Profile of the dentists members of the Family Health Program in a City South of Brazil

The objective of this study was to assess the profile of the dentists members of the Family Health Program in a city south of Brazil. To conduct the study using a quantitative and qualitative methodological approach, by applying a questionnaire to dentists members of the Family Health Program in the city of Santa Maria-RS, in the month of August 2008. The questionnaire contained closed, open and semi-open questions. The data were analyzed by descriptive statistics and percentages. Most interviewed are female and age is between 28 and 45 years. The period of formation of dentists ranged between 3 and 24 years. Eighty percent of professionals have already developed activities in PSFs from other cities for a period ranging from 1 to 3 years. The dentists joined the PSF with temporary contract, play a day of work 40 hours weekly and receive 8 to 10 minimum wages monthly. All interviewees are specialists in Public Health, working in teams and are satisfied with the work done in the PSF. Believe that academic training did not provide the necessary basis to act in the Family Health Program. Preventive activities / education and clinics are performed by the interviewees. The evaluation of the profile of the dentists members of the Family Health Program is important for developing strategies to improve the skills of professionals and ensure the implementation of integrated policies for oral health to the Family Health Program

Bonding of universal adhesive system to enamel surrounding real-life carious cavities

This study aimed to evaluate the bond strength of a universal adhesive system to enamel surrounding real-life carious cavities. Twentyeight permanent molars (n = 7) with carious lesions in dentin were subjected to selective carious tissue removal to firm dentin and had their crowns sectioned longitudinally. A universal adhesive system (Single Bond Universal [SBU] used in either etch-and-rinse and self-etch strategies) was compared with an etch-and-rinse Adper Single Bond 2 (ASB) and a selfetch Clearfil SE Bond (CSE) adhesive systems (control systems). Adhesives were applied on the enamel, assumed demineralized, surrounding the cavity margins and on sound enamel (control substrate). Composite cylinders were built (0.72 mm2) and microshear bond strength (μSBS) test was performed after 24 h of water storage. The μSBS values (MPa) were analyzed using two-way ANOVA and Tukey’s post hoc tests (α = 0.05). Bond strength values obtained in demineralized enamel surrounding carious cavity margins were significantly lower than that obtained in sound enamel (distant from carious cavity margins) (p = 0.035). The bonding strategy of the SBU did not influenced the bond strength values, which were higher than that obtained with ASB. CSE showed similar μSBS values to ASB and SBU in the self-etch mode. In conclusion, the bond strength to enamel assumed demineralized is lower than to sound enamel. The enamel surrounding carious cavities jeopardize the bonding of universal adhesive system. The bond strength of universal adhesive is similar, regardless to bonding strategy

Graduate and Undergraduate Teaching of Primary Tooth Pulpectomy : A Comparison among Brazilian Dental Schools

Objective: To compare the teaching of the pulpectomy in primary teeth among graduate and undergraduate Brazilian dental schools. Material and Methods: From August 2015 to July 2016, an 11-question survey was sent to 44 graduate and 207 undergraduate dental schools. Data obtained were summarized using descriptive statistics. Results: The response rate was higher from graduate (56.8%) than undergraduate (41.1%) courses. Pulpectomy was taught by all participating schools. More than 90% of the undergraduate and graduate courses recommend the use of hand instruments for canals debridement, but the widening of root canals was advised in 69.4% of undergraduate and in 84% of graduate schools. Regarding the irrigatings, 1% sodium hypochlorite as a single irrigating solution was the most taught for both biopulpectomy and necropulpectomy. The iodoform-based Guedes-Pinto paste as the single indication was the preferred root canal filling material in undergraduate schools (30.6%), while the zinc oxidethickened calcium hydroxide paste as the single option was the most recommended in graduate courses (36%). Endodontic hand file associated with lentulo drill for filling root canals was recommended by most courses. Overall, biopulpectomy was performed in one session, while necropulpectomy led two sessions. Periapical radiograph for diagnosis and final obturation was the most adopted conduct by undergraduate (68.2%) and graduate (72%) schools. Gutta-percha and glass ionomer cement were preferred materials to seal the entrance of the pulp chamber. Conclusion: There was variability in the techniques and materials taught to perform pulpectomy in primary teeth among Brazilian graduate and undergraduate dental schools. Calcium hydroxide paste has been used in similar proportion to iodoform-based paste

Effect of inspiratory muscle training on patients undergoing bariatric surgery: a systematic review

Investigaciones comprobaron que, entre las varias técnicas relacionadas a la fisioterapia respiratoria, el entrenamiento muscular inspiratorio (TMI) es fundamental para la recuperación de la función pulmonar y en la prevención de complicaciones respiratorias. Pero poco se sabe sobre los resultados del TMI en pacientes sometidos a la cirugía bariátrica. El propósito de este estudio es revisar sistemáticamente los estudios clínicos aleatorios que evaluaron los resultados del TMI comparado al TMI sham, fisioterapia convencional (ejercicios respiratorios y deambulación precoz) o ninguna intervención en la función pulmonar en pacientes sometidos a la cirugía bariátrica. Se buscó textos en las bases de datos PubMed / MEDLINE, Cochrane, TRIP, PEDro y Scopus, sin restricción de fecha de publicación ni de idioma según recomienda la PRISMA. Dos revisores eligieron los estudios, recolectaron datos y evaluaron el riesgo de sesgo de forma independiente. De los 2.184 estudios probablemente elegidos, se excluyeron dos. Se adaptó el criterio de riesgo de sesgo y lo dividió en nueve áreas empleando el Manual de Cochrane. En esta revisión participaron 62 personas, siendo 30 de ellas elegidas para recibir el dispositivo Threshold® TMI, pero en momentos distintos, en el preoperatorio y el posoperatorio. A pesar de que el TMI aumentó la presión inspiratoria máxima (PIM) en relación a la fisioterapia convencional, en la presión espiratoria máxima (PEM) no se encontraron diferencias significativas. Los estudios presentaron bajo e incierto riesgo de sesgo. El TMI puede ser el tratamiento más eficaz en comparación con la fisioterapia convencional aislada tanto en el preoperatorio como en el posoperatorio. Pero no se encontraron evidencias concretas en la toma de decisiones clínicas.Studies have shown that among the various techniques that involve chest physical therapy, the inspiratory muscle training (IMT) is essential in the recovery of lung function and in preventing respiratory complications. However, the effect of IMT on patients undergoing bariatric surgery is still inconclusive. The aim of this study was to systematically review randomized and controlled trials that assessed the effect of IMT compared with sham IMT, standard physical therapy (breathing exercises and early ambulation) or no intervention in the lung function on patients undergoing bariatric surgery. The search was conducted in PubMed/MEDLINE, Cochrane, TRIP, PEDro and Scopus databases with no publication year or language limits, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. From 2,184 potentially eligible studies, two studies were included. Bias risk criteria were adapted and divided into nine main areas using the Cochrane Handbook. This review included 62 participants, being 30 allocated to receive Threshold® IMT device, but in different periods: preoperative and postoperative. IMT promoted increased maximal inspiratory pressure (MIP) in relation to standard physical therapy, but no significant differences were found in maximal expiratory pressure (MEP). The studies showed low and unclear bias risk. IMT seems to be the most effective treatment in comparison with standard physical therapy alone in pre- or postoperative period. However, there is no solid evidence for clinical decision-making.Estudos têm demonstrado que, dentre as diversas técnicas que envolvem a fisioterapia respiratória, o treinamento muscular inspiratório (TMI) é essencial na recuperação da função pulmonar e na prevenção de complicações respiratórias. Porém, o efeito do TMI em pacientes submetidos à cirurgia bariátrica ainda é inconclusivo. O objetivo deste estudo foi revisar sistematicamente ensaios clínicos randomizados que avaliaram o efeito do TMI em comparação a TMI sham, fisioterapia convencional (exercícios respiratórios e deambulação precoce) ou nenhuma intervenção na função pulmonar em pacientes submetidos à cirurgia bariátrica. A estratégia de busca foi realizada nas bases de dados PubMed / MEDLINE, Cochrane, TRIP, PEDro e Scopus sem restrição de ano de publicação ou de idioma, conforme a recomendação PRISMA. Dois revisores selecionaram os estudos, extraíram os dados e avaliaram o risco de viés de forma independente. Dos 2.184 estudos potencialmente elegíveis, 2 foram incluídos. O critério do risco de viés foi adaptado e dividido em 9 áreas usando o Handbook da Cochrane. Esta revisão incluiu 62 participantes, sendo 30 alocados para receber dispositivo Threshold® TMI, mas em diferentes períodos, pré-operatório e pós-operatório. O TMI promoveu aumento da pressão inspiratória máxima (PIM) em relação à fisioterapia convencional, mas não foram encontradas diferenças significativas na pressão expiratória máxima (PEM). Os estudos apresentaram baixo e incerto risco de viés. O TMI parece ser o tratamento mais eficaz em comparação à fisioterapia convencional isolada tanto no pré quanto no pós-operatório. No entanto, não há nenhuma evidência sólida para a tomada de decisões clínicas

Can Endodontic Irrigating Solutions Influence the Bond Strength of Adhesives to Coronal Dental Substrates? : A Systematic Review and Meta-Analysis of In Vitro Studies

Purpose: To systematically review the literature to analyze the influence of endodontic irrigating solutions on the bond strength of adhesives to coronal enamel or dentin. Materials and Methods: The PubMed/MEDLINE, Web of Science and Scopus electronic databases were used to select laboratory studies related to the research question, without publication year or language limits. From 2461 potentially eligible studies, 2451 were selected for full-text analysis, and 97 were included in the systematic review. Two authors independently selected the studies, extracted the data, and assessed the risk of bias. Pooling bond strength data were calculated using RevMan5.1 with random effects model (α = 0.05), comparing control (no endodontic irrigating solution) and experimental groups (one or more endodontic solutions). Results: No significant difference was found between the control and experimental groups (p = 0.12) in the overall meta-analysis and in the meta-analysis excluding chlorhexidine (p = 0.06). High heterogeneity was found in the meta-analyses. Most included studies in the systematic review were scored as having a high risk of bias. Conclusion: The different endodontic irrigating solutions evaluated showed no negative influence on the bond strength of dental adhesives to coronal dental substrates

Degradation of resin-dentin bonds of etch-and-rinse adhesive system to primary and permanent teeth

The aim of this in vitro study was to compare the degradation of resin-dentin bonds of an etch-and-rinse adhesive system to primary and permanent teeth. Flat superficial coronal dentin surfaces from 5 primary second molars and 5 permanent third molars were etched with phosphoric acid and bonded with an adhesive system (Adper Single Bond 2, 3M ESPE). Blocks of resin composite (Z250, 3M ESPE) were built up and the teeth sectioned to produce bonded sticks with a 0.8 mm(2) cross-sectional area. The sticks of each tooth were randomly divided and assigned to be subjected to microtensile testing immediately (24 h) or after aging by water storage (6 months). Data were analyzed by two-way repeated measures ANOVA and Tukey post hoc test (alpha = 0.05). Failure mode was evaluated using a stereomicroscope (400x). Microtensile values significantly decreased after the 6 months aging, independent of the dentin substrate. In 24 h, the values obtained to primary dentin were lower compared with permanent dentin. This difference was not maintained after aging. Adhesive/mixed failure was predominant in all experimental groups. In conclusion, degradation of resin-dentin bonds of the etch-and-rinse adhesive system occurred after 6 months of water storage; however, the reduction in bond strength values was higher for permanent teeth

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities’ dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making

Diagnostic challenge of peritoneal tuberculosis: A case report / Desafio diagnóstico de tuberculose peritoneal: Um relato de caso

Tuberculosis is caused by bacteria of the Mycobacterium tuberculosis Complex, which mainly affect the lungs, but other sites can also be infected, such as the peritoneum. The clinical manifestations of peritoneal tuberculosis are nonspecific, with ascites (93%), abdominal pain (73%), and fever (58%). This makes the diagnostic process more complicated and leads to a delay in adequate treatment. We report a case of ascites caused by peritoneal tuberculosis in an elderly patient being treated for bladder cancer by intravesical therapy with BCG. There was a diagnostic dilemma due to the possibility of carcinomatosis related to a history of bladder cancer. Tuberculosis is caused by bacteria of the Mycobacterium tuberculosis Complex, which mainly affect the lungs, but other sites can also be infected, such as the peritoneum. The clinical manifestations of peritoneal tuberculosis are nonspecific, with ascites (93%), abdominal pain (73%), and fever (58%). This makes the diagnostic process more complicated and leads to a delay in adequate treatment. We report a case of ascites caused by peritoneal tuberculosis in an elderly patient being treated for bladder cancer by intravesical therapy with BCG. There was a diagnostic dilemma due to the possibility of carcinomatosis related to a history of bladder cancer.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter- examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter- examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth