Potencial tóxico dos alginatos para uso odontológico

Alginate or irreversible hydrocolloid is one the most accepted and frequently employed impression materials in dental practice. Substances like zinc, cadmium, lead silicate and fluorides, which are included in several alginate brands with the aim of improving their physical, chemical and mechanical properties, are a source of serious concern as regards their toxicity. Some brands of alginate have been reported to contain potentially toxic fluorides and metals such as cadmium, lead and zinc silicates, either singly or combined. Consequently, special care should be taken while preparing of these materials. It is necessary to monitor potentially toxic chemicals and metals in the alginates continually to avoid contamination of dental professionals and patients. In this review, alginates used in dentistry are analyzed for potential toxicity.

The influence of residual salivary fluoride from dentifrice on enamel erosion: An in situ study

The objective of this study was to assess the salivary residual effect of fluoride dentifrice on human enamel subjected to an erosive challenge. This crossover in situ study was performed in two phases (A and B), involving ten volunteers. In each phase, they wore acrylic palatal appliances, each containing 3 human enamel blocks, during 7 days. The blocks were subjected to erosion by immersion of the appliances in a cola drink for 5 minutes, 4 times a day. Dentifrice was used to brush the volunteers' teeth, 4 times a day, during 1 minute, before the appliance was replaced into the mouth. In phases A and B the dentifrices used had the same formulation, except for the absence (PD) or presence (FD) of fluoride, respectively. Enamel alterations were determined using profilometry, microhardness (%SMHC), acid- and alkali-soluble F analysis. The data were tested using ANOVA (p < 0.05). The concentrations (mean ± SD) of alkali- and acid-soluble F (μgF/cm 2) were, respectively, PD: 1.27 a ± 0.70/2.24∧ A ± 0.36 and FD: 1.49 a ± 0.44/2.24∧ ± 0.67 (p > 0.05). The mean wear values (± SD, μm) were PD: 3.63 a ± 1.54 and FD: 3.54 a ± 0.90 (p > 0.05). The mean %SMHC values (± SD) were PD: 89.63 a ± 4.73 and FD: 87.28 a ± 4.01 (p > 0.05). Thus, we concluded that the residual fluoride from the fluoride-containing dentifrice did not protect enamel against erosion.

In vitro-evaluation of secondary caries formation around restoration.

The objective of this in vitro study was to evaluate demineralization around restorations. Class V preparations were made on the buccal and lingual surfaces of each tooth. TPH (Group 1), Fuji II LC (Group 2), Tetric (Group 3), Dyract (Group 4), GS 80 (Group 5) and Chelon Fil (Group 6) were randomly placed in equal numbers of teeth. The teeth were submitted to a pH-cycling model associated with a thermocycling model. Sections were made and the specimens were examined for the presence of demineralization under polarized light microscopy. Demineralization was significantly reduced with Chelon Fil (Group 6). Furthermore, a similar inhibitory effect on the development of demineralization was observed in Groups 2, 4 and 5.

Urinary fluoride excretion in children exposed to fluoride toothpaste and to different water fluoride levels in a tropical area of Brazil

The aim of this study was to evaluate the urinary fluoride excretion of 2- to 7-year-old children exposed to different water fluoride concentrations in the city of Catolé do Rocha, PB, Brazil. Forty-two children were allocated to 3 groups according to the concentration of fluoride in the water: G1 (n=10; 0.5-1.0 ppm F), G2 (n=17; 1.1-1.5 ppm F) and G3 (n= 15; >1.51 ppm F). The study was carried out in two 1-week phases with 1-month interval between the moments of data collection: in the first phase, the children used a fluoride toothpaste (FT) (1,510 ppm F) for 1 week, whereas in the second phase a non-fluoride toothpaste (NFT) was used. The urine was collected in a 24-h period in each week-phase according to Marthaler's protocol. The urinary fluoride excretion data expressed as mean (SD) in ì g/24 h were: G1-FT= 452.9 (290.2); G1-NFT= 435.1 (187.0); G2-FT= 451.4 (224.0); G2-NFT= 430.3 (352.5); G3-FT=592.3 (390.5); and G3-NFT=623.6 (408.7). There was no statistically significant difference between the water fluoride groups, and regardless of the week phase (ANOVA, p>0.05). The use of fluoride toothpaste (1,510 ppmF) did not promote an increase in urinary fluoride excretion. There was a trend, though not significant, as to the increase of urine fluoride concentration in relation to fluoride concentrations in the water. The excretion values suggest that some children are under risk to develop dental fluorosis and information about the appropriate use of fluoride is necessary in this area.

Evaluation of children's behavior aged 0-3 years during dental care: A longitudinal analysis

Child temperament has been studied in various researches and may be useful to predict how a child responds to dental treatment, especially very young children. The purpose of the present longitudinal study was to evaluate the behavioral manifestation of children aged 0 to 3 years, considering different types of dental situation. A total of 169 children were selected and the following data were collected: the age of the child, gender, age of the mother, number of dental visits and their respective dates, stimuli offered to the child, and behavioral response to these stimuli. The children and their respective behaviors were divided into five groups according to the dental situation offered: control, missed visits, fluoride varnish, restoration, and dental trauma. The data were submitted to descriptive and inferential analysis using the chi-square test, with the level of significance set at 5%. Analysis of the different situation offered to infants during routine dental care revealed a predominance of collaborating and partially collaborating behavior, and age at the time of dental care influenced the behavior of the infants, irrespective of the stimulus group. The different types of dental situation provoked changes in the behavioral response of the children of certain age groups, especially in the dental trauma group.

Prevalence of enamel white spots and risk factors in children up to 36 months old

The aim of this study was to determine the prevalence of enamel white spots and the quality of oral hygiene in children up to 36 months old, in municipalities with different fluoride levels in the water supply, analyzing the contribution of several variables. After approval of the Ethics Committee, the parents signed an informed consent form and were interviewed about their educational level, economic classification of the family, nursing habits, use of toothpaste, access to dental service and other information. The children were clinically examined using the same codes and criteria established by the WHO (World Health Organization) and ADA (American Dental Association). The data were processed and analyzed with the Epi-info software program, version 3.2, and Microsoft Excel. Fisher's exact test (p<0.05) was applied to assess the association among the variables. The enamel white spot prevalence was 30.8% and the age group, duration of the bedtime milk feeding habit, age of initial practice of oral hygiene and presence of caries lesions with cavitation were considered statistically significant with regard to enamel white spot prevalence (p < 0.05). No association was found between oral hygiene quality and the study variables. © 2009 Sociedade Brasileira de Pesquisa Odontológica.

Evaluation of some properties of fermented milk beverages that affect the demineralization of dental enamel

The aim of this in vitro study was to evaluate the erosive capacity of fermented milk beverages, as well as some of their properties that affect the demineralization of dental enamel (pH, buffering capacity, fluoride, calcium and phosphorus contents). Three different batches of 6 commercial brands of fermented milk beverages were analyzed. pH evaluation was accomplished using a potentiometer. The buffering capacity was measured by adding 1 mol L -1 NaOH. Fluoride concentration was assessed by an ion specific electrode after hexamethyldisiloxane-facilitated diffusion, and calcium and phosphorus concentrations were assessed by a colorimetric test using a spectrophotometer. Sixty specimens of bovine enamel were randomly assigned to 6 groups (n = 10). They were exposed to 4 cycles of demineralization in the fermented milk and remineralization in artificial saliva. Enamel mineral loss was determined by surface microhardness (%SMHC) and profilometric tests. The samples' pH ranged from 3.51 to 3.87; the buffering capacity ranged from 470.8 to 804.2 μl of 1 mol L -1 NaOH; the fluoride concentration ranged from 0.027 to 0.958 μgF/g; the calcium concentration ranged from 0.4788 to 0.8175 mgCa/g; and the phosphorus concentration ranged from 0.2662 to 0.5043 mgP/g. The %SMHC ranged from-41.0 to -29.4. The enamel wear ranged from 0.15 μm to 0.18 μm. In this in vitro study, the fermented milk beverages did not promote erosion of the dental enamel, but rather only a superficial mineral loss.

Enamel remineralization by fluoride-releasing materials: Proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH 1). Artificial caries lesions were induced and surface microhardness test (SMH 2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer 1/4 diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH 3) was assessed to calculate percent recovery of surface microhardness (%SMH R). Fluoride present in enamel (μg F/mm 3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (ΔZ). There was no significant difference between Z 100 and control groups on analysis performed on - %SMH R, ΔZ, μ F and μ F/mm 3 (p>0.05). Results showed a positive correlation between %SMH R and μg F/mm 3 (r=0.9770; p=0.004), %SMH R and μg F (r=0.9939; p=0.0000001), DZ and μg F/mm 3 (r=0.9853; p=0.0002), ΔZ and μg F (r=0.9975; p=0.0000001) and between μg F/mm 3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Historical and recent biological markers of exposure to fluoride

Recent and historical biomarkers assess chronic or subchronic exposure to fluoride. The most studied recent biomarkers are nails and hair. Both can be non-invasively obtained, although collection of nails is more accepted by the subjects. External contamination may be a problem for both biomarkers and still needs to be better evaluated. Nails have been more extensively studied. Although the available knowledge does not allow their use as predictors of dental fluorosis by individual subjects, since reference values of fluoride have not yet been established, they have a strong potential for use in epidemiological surveys. Toenails should be preferred instead of fingernails, and variables that are known to affect nail fluoride concentrations - such as age, gender and geographical area - should be considered. The main historical biomarkers that could indicate total fluoride body burden are bone and dentin. Of these, bone is more studied, but its fluoride concentrations vary according to the type of bone and subjects' age and gender. They are also influenced by genetic background, renal function and remodeling rate, variables that complicate the establishment of a normal range of fluoride levels in bone that could indicate 'desirable' exposure to fluoride. The main issue when attempting to use bone as biomarker of fluoride exposure is the difficulty and invasiveness of sample collection. In this aspect, collection of dentin, especially from 3rd molars that are commonly extracted, is advantageous. However, mean values also span a wide range and reference concentrations have not been published yet. © 2011 S. Karger AG, Basel.

Mechanisms of action of fluoride for caries control

Fluoride was introduced into dentistry over 70 years ago, and it is now recognized as the main factor responsible for the dramatic decline in caries prevalence that has been observed worldwide. However, excessive fluoride intake during the period of tooth development can cause dental fluorosis. In order that the maximum benefits of fluoride for caries control can be achieved with the minimum risk of side effects, it is necessary to have a profound understanding of the mechanisms by which fluoride promotes caries control. In the 1980s, it was established that fluoride controls caries mainly through its topical effect. Fluoride present in low, sustained concentrations (sub-ppm range) in the oral fluids during an acidic challenge is able to absorb to the surface of the apatite crystals, inhibiting demineralization. When the pH is re-established, traces of fluoride in solution will make it highly supersaturated with respect to fluorhydroxyapatite, which will speed up the process of remineralization. The mineral formed under the nucleating action of the partially dissolved minerals will then preferentially include fluoride and exclude carbonate, rendering the enamel more resistant to future acidic challenges. Topical fluoride can also provide antimicrobial action. Fluoride concentrations as found in dental plaque have biological activity on critical virulence factors of S. mutans in vitro, such as acid production and glucan synthesis, but the in vivo implications of this are still not clear. Evidence also supports fluoride's systemic mechanism of caries inhibition in pit and fissure surfaces of permanent first molars when it is incorporated into these teeth pre-eruptively. © 2011 S. Karger AG, Basel.

Interdisciplinary approach to the management of Ewing sarcoma: A case report

Ewing sarcoma is a common primary bone malignancy occurring in childhood and adolescence. This case report describes a 4-year-old female patient who had Ewing sarcoma in the left clavicular region. The patient underwent total excision of the left clavicle and subsequently developed periodontitis and multiple carious lesions after chemotherapy. Caries risk and salivary flow rate tests were performed, followed by periodontal treatment, topical fluoride application, restoration of caries, and oral hygiene instruction. The care of this patient demonstrates that an interdisciplinary approach is essential to eliminate all foci of infection, minimize morbidity, and improve the patient's general health before, during, and after oncological treatment. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Water fluoridation in 40 Brazilian cities: 7 year analysis.

Fluoride levels in the public water supplies of 40 Brazilian cities were analyzed and classified on the basis of risk/benefit balance. Samples were collected monthly over a seven-year period from three sites for each water supply source. The samples were analyzed in duplicate in the laboratory of the Center for Research in Public Health - UNESP using an ion analyzer coupled to a fluoride-specific electrode. A total of 19,533 samples were analyzed, of which 18,847 were artificially fluoridated and 686 were not artificially fluoridated. In samples from cities performing water fluoridation, 51.57% (n=9,720) had fluoride levels in the range of 0.55 to 0.84 mg F/L; 30.53% (n=5,754) were below 0.55 mg F/L and 17.90% (n=3,373) were above 0.84 mg F/L (maximum concentration=6.96 mg F/L). Most of the cities performing fluoridation that had a majority of samples with fluoride levels above the recommended parameter had deep wells and more than one source of water supply. There was some variability in the fluoride levels of samples from the same site and between collection sites in the same city. The majority of samples from cities performing fluoridation had fluoride levels within the range that provides the best combination of risks and benefits, minimizing the risk of dental fluorosis while preventing dental caries. The conduction of studies about water distribution systems is suggested in cities with high natural fluoride concentrations in order to optimize the use of natural fluoride for fluoridation costs and avoid the risk of dental fluorosis.

Efficacy of mouth rinses and toothpaste on tooth whitening.

People increasingly desire tooth whitening. Considering the wide range of whitening products on the market, this study evaluated the efficacy of whitening toothpastes and mouth rinses compared with the 10% carbamide peroxide (CP) whitening gel. We obtained 120 cylindrical specimens from bovine teeth, which were darkened for 24 hours in a coffee solution. The color measurement was performed by a spectrophotometer using the CIE L*a*b* system, and specimens were divided into six groups according to the use of the following agents: group 1, conventional fluoridated toothpaste; group 2, Close Up White Now; group 3, Listerine Whitening; group 4, Colgate Plax Whitening; group 5, experimental mouth rinse with Plasdone; and group 6, 10% CP Whiteness Perfect. After the simulation of 12 weeks of treatment for groups 1 to 5 and 14 days of treatment for group 6, the specimens were subjected to a new color reading. Data were subjected to one-way analysis of variance (α=0.05), which showed significant differences among groups after 12 weeks for ΔE (p=0.001). Results of the Tukey test revealed that groups 3, 4, and 6 presented significantly higher color alteration than groups 1, 2, and 5. The whitening toothpaste Close Up White Now and the experimental mouth rinse with Plasdone showed similar color alteration as conventional toothpaste after a 12-week treatment simulation. These groups presented significantly lower color alteration compared with whitening mouth rinses Listerine and Colgate Plax Whitening, which showed similar results to those observed after 14 days of bleaching with 10% CP treatment.

In situ evaluation of a low fluoride concentration gel with sodium trimetaphosphate in enamel remineralization

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

Synthesis, characterization and thermal behavior of solid state compounds of heavy trivalent lanthanide succinates

Solid-state Ln-L compounds, where Ln stands for heavy trivalent lanthanides or yttrium(III) (Tb-Lu, Y) and L is succinate, have been synthesized. Simultaneous thermogravimetry and differential thermal analysis (TG-DTA), differential scanning calorimetry (DSC), infrared spectroscopy, TG-DTA coupled to FTIR, elemental analysis, X-ray powder diffractometry and complexometry were used to characterize and study the thermal behavior of these compounds. For the terbium to thulium and yttrium compounds, the dehydration, as well the thermal decomposition of the anhydrous compound occurs in two consecutive steps, while ytterbium and lutetium the dehydration occurs in a single step. The results also led to information about the ligand's denticity, thermal stability and thermal decomposition of these compounds. © 2013 Elsevier B.V.