminant validity. Extracted mean variance and scalability were slightly higher for PSS10 than for PSS14. The results were consistent in both cities. In conclusion, the single-factor solution is not recommended for assessing stress in pregnant women. The reduced, 10-item two-factor scale appears to be more appropriate for measuring perceived stress in pregnant women