Emprego do óleo de Melaleuca alternifolia Cheel (Myrtaceae) na odontologia: perspectivas quanto à utilização como antimicrobiano alternativo às doenças infecciosas de origem bucal

O interesse por medicamentos alternativos, principalmente daqueles provenientes de extratos naturais, tem aumentado nas últimas décadas. A Melaleuca alternifolia é um arbusto pertencente ao gênero Melaleuca, popularmente conhecida como árvore de chá, cujo principal produto é o óleo essencial (TTO - tea tree oil), de grande importância medicinal por possuir comprovada ação bactericida e antifúngica contra diversos patógenos humanos. em virtude da atividade terapêutica em diversas especialidades médicas, o TTO passou a ser empregado na área odontológica. Esta revisão de literatura foi realizada com o objetivo de discutir os ensaios já realizados com o TTO contra microrganismos relacionados à doença cárie, doença periodontal e problemas pulpares. O óleo de Melaleuca tem demonstrado boa ação antibacteriana in vitro contra microrganismos bucais, porém, pesquisas envolvendo o estudo do mecanismo de ação sobre as células microbianas ou estudos in vivo ainda são escassos e precisam ser realizados, já que esse produto pode ser útil na odontologia, seja na manutenção química da higiene ou prevenção de doenças bucais.

Percepção das condições de saúde bucal por gestantes atendidas em uma unidade de saúde no município de Araraquara, São Paulo, Brasil

OBJETIVOS: avaliar a percepção das condições de saúde bucal de um grupo de gestantes, através da aplicação do índice General Oral Health Assessment Index (GOHAI). MÉTODOS: participaram do estudo 53 gestantes que freqüentavam uma Unidade Básica de Saúde em Araraquara, São Paulo. Foi aplicado um questionário contendo questões do índice GOHAI, questões sobre a autopercepção das condições bucais e sobre as características sócio-demográficas. Por meio dos testes não-paramétricos Mann-Whitney e Kruskall-Wallis, foram determinados a associação das variáveis sociais e de autopercepção com o índice GOHAI. RESULTADOS: a percepção das condições bucais, medida pelo índice GOHAI, foi positiva e apresentou um valor médio de 31,6. Os dados subjetivos mostram que apenas 12,0% das gestantes classificaram sua condição bucal como ruim, a maioria declarou nenhum problema dentário, embora 58,7% tenha relatado distúrbios gengivais. As questões como dor e/ou desconforto foram as mais percebidas pelas gestantes. CONCLUSÕES: as gestantes fizeram uma avaliação positiva de sua condição bucal, estando o índice GOHAI associado a variáveis relacionadas à autopercepção. Tal índice pode ser aplicado em grupos populacionais como as gestantes, possibilitando medidas educativas e/ou preventivas direcionadas às suas reais necessidades.

Autopercepção das condições de saúde bucal por idosos

OBJETIVO: Avaliar a autopercepção das condições de saúde bucal por idosos e analisar os fatores clínicos, subjetivos e sociodemográficos que interferem nessa percepção. MÉTODOS: Participaram do estudo 201 pessoas, dentadas, com 60 anos ou mais, funcionalmente independentes, que freqüentavam um centro de saúde localizado em Araraquara, SP, Brasil. Foi aplicado questionário com questões sobre as características sociodemográficas da amostra, a autopercepção da condição bucal e o índice Geriatric Oral Health Assessment Index (GOHAI). Realizou-se exame clínico para determinar a prevalência das principais doenças bucais. Foram usados testes estatísticos para determinar a associação das variáveis sociodemográficas e clínicas e do índice GOHAI com a autopercepção da condição bucal e a identificação dos preditores da auto-avaliação. RESULTADOS: O exame clínico revelou grande prevalência das principais doenças bucais, apesar de 42,7% das pessoas avaliarem sua condição bucal como regular. As variáveis associadas à auto-avaliação foram: classe social, índice de GOHAI, dentes cariados e indicados para extração. A análise multivariada mostrou que os preditores da auto-avaliação foram o GOHAI, os dentes com extração indicada e o índice Community Periodontal Index and Treatment Needs. Esses preditores explicaram 30% da variabilidade da auto-avaliação. CONCLUSÕES: Concluiu-se que a percepção da saúde bucal teve pouca influência nas condições clínicas, mostrando ser necessário desenvolver ações preventivas e educativas para a população.

Reprodutibilidade de uma escala odontológica proposta como indicador de saúde bucal em crianças e adolescentes HIV+/SIDA

O objetivo deste trabalho foi estimar a reprodutibilidade de uma escala odontológica para avaliação da saúde bucal de crianças e adolescentes HIV+. A amostra, com delineamento não probabilístico, constituiu-se de 27 crianças e adolescentes HIV+. A escala foi aplicada, em duas ocasiões, com intervalo de sete dias. Estimou-se a reprodutibilidade intraexaminador pela estatística Kappa. Nas questões relativas à mãe, houve concordância máxima nos itens referentes à importância da saúde bucal, hábito de escovação diária e utilização de escova dental. A procura de atendimento odontológico motivado por estética e para manutenção de hálito puro apresentou concordância boa. Nas questões relativas à criança, observou-se concordância regular nos itens referentes ao fio dental. Com relação à organização do sistema de saúde, chama atenção a dificuldade dos respondentes em relatar o local e o profissional que realizou orientações educativas preventivas. A reprodutibilidade dos domínios percepção, cuidado e promoção foi de 0,48, 0,21 e 0,64, respectivamente. Sugere-se a necessidade de reestruturação das questões componentes dos algoritmos propostos pela escala para as dimensões de percepção e cuidado, a par da necessidade da saúde bucal ser inserida em programas de atendimento a portadores HIV+.

Estudo comparativo das alterações celulares no líquen plano e no carcinoma epidermóide bucal

Atualmente, muito se discute a respeito da natureza pré-maligna do líquen plano bucal. OBJETIVO: O presente trabalho tem como objetivo analisar as alterações das células epiteliais presentes no líquen plano bucal, comparando-as com aquelas observadas no carcinoma epidermóide. MATERIAL E MÉTODO: Cortes histológicos de líquen plano bucal e carcinoma epidermóide, corados com hematoxilina-eosina, foram analisados por meio da microscopia de luz. RESULTADO: As alterações mais frequentemente observadas no líquen plano bucal foram aumento da relação núcleo/citoplasma (93,33%), espessamento da membrana nuclear (86,67%) e bi-ou multinucleação (86,67%). O teste t de Student (alfa=5%) revelou haver diferença estatisticamente significante entre o número médio de alterações celulares no líquen plano bucal (5,87±1,57) e no carcinoma epidermóide (7,60±1,81). Quanto aos tipos de alterações, o teste de qui-quadrado também revelou haver diferença estatisticamente significante entre as lesões avaliadas em relação às seguintes alterações celulares: hipercromatismo nuclear, mitoses atípicas, pleomorfismo celular e diferenciação celular anormal (p<0,05). CONCLUSÃO: Apesar de que, em alguns casos, alguns patologistas possam fazer confusão no diagnóstico histopatológico do líquen plano bucal, os resultados obtidos neste estudo mostram que as alterações presentes no líquen plano bucal diferem consideravelmente daquelas observadas no carcinoma epidermóide, evidenciando o quão distintas são estas duas doenças.

Polyurethane and PTFE membranes for guided bone regeneration: Histopathological and ultrastructural evaluation

Objective: The purpose of this study was to research a membrane material for use in guided bone regeneration. Study design: In this study, 25 male Wistar rats were used to analyze the biocompatibility and degradation process of biomembranes. The morphological changes in subcutaneous implantations were assessed after 7, 14, 21, 28 and 70 days. The materials were made of polyurethane polymer (AUG) obtained from vegetal oil (Ricinus communis) and polytetrafluoroethylene membrane (PTFE). The surface characteristics of the physical barriers in scanning electronic microscopic (SEM) were also evaluated. Results: In both groups, the initial histological analysis showed moderate inflammatory infiltrate, which was predominantly polymorphonuclear. There was also a presence of edema, which was gradually replaced by granulation tissue, culminating in a fibrous capsule. In the AUG group, some multinucleated giant cells were present in the contact interface, with the space previously occupied by the material. However, membrane degradation was not observed during the period studied. According to the present SEM findings, porosity was not detected in the AUG or PTFE membranes. Conclusion: The researched material is biocompatible and the degradation process is extremely slow or may not even occur at all.

Double teeth in primary dentition: Report of two clinical cases

Odontogenic anomalies can occur as a result of conjoining or twinning defects. These include fusion, gemination and concrescence. This article presents two case reports of double teeth. In the first case reported, a 4-year-old white boy presented primary double teeth associated to the absence of the right permanent mandibular lateral incisor. In the second case, a 5-year-old white girl had a family history of anomaly in primary dentition. The girl and her mother presented double teeth in the primary dentition. Her mother showed hypodontia in the permanent dentition. Extra and intra oral clinical examination was made in both cases. Radiographic analyses showed the involvement of the permanent tooth. Authors conclude that double teeth in primary dentition have to be carefully analysed as they may be associated with anomalies in the permanent dentition. Correct diagnosis of the condition implicates in a better prognosis for the patient.

Ameloblastic fibro-odontoma: A case report

Ameloblastic fibro-odontoma (AFO) is a rare, benign, slow-growing odontogenic tumor, generally asymptomatic and more prevalent in children and adolescents. We report a case of AFO in the mandible of an eight-year-old Caucasian male patient, and review the literature. Intraoral examination revealed a swelling extending from the deciduous second molar to the retromolar triangle, covered with normal mucosa. A panoramic radiograph showed a large, well-demarcated radiolucency with radiopaque areas. The provisional diagnosis was of AFO, and so an incisional biopsy was performed. Histologically, the lesion was composed of connective tissue resembling the dental papilla, with epithelial strands or islands, as well as denticles and amorphous masses of enamel and dentin consistent with a diagnosis of AFO. Surgical excision and curettage of the lesion were performed. The patient has been monitored for eight years and the lesion has not recurred.

Clinicopathological analysis of oral mucous autoimmune disease: A 27-year study

Objectives: The aim of the present study was to analyze the main clinical and histopathological features of autoimmune diseases with oral manifestations such as oral lichen planus (OLP); mucous membrane pemphigoid (MMP); pemphigus vulgaris (PV) and erythema multiforme (EM). Study design: Retrospective review of 5770 files from the Oral Pathology Laboratory of Sao Jose dos Campos Dental School, São Paulo State University (UNESP) comprising a 27- year period from 1974 to 2000.Results: The cases accounted for 64 (1.10%) of 5770 anatomopathological examinations performed over the study period. Among the autoimmune diseases diagnosed, 49 (76.56%) were OLP, 6 (9.37%) were MMP, 5 (7.82%) were em and 4 (6.25%) were PV. Descriptive statistical analysis was used.Conclusion: The initial manifestations of most autoimmune diseases occur in the oral mucosa. An earlier diagnosis and proper therapeutic protocol will delay the dissemination of the lesions, thus greatly contributing to a better prognosis and quality of life of the patient.

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.

Effects of Chamomilla recutita (L.) on oral wound healing in rats

Objectives. The purpose of this study was to evaluate the effect of Chamomilla recutita on the healing of ulcers in rats.Study Design. A 5-mm wound was inflicted on the tongue of 36 rats. Treatment group animals were treated topically with 0.04 mL/day of chamomile ointment, whereas control group animals were not treated. Animals were sacrificed after 3, 7 or 10 days. Semi-quantitative analysis of the degree of inflammation, fibroblast count and wound size was performed, as well as histometric analysis of re-epithelialization and percentage of collagen fibers of the lesion.Results. Animals treated with chamomile showed the best results regarding epithelialization and percentage of collagen fibers after 10 days. As expected, time had a statistically significant effect (p<0.05) on fibroblast count, epithelialization, inflammation and wound size; animals sacrificed at 3 days showed the worst results.Conclusions. Chamomile stimulated re-epithelialization and the formation of collagen fibers after 10 days of treatment; it did not, however, influence inflammation or fibroblast count.

Porous titanium for biomedical applications: An experimental study on rabbits

Objective: The aim of this study was to carry out an in vivo assessment of bone ingrowth in two different types of porous titanium -the first being completely porous, and the second with a porous surface and dense nucleus, manufactured by powder metallurgy- and to evaluate their mechanical properties. Study design: Ten scaffolds from each group were submitted to metallographic analysis and compression tests. Next, two scaffolds of each type were inserted into 14 rabbits, which were sacrificed 8 weeks after surgery. The samples were submitted for histological examination. Results: Metallographic analysis revealed interconnected pores, and the average interconnected pore diameter was about 360 mm, with 36% total porosity. The totally porous titanium samples and the titanium samples with porous surface and dense nucleus showed an average compressive strength of 16.19 MPa and 69.27 MPa, respectively. After 8 weeks, the animals showed bone ingrowth, even into the most internal pores. Conclusions: The pore morphology was effective in permitting bone ingrowth in both groups. Titanium scaffolds with a porous surface and dense nucleus showed the best mechanical properties and most adequate interface.

Comparative analysis of cell proliferation ratio in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma

Background: Although oral lichen planus has been classified by the World Health Organization (WHO) as a potentially malignant disorder, such classification is still the target of much controversy. Aim: To evaluate the cell proliferation rate in oral lichen planus, comparing it to the rate observed in epithelial dysplasia and oral squamous cell carcinoma, aiming at indications which might indicate the potential for malignant transformation. Material and Methods: Twenty-four cases of each lesion were submitted to the streptoavidin-biotin and AgNOR technique to evaluate the immunohistochemical expression of PCNA and the mean NORs/ nucleus, respectively. Results: Positivity for PCNA was observed in 58.33% of oral lichen planus cases, 83.33% of epithelial dysplasia cases and 91.67% of oral squamous cell carcinoma cases. Chi-squared test showed that the number of positive cases for PCNA was significantly lower in oral lichen planus than in oral squamous cell carcinoma (p<0.05). No significant statistical difference between oral lichen planus and epithelial dysplasia (p>0.05) and between the epithelial dysplasia and oral squamous cell carcinoma (p>0.05) was observed. The mean NORs/ nucleus in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma were 1.74 +/- 0.32, 2.42 +/- 0.62 e 2.41 +/- 0.61, respectively. Variance analysis (ANOVA) revealed significant statistical difference between oral lichen planus and the other studied lesions (p<0.05). Conclusion: Oral lichen planus cell proliferation rate was less than in oral epithelial dysplasia and oral squamous cell carcinoma which might explain the lower malignant transformation rate.

Rational use of antimicrobials in dentistry during pregnancy

The use of medicines during pregnancy deserves special attention from dentists due to the potential risks to fetal development. The prescription of antimicrobial drugs during this period must be based not only on the etiology of the disease but also on the drug's effect on the embryo, which may be toxic, possibly leading to irreversible lesions. Interest in studies of the teratogenic effects of drugs increased in response to reports of the high incidence of phocomelia in patients treated with thalidomide. Although teratogenicity has long been known, pregnant women today are still exposed to this risk. The effects of drugs depend on the level of susceptibility of the fetus and on the period of exposure during pregnancy. In this context, and considering the paucity of studies on this subject in dentistry, the aim of this review was to offer an up-to-date compilation of data on the antimicrobial drugs most frequently used during pregnancy and the effects of their use.

Effect of low-calcium diet and grind diet on bone turnover of ovariectomized female rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)