Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome

The standardization of in situ protocols for dental erosion is important to enable comparison between studies. Objective: Thus, the objectives of this study were to evaluate the influence of the location of in situ intraoral appliance (mandibular X palatal) on the extent of enamel loss induced by erosive challenges and to evaluate the comfort of the appliances. Material and Methods: One hundred and sixty bovine enamel blocks were selected according to their initial surface hardness and randomly divided into two groups: GI - palatal appliance and GII - mandibular appliance. Twenty volunteers wore simultaneously one palatal appliance (containing 4 enamel blocks) and two mandibular appliances (each one containing 2 enamel blocks). Four times per day during 5 days, the volunteers immersed their appliances in 0.01 M hydrochloric acid for 2 minutes, washed and reinserted them into the oral cavity for 2 hours until the next erosive challenge. After the end of the in situ phase, the volunteers answered a questionnaire regarding the comfort of the appliances. The loss of tissue in the enamel blocks was determined profilometrically. Data were statistically analyzed by paired t-test, Chi-square and Fisher's Exact Test (p<0.05). Results: The enamel blocks allocated in palatal appliances (GI) presented significantly higher erosive wear when compared to the blocks fixed in mandibular appliances (GII). The volunteers reported more comfort when using the palatal appliance. Conclusions: Therefore, the palatal appliance is more comfortable and resulted in higher enamel loss compared to the mandibular one

Eroded enamel rehardening using two intraoral appliances designs in different times of salivary exposure

The aim of this study was evaluated the eroded enamel rehardening potential using upper palatal and lower buccal removable appliances in different times of salivary exposure (30 min, 1h, 2h, 12h) after a single erosive challenge event. After initial surface hardness evaluation, bovine enamel blocks were eroded in vitro (0.01 M hydrochloric acid, pH 2.3, 30 seconds), selected (n = 160) and randomly assigned to the two appliance designs and twenty volunteers. Four enamel blocks were inserted in each removable appliance. On the in situ phase, the volunteers were instructed to use the upper palatal and lower buccal appliances simultaneously for 12 nonconsecutive hours. After each predetermined period of time of salivary exposure, the enamel blocks were removed from the appliances for immediate evaluation of surface hardness, enabling percentage of surface hardness recovery calculation (%SHR). The data were analyzed using two-way ANOVA and Tukey?s test (?=5%). The results showed no difference in the degree of enamel rehardening by the upper palatal or lower buccal appliances (p >0.0001). Regarding the time of use of the appliances, it was demonstrated that 30 minutes (upper = 21.12%, lower = 19.84%) and 1 hour (upper = 35.69%, lower = 30.50%) promoted lower hardness recovery than two hours (upper = 44.65%, lower 40.80%) of salivary exposure (p<0.0001). The use of 12 hours (upper = 49.33%, lower = 49.00%), including the sleeping time of the volunteers did not increase the %SHR. The location of the appliance does not influence the re-hardening ability of saliva and the use of intraoral appliances for 2 hours seems to be appropriate for partial rehardening of the softened enamel surface

Psoríase: revisão bibliográfica / Psoriasis: a literature review

RESUMO: Dermatoses como a psoríase, de maneira geral apresentam grande impacto na qualidade de vida e tal fato passou a ser questionado e estudado com maior profundidade há aproximadamente 10 anos, pelo interesse no desenvolvimento de instrumentos capazes de avaliar a qualidade de vida na dermatologia. MÉTODOS: A revisão sistemática foi arquitetada inicialmente com uma pesquisa no Mesh e Decs para encontrar os descritores desejados: Psoríase, Dlqi, Dermatite psoriática e Dermatoses crônicas. Posteriormente, esses descritores foram pesquisados, em 2021 nas bases de dados Medline, Lilacs, Scielo e UpToDate, nos últimos 05 anos. RESULTADOS: Essa busca resultou em 14 artigos para elaboração dessa revisão. CONCLUSÃO: O Dermatology Life Quality Index (DLQI), é o instrumento mais utilizado para medir a qualidade de vida nos grandes estudos clínicos sobre psoríase, apresentando 10 questões relacionadas às experiências vivenciadas pelos pacientes. Mesmo diante de grandes avanços acerca da compreensão da Psoríase, inúmeras questões ainda necessitam de reflexões, ressaltando-se o questionamento quanto ao papel do componente emocional como causa ou consequência da doença e sua gravidade

Molar Incisor Hypomineralization (MIH): relevant outcomes in epidemiological survey and parents preferences regarding treatment

O artigo 1 avaliou a associação entre a Hipomineralização Molar Incisivo (HMI) e a Hipomineralização de Molares Decíduos (HMD) em 680 escolares. Os dados foram analisados através de análise descritiva e modelo de regressão logística (MRL). Dentre as crianças avaliadas, 4,3% apresentaram HMD e HMI. O MRL mostrou que o sexo e a HMD impactaram na ocorrência de HMI. Crianças com HMD tiveram 2,9 vezes mais chances de ter HMI do que aquelas sem HMD. O artigo 2 comparou diferentes índices de diagnóstico de HMI o índice HMI simplificado/MIH_s e estendido/MIH_e e o MIH-Severity Scoring System/MIH-SSS, em 680 escolares. A prevalência de HMI foi de 24,7% e a característica clínica mais comum foi a opacidade demarcada (81,7%-MIH_s e 85,45%-MIH-SSS). Observou-se uma associação positiva entre os índices (teste qui-quadrado). O MIH-SSS demonstrou um tempo médio de aplicação menor comparado ao MIH_s e MIH_e (ANOVA/Tukey). Todos os índices diagnosticaram efetivamente HMI e suas características. O artigo 3 avaliou se a ocorrência de fratura pós-eruptiva, restauração atípica e cárie atípica é influenciada pela cor da opacidade em dentes com HMI. Os dados foram analisados através de análise descritiva e teste qui-quadrado. A ocorrência da opacidade demarcada amarelo-marrom foi 63,29% e observou-se que sua presença influenciou na ocorrência de fratura pós-eruptiva, restauração atípica e cárie atípica. O artigo 4 avaliou se o número de dentes afetados pela HMI, gravidade da HMI, experiência anterior de cárie, índice de placa visível (IPV), índice de sangramento gengival (ISG), idade e sexo impactam no desenvolvimento de lesão de cárie em primeiros molares permanentes. Escolares (n=476) foram avaliados para o diagnóstico de HMI, cárie, IPV e ISG. Regressão binomial negativa inflacionada de zeros foi utilizada para avaliar o impacto das variáveis no desenvolvimento de cárie considerando ou não a restauração em molares com HMI. Na presença de restauração, a idade, a gravidade da HMI e a experiência anterior de cárie impactaram significativamente no desenvolvimento de lesão de cárie (R2=0,176). Sem considerar as restaurações atípicas nos molares afetados pela HMI, apenas a idade e a experiência anterior de cárie foram estatisticamente significantes (R2=0,167). A HMI não influenciou na presença de lesões de cárie nos molares com HMI. O artigo 5 avaliou o conhecimento e preferência dos pais em relação a diferentes tratamentos para HMI. Os pais (n=50) responderam um questionário de conhecimento sobre HMI antes e depois da exibição de um vídeo explicativo, seguido de um questionário com diferentes situações clínicas e opções de tratamento. Os dados foram analisados através de análise descritiva e teste de Wilcoxon. Foi observado o aumento do nível de conhecimento e confiança após a exibição do vídeo. Para molares, as escolhas dos pais foram diferentes nos cenários com presença de dor em comparação com os cenários sem relato de dor. Para incisivos, notou-se que os pais optaram por uma abordagem mais invasiva na presença de dor e queixa estética.Article 1 evaluated the association between Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molars (HSPM) in 680 schoolchildren. Data were analyzed using descriptive analysis and logistic regression model (LRM). Among the evaluated children, 4.3% had HSPM and MIH. The LRM showed that sex and HSPM impacted the occurrence of MIH. Children with HSPM were 2.9 times more likely to have MIH than those without HSPM. Article 2 compared different MIH diagnostic indices the simplified/MIH_s and extended/MIH_e MIH index and the MIHSeverity Scoring System/MIH-SSS in 680 schoolchildren. The prevalence of MIH was 24.7% and the most common clinical feature was demarcated opacity (81.7%-MIH_s and 85.45%-MIH-SSS). A positive association was observed between the indices (chisquare test). MIH-SSS demonstrated a shorter average application time compared to MIH_s and MIH_e (ANOVA/Tukey). All indexes effectively diagnosed MIH and its characteristics. Article 3 evaluated whether the occurrence of post-eruptive breakdown (PEB), atypical restoration and atypical caries is influenced by the opacity color of the MIH-affected tooth. Data were analyzed using descriptive analysis and chi-square test. The occurrence of yellow-brown demarcated opacity was 63.29% and its presence influenced the occurrence of PEB, atypical restoration and atypical caries. Article 4 assessed whether the number of teeth affected by MIH, severity of MIH, previous caries experience, visible plaque index (VPI), gingival bleeding index (ISG), age and sex impact the development of caries in first permanent molars. Schoolchildren (n=476) were evaluated for the diagnosis of MIH, caries lesions, VPI and ISG. Zeroinflated negative binomial regression was used to evaluate the impact of variables on the development of caries lesions, considering or not the atypical restoration of molars with MIH. In the presence of restoration, age, severity of MIH and previous caries experience significantly impacted the development of caries lesions (R2=0.176). Without atypical restoration in molars affected by MIH, only age and previous caries experience were statistically significant (R2=0.167). MIH did not influence the presence of caries lesions in molars with MIH. Article 5 assessed parents\' knowledge and preferences regarding different treatments for MIH. Parents (n=50) answered a knowledge questionnaire about MIH before and after viewing an explanatory video, followed by a questionnaire with different clinical situations and treatment options. Data were analyzed using descriptive analysis and the Wilcoxon test. An increase in the level of knowledge and confidence was observed after watching the video. For molars, parental choices were different in scenarios with the presence of pain compared to scenarios without pain. For incisors, it was noted that parents opted for a more invasive approach in the presence of pain and aesthetic complaints

Enamel erosive Remineralization and demineralization considering different times of salivary action and intraoral appliances: In situ study

O potencial protetor da saliva tem sido descrito como um importante fator que influencia na patogênese da erosão dentária. O objetivo desse trabalho foi avaliar o efeito remineralizador in situ da saliva sobre lesões iniciais de erosão e a sua capacidade protetora em relação à desmineralização erosiva do esmalte, através da utilização de dispositivos intrabucais palatino e mandibular em diferentes tempos de avaliação (30 min, 1h, 2h e 12h). Este estudo foi dividido em dois subprojetos, cada um com número amostral de 20 voluntários. No subprojeto I, após a avaliação da dureza de superfície inicial, os blocos de esmalte foram desmineralizados in vitro (ácido clorídrico 0,01 M por 30 segundos), selecionados e divididos aleatoriamente entre os 2 dispositivos, sendo utilizado quatro blocos por dispositivo palatino e dois blocos por dispositivo mandibular (2 dispositivos por voluntário/direito e esquerdo). Durante a etapa in situ, os voluntários foram orientados a utilizar os dispositivos durante o período máximo de 12 horas, de modo que após cada período de tempo pré-determinado, os dispositivos foram removidos da cavidade bucal para retirada dos blocos de esmalte e avaliação imediata da dureza superficial pós remineralização. No Subprojeto II, blocos de esmalte foram selecionados pela dureza de superfície inicial e distribuídos aleatoriamente entre os voluntários de acordo com o fator tempo e tipo de dispositivo intrabucal. Além destes, foi utilizado um grupo controle com blocos não submetidos à ação salivar. Na etapa in situ, para cada tempo em avaliação, os voluntários utilizaram os dispositivos com dois blocos de esmalte em cada dispositivo palatino (1 dispositivo por voluntário) e um bloco em cada mandibular (2 dispositivos por voluntário/direito e esquerdo). Imediatamente após cada fase da etapa in situ, os blocos (grupos experimentais e controle) sofreram desmineralização erosiva através da imersão em ácido clorídrico durante 30 segundos e, em seguida, a dureza superficial foi avaliada. Os dados foram analisados utilizando ANOVA 2 critérios e teste Tukey subprojeto I e Kruskal-Wallis e teste Tukey subprojeto II, considerando p<0,05. No subprojeto I, houve diferença estatisticamente significativa (p <0.0001) entre os tempos de 30 minutos e 2 horas, o qual não mostrou diferença em relação ao tempo de 12 horas. Não houve diferença na recuperação de dureza dos espécimes mantidos na maxila em relação aos espécimes mantidos na mandíbula. No subprojeto II, não se observou diferença entre os tipos de dispositivos. Porém, quando os tempos foram comparados entre si, foi observada diferença estatisticamente significativa entre os tempos de 30 minutos e 2 horas, o qual não mostrou diferença quando comparado com o período de 12 horas. Diferença estatisticamente significativa foi encontrada quando os tempos de 2 horas e 12 horas foram comparados com o grupo controle, tanto para utilização do dispositivo palatino quando mandibular. Portanto, independente do tipo de dispositivo utilizado, o tempo de 2 horas de exposição salivar apresentou potencial remineralizador, bem como promoveu algum nível de proteção em relação à desmineralização erosiva do esmalte, sendo que um aumento da exposição do esmalte à saliva (12 horas) não aumentou estes efeitos.The protective potential of saliva has been described as an important factor that influences the pathogenesis of dental erosion. The aim of this study was to evaluate in situ the remineralizing effect of saliva on initial erosion lesions and the protective effect of saliva in relation to erosive enamel desmineralization, using palatal and mandibular appliances in different times of salivary exposure (30 min, 1h, 2h e 12h). This study consisted of two subprojects, each one with a sample size of 20 volunteers. In subproject I, after initial surface hardness evaluation, enamel blocks were demineralized in vitro (hydrochloric acid 0.01 M for 30 seconds), selected and randomly assigned between two types of appliances. Four blocks were placed on the palatal device and two blocks for the mandibular appliance (2 aplliances per volunteer / right and left). In the in situ phase, the volunteers were instructed to use the palatal and mandibular appliances for 12 hours, so that after every predetermined period of time, the enamel blocks were removed from the appliances for immediate evaluation of surface hardness (remineralization surface hardness). In subproject II, enamel blocks were selected using initial surface hardness and randomized among the volunteers according to factors time (30 min, 1h, 2h, and 12h) and types of intrabucal aplliance (palatal and mandibular). A control group with enamel blocks not subjected to salivary effect was also used. In in situ phase, the volunteers used intrabucal appliances with two enamel blocks in the palatal appliance (1 appliance per volunteer) and one block in each mandibular appliance (2 aplliances per volunteer / right and left). Imeddiatelly after use in each phase, the enamel blocks were desmineralized and the surface hardness was assessed. The data were analyzed using two-way ANOVA and Tukey test subproject I; Kruskal-Wallis and Tukey test subproject II, considering p<0.05. In subproject I, was observed a significant difference (p <0.0001) between 30 minutes and 2 hours, which showed no difference comparing to 12 hours. There was no significant difference in hardness recovery between specimens kept in the maxilla and mandibula. In subproject II, no significant difference was seen between the types of intraoral appliances. However, when times were compared, there was no difference between 30 minutes and 2 hours, which showed no difference compared to the 12 hours. Significant difference was found when the periods of 2 hours and 12 hours were compared with the control group (without exposure to saliva), for both, palatal and mandibular aplliances. Therefore, regardless of the type of appliance, 2 hours of salivary exposure showed remineralizing potential, as well as promoted some level of protection in relation to erosive enamel demineralization, and increased enamel exposure to saliva (12 hours) did not increase these effects

Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome

Abstract The standardization of in situ protocols for dental erosion is important to enable comparison between studies. Objective: Thus, the objectives of this study were to evaluate the influence of the location of in situ intraoral appliance (mandibular X palatal) on the extent of enamel loss induced by erosive challenges and to evaluate the comfort of the appliances. Material and Methods: One hundred and sixty bovine enamel blocks were selected according to their initial surface hardness and randomly divided into two groups: GI - palatal appliance and GII - mandibular appliance. Twenty volunteers wore simultaneously one palatal appliance (containing 4 enamel blocks) and two mandibular appliances (each one containing 2 enamel blocks). Four times per day during 5 days, the volunteers immersed their appliances in 0.01 M hydrochloric acid for 2 minutes, washed and reinserted them into the oral cavity for 2 hours until the next erosive challenge. After the end of the in situ phase, the volunteers answered a questionnaire regarding the comfort of the appliances. The loss of tissue in the enamel blocks was determined profilometrically. Data were statistically analyzed by paired t-test, Chi-square and Fisher's Exact Test (p<0.05). Results: The enamel blocks allocated in palatal appliances (GI) presented significantly higher erosive wear when compared to the blocks fixed in mandibular appliances (GII). The volunteers reported more comfort when using the palatal appliance. Conclusions: Therefore, the palatal appliance is more comfortable and resulted in higher enamel loss compared to the mandibular one

Vitamin E: A potential preventive approach against dental erosion-an in vitro short-term erosive study.

OBJECTIVES This study evaluated the in vitro effect of different components of palm oil on enamel in a short-term erosive challenge. METHODS The acquired enamel pellicle (AEP) was previously formed in situ for 2 h. Subsequently, the bovine enamel blocks were treated in vitro according to following solutions: G1-palm oil; G2-85% tocotrienol solution; G3-oily vitamin E; G4-oily vitamin A; G5-deionized water (negative control); G6-stannous-containing solution (Elmex® Erosion Protection Dental Rinse) (positive control). After application of the treatment solutions (500 µl, 30 s), the blocks were immersed in 0.5% citric acid (pH 2.4) during 30 s (initial erosion). The response variable was the percentage of surface hardness loss. Data were analyzed by one-way ANOVA and Fisher's Test (p < 0.05). RESULTS The positive control (G6), palm oil (G1) and oily vitamin E (G3) groups presented the lowest percentage of surface hardness loss, and were statistically different from the negative group (G5) (p < 0.05), and no differences were found between these three groups. The 85% tocotrienol solution (G2) and oily vitamin A groups (G4) were not different to the negative control group. CONCLUSIONS Stannous-containing positive control (Elmex® Erosion Protection), palm oil and oily Vitamin E were able to protect enamel against the erosive challenge performed in this in vitro study. In addition, vitamin E is probably the key ingredient of palm oil responsible for preventing enamel erosion. CLINICAL SIGNIFICANCE Vitamin E presented similar preventive effect to a commercial mouthwash stannous-containing solution (Elmex® Erosion Protection) against initial erosion and, it can be considered as a promising natural alternative for the formulations of solutions aiming to prevent erosive tooth wear

Effect of different salivary exposure times on the rehardening of acid-softened enamel

Abstract This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers’ sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey’s test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion