Diagnostic and clinical factors associated with pulpal and periapical pain

A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3%) and hyperreactive pulpalgia (14.4%), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4%). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.

A retrospective study of Traumatic Dental Injuries in a Brazilian dental urgency service

Epidemiologic aspects of traumatic dental injuries (TDI) were evaluated in the permanent dentition in a sample of 847 patients treated at the Dental Urgency Service of the Dental School of the Federal University of Goiás, Brazil, between May 2000 and May 2008. The statistical treatment analyzed data from frequency distribution and chi-square test. The level of significance was set at 5% for all analyses. The results showed a higher incident among males (610; 72.01%) with mean age of 6-10 year-old. Uncomplicated crown fracture (without pulp exposure) (502; 26.95%), avulsion (341; 18.30%) and complicated crown fracture (with pulp exposure) (330; 17.71%) were the most prevalent TDI. The prevalence of trauma throughout the years showed proportionality, being observed a larger number of cases between July and September (249; 29.39%). The most affected teeth were the maxillary central incisors (65.65%), followed by the maxillary left lateral incisors (19.67%). In 311 participants (18.25%), only one tooth was involved, while in most patients (536; 81.75%), TDI occurred in more than one tooth. Significant proportion (82.27%) of traumatized teeth presented completely formed root apex. The main etiologic factors involved in TDI were falls (51.71%), traffic accidents (22.90%) and violence (5.67%). Based on the obtained data, it may be concluded that accurate policies of TDI prevention must be established, capable of stimulating the exposure of appropriate protocols for management of these lesions. The prevalence of TDI in Goiânia subpopulation is compared to the prevalence reported in epidemiological studies in others populations.

Influence of intracanal post on apical periodontitis identified by cone-beam computed tomography

The determination of the success of endodontic treatment has been often discussed based on outcome obtained by periapical radiography. The aim of this study was to verify the influence of intracanal post on apical periodontitis detected by cone-beam computed tomography (CBCT). A consecutive sample of 1020 images (periapical radiographs and CBCT scans) taken from 619 patients (245 men; mean age, 50.1 years) between February 2008 and September 2009 were used in this study. Presence and intracanal post length (short, medium and long) were associated with apical periodontitis (AP). Chi-square test was used for statistical analyses. Significance level was set at p<0.01. The kappa value was used to assess examiner variability. From a total of 591 intracanal posts, AP was observed in 15.06%, 18.78% and 7.95% using periapical radiographs, into the different lengths, short, medium and long, respectively (p=0.466). Considering the same posts length it was verified AP in 24.20%, 26.40% and 11.84% observed by CBCT scans, respectively (p=0.154). From a total of 1,020 teeth used in this study, AP was detected in 397 (38.92%) by periapical radiography and in 614 (60.19%) by CBCT scans (p<0.001). The distribution of intracanal posts in different dental groups showed higher prevalence in maxillary anterior teeth (54.79%). Intracanal posts lengths did not influenced AP. AP was detected more frequently when CBCT method was used.

Effectiveness of different final irrigation protocols in removing debris in flattened root canals

This study evaluated in vitro the capacity of debris removal from the apical third of flattened root canals, using different final irrigation protocols. Thirty human mandibular central incisors with a mesiodistal flattened root were prepared using rotary instrumentation by Endo-Flare 25.12 and Hero 642 30.06, 35.02, 40.02 files, irrigated with 2 mL of 1% NaOCl after each file. The specimens were randomly distributed into 5 groups according to the final irrigation of root canals: Group I: 10 mL of distilled water (control), Group II: 10 mL of 1% NaOCl for 8 min, Group III: 2 mL of 1% NaOCl for 2 min (repeated 4 times), Group IV: 10 mL of 2.5% NaOCl for 8 min, and Group V: 10 mL of 2.5% NaOCl for 2 min (repeated 4 times). The apical thirds of the specimens were subjected to histological processing and 6-μm cross-sections were obtained and stained with hematoxylin-eosin. The specimens were examined under optical microscopy at ×40 magnification and the images were subjected to morphometric analysis using the Scion image-analysis software. The total area of root canal and the area with debris were measured in square millimeters. Analysis of variance showed no statistically significant difference (p>0.05) among the groups GI (2.39 ± 3.59), GII (2.91 ± 2.21), GIII (0.73 ± 1.36), GIV (0.95 ± 0.84) and GV (0.51 ± 0.22). In conclusion, the final irrigation protocols evaluated in this study using the Luer syringe presented similar performance in the removal of debris from the apical third of flattened root canals.

Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.

Hábitos de sucção não nutritiva em crianças pré-escolares

OBJETIVO: Verificar a prevalência e os fatores associados aos hábitos de sucção não nutritiva em crianças pré-escolares matriculadas em creches e pré-escolas de Natal (RN). MÉTODOS: Foi conduzido um estudo transversal com 1.190 crianças de ambos os sexos na faixa etária de 3 a 5 anos, matriculadas em creches e pré-escolas de Natal. Não foram incluídas no estudo crianças com fendas labiopalatinas, desordens temporomandibulares, ou aquelas submetidas a tratamento ortodôntico e/ou ortopédico; também não fizeram parte da amostra instituições de ensino especializadas em crianças portadoras de deficiência. Utilizou-se um questionário estruturado, respondido pelos pais ou responsável, com dados sobre a instituição, sexo e idade das crianças, escolaridade dos pais e questões relacionadas aos hábitos. A análise dos dados foi realizada através do teste do qui-quadrado e a regressão logística. RESULTADOS: Obteve-se prevalência de 40,2% de hábitos de sucção não nutritiva, dos quais 27,7% eram de sucção de chupeta e 12,5% de dedo. Os hábitos de sucção apresentaram maior percentual para o sexo feminino, destacando-se a sucção de dedo (p = 0,02); em crianças com menos idade destacou-se a sucção de chupeta (p = 0,0006). Observou-se maior frequência de sucção de chupeta e de dedo, respectivamente, para o nível superior (p < 0,05) e fundamental (p < 0,05) de escolaridade dos pais. A regressão logística demonstrou que a menor idade dos indivíduos (p = 0,033) e o nível médio de escolaridade dos pais (p = 0,035) são fatores independentes para a persistência dos hábitos. CONCLUSÃO: Verificou-se uma alta prevalência de realização dos hábitos de sucção não nutritiva, apresentando como fatores de destaque a menor idade das crianças e o nível médio de escolaridade dos pais.

HOXB5 expression in oral squamous cell carcinoma

Human HOX genes encode transcription factors that act as master regulators of embryonic development. They are important in several processes such as cellular morphogenesis and differentiation. The HOXB5 gene in particular has been reported in some types of neoplasm, but not in oral cancer. OBJECTIVE: The present study investigated the expression of HOXB5 in oral squamous cell carcinoma (SCC) and in non-tumoral adjacent tissues, focusing on verifying its possible role as a broad tumor-associated gene and its association with histopathological and clinical (TNM) characteristics. MATERIAL AND METHODS: RT-PCR was performed to amplify HOXB5 mRNA in 15 OSCCs and adjacent non-tumoral epithelium. A possible association with TNM and histopathologic data was verifed by the chi-square and post-hoc t-test. RESULTS: HOXB5 was amplifed in 60% non-tumoral epithelium and in 93.3% carcinomas. No statistically signifcant differences were found regarding the HOXB5 mRNA expression and TNM or histological grade. CONCLUSION: HOXB5 is expressed in OSCCs and its role in cancer progression should be further investigated.

Evaluation of simulated bone lesion in the head of the mandible by using multislice computed tomography

Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. OBJECTIVE: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. MATERIAL AND METHODS: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. RESULTS: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. CONCLUSIONS: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.

Avaliação dos fatores determinantes da estética do perfil facial

OBJETIVO: avaliar a influência da idade, do sexo, da relação oclusal sagital, do Padrão Facial e de 8 medidas do perfil facial sobre a estética do perfil. MÉTODOS: foram utilizadas tabelas de contingência, o Teste Qui-quadrado e o coeficiente de Cramér para avaliar a possível associação entre a nota dada por 32 avaliadores (14 ortodontistas, 12 leigos e 6 artistas) para a estética do perfil de 100 brasileiros - adultos, leucodermas, portadores de selamento labial passivo - e a idade, o sexo, a relação oclusal sagital, o Padrão Facial e as variáveis da análise facial numérica do perfil. RESULTADOS: não foi observada associação entre a idade, o sexo e a relação oclusal sagital e a estética do perfil facial. A associação foi observada entre a nota recebida para a estética do perfil e o Padrão Facial, o ângulo de convexidade facial e o ângulo do terço inferior da face. CONCLUSÃO: o Padrão Facial, definido na avaliação do perfil pela convexidade do perfil facial, e a projeção anterior do mento foram, entre os fatores avaliados, os determinantes para a estética do perfil facial.

Association between overbite and craniofacial growth pattern

The purpose of the present study was to assess the association between overbite and craniofacial growth pattern. The sample comprised eighty-six cephalograms obtained during the orthodontic pretreatment phase and analyzed using the Radiocef program to identify the craniofacial landmarks and perform orthodontic measurements. The variables utilized were overbite, the Jarabak percentage and the Vert index, as well as classifications resulting from the interpretation of these measurements. In all the statistical tests, a significance level of 5% was considered. Measurement reliability was checked by calculating method error. Weighted Kappa analysis showed that agreement between the facial types defined by the Vert index and the direction of growth trend established by the Jarabak percentage was not satisfactory. Owing to this lack of equivalency, a potential association between overbite and craniofacial growth pattern was evaluated using the chi-square test, considering the two methods separately. No relationship of dependence between overbite and craniofacial growth pattern was revealed by the results obtained. Therefore, it can be concluded that the classification of facial growth pattern will not be the same when considering the Jarabak and the Ricketts anayses, and that increased overbite cannot be associated with a braquifacial growth pattern, nor can openbite be associated with a dolichofacial growth pattern.

Relationship among malocclusion, number of occlusal pairs and mastication

This study evaluated the relationship among malocclusion, number of occlusal pairs, masticatory performance, masticatory time and masticatory ability in completely dentate subjects. Eighty healthy subjects (mean age = 19.40 ± 4.14 years) were grouped according to malocclusion diagnosis (n = 16): Class I, Class Class II-2, Class III and Normocclusion (control). Number of occlusal pairs was determined clinically. Masticatory performance was evaluated by the sieving method, and the time used for the comminute test food was registered as the masticatory time. Masticatory ability was measured by a dichotomic self-perception questionnaire. Statistical analysis was done by one-way ANOVA, ANOVA on ranks, Chi-Square and Spearman tests. Class II-1 and III malocclusion groups presented a smaller number of occlusal pairs than Normocclusion (p < 0.0001), Class I (p < 0.001) and II-2 (p < 0.0001) malocclusion groups. Class I, and III malocclusion groups showed lower masticatory performance values compared to Normocclusion (p < 0.05) and Class II-2 (p < 0.05) malocclusion groups. There were no differences in masticatory time (p = 0.156) and ability (χ2 = 3.58/p= 0.465) among groups. Occlusal pairs were associated with malocclusion (rho = 0.444/p < 0.0001) and masticatory performance (rho = 0.393/p < 0.0001), but malocclusion was not correlated with masticatory performance (rho = 0.116/p= 0.306). In conclusion, masticatory performance and ability were not related to malocclusion, and subjects with Class I, II-1 and III malocclusions presented lower masticatory performance because of their smaller number of occlusal pairs.

Adsorption of amyloglucosidase from Aspergillus niger NRRL 3122 using ion exchange resin

Amyloglucosidase enzyme was produced by Aspergillus niger NRRL 3122 from solid-state fermentation, using deffated rice bran as substrate. The effects of process parameters (pH, temperature) in the equilibrium partition coefficient for the system amyloglucosidase - resin DEAE-cellulose were investigated, aiming at obtaining the optimum conditions for a subsequent purification process. The highest partition coefficients were obtained using 0.025M Tris-HCl buffer, pH 8.0 and 25ºC. The conditions that supplied the highest partition coefficient were specified, the isotherm that better described the amyloglucosidase process of adsorption obtained. It was observed that the adsorption could be well described by Langmuir equation and the values of Qm and Kd estimated at 133.0 U mL-1 and 15.4 U mL-1, respectively. From the adjustment of the kinetic curves using the fourth-order Runge-Kutta algorithm, the adsorption (k1) and desorption (k2) constants were obtained through optimization by the least square procedure, and the values calculated were 2.4x10-3 mL U-1 min-1 for k1 and 0.037 min-1 for k2 .

Efeitos de dietas com níveis crescentes de milho no metabolismo ruminal de energia e proteína em bubalinos

Avaliaram-se os efeitos de dietas com níveis crescentes de milho em grão moído (0, 22, 37 e 49% na MS) em substituição ao feno de coast-cross mantendo-se diferentes relações proteína:carboidratos não-fibrosos (PB:CNF = 1,01; 0,39; 0,33 e 0,27) sobre o metabolismo ruminal de búfalos. Utilizaram-se quatro búfalos fistulados no rúmen, mantidos em delineamento quadrado latino 4 × 4, para a coleta de amostras do líquido ruminal, colhidas em cada período experimental (de 28 dias) nos tempos 0, 2, 4 e 8 horas após a alimentação. Em geral, os bubalinos apresentaram boa capacidade tamponante no rúmen, com pH médio alto (6,70) e aumento da ingestão de milho em grão moído. O acréscimo nos níveis de milho na dieta promoveu aumento da produção de ácido butírico. Somente a dieta com 49% de milho promoveu melhor fermentação ruminal, com menor propoção de ácidos acético:propiônico. A relação PB:CNF de 1,01 indica deficiência de energia da dieta disponível para microrganismos no rúmen ao longo do dia, enquanto dietas com PB:CNF entre 0,39 e 0,27 promovem fermentações ruminais semelhantes, o que indica sincronismo na utilização de nitrogênio e energia pelos microrganismos no rúmen nessas condições.

Metabolismo mineral em bubalinos com ingestões de diferentes níveis de fósforo

Objetivou-se avaliar os efeitos da ingestão diária de quatro níveis de fósforo (8, 12, 15 e 18 g) sobre o metabolismo de macrominerais (P, Ca, Mg, Na, K e S), incluindo a ingestão, a concentração no rúmen, a taxa de passagem do líquido ruminal, a excreção nas fezes e a disponibilidade aparente. Utilizaram-se quatro bubalinos adultos com fístulas ruminais em delineamento quadrado latino (4 × 4) com dieta total constituída de cana-de-açúcar como volumoso (85%) e concentrado formulado com um dos níveis de fósforo. Os níveis de fósforo não ocasionaram diferença significativa na concentração mineral no rúmen de nenhum mineral estudado. A concentração média de fósforo no conteúdo ruminal foi de 0,98% na matéria seca, enquanto o teor de fósforo nas rações variou de 0,12 a 0,34%, comprovando alta reciclagem de fósforo pela saliva. Níveis crescentes de fósforo na dieta, variando de 8 a 18 g/animal/dia, não influenciam as disponibilidades de cálcio e magnésio. Com o nível de fósforo de 15 g/dia, houve melhor utilização do fósforo da dieta. A ingestão de níveis crescentes de fósforo em g/kg0,75 (X) promoveu aumento linear na excreção fecal desse mineral em g/kg0,75 (Y) e baixos valores de disponibilidade do fósforo, que pode ser estimado pela equação Y = 0,03 + 0,610X, o que indica deficiência desse elemento mineral na dieta para o metabolismo animal.

Efeitos de dietas contendo Leucaena leucocephala e Saccharomyces cerevisiae sobre a fermentação ruminal e a emissão de gás metano em bovinos

Este trabalho foi realizado com o objetivo de avaliar os efeitos do uso de leucena e levedura em dietas para bovinos sobre o metabolismo ruminal, incluindo o pH e as produções de ácido graxos voláteis (AGV), amônia e gás metano. Quatro bovinos machos com 800 kg e fistulados no rúmen foram mantidos em quadrado latino 4 × 4, em arranjo fatorial 2 × 2, composto de dois níveis de leucena (20 e 50% MS) e feno de capim coast-cross na presença ou ausência de levedura. Não houve influência das dietas nos valores médios de pH (média 6,82) e nas concentrações de amônia no rúmen, que variaram de 18 a 21 mg/100 mL. Houve interação entre níveis de leucena e levedura na concentração total de AGV. As dietas não diferiram quanto à concentração de ácido acético, mas os animais alimentados com a dieta com 50% de leucena e contendo levedura apresentaram maiores concentrações médias de ácido propiônico (média 19,14 mM). A emissão de metano reduziu em12,3% em relação à mesma dieta sem levedura e em 17,2% quando os animais foram alimentados com 20% de leucena com levedura. Verificou-se efeito associativo de leucena, quando fornecida em alto nível na dieta (50% MS), e levedura na redução da emissão de metano e na melhoria no padrão de fermentação no rúmen, o que pode reduzir as perdas de energia e melhorar eficiência energética do animal.