Avaliação: um instrumento para o planejamento: análise de um programa municipal para prestação de assistência odontológica à população pré-escolar: a experiência de São Bernardo do Campo

Uma apreciação de um programa de prestação de serviços odontológicos para crianças de 4 a 6 anos, desenvolvido pela Seção de Odontologia da Secretaria de Saúde e Promoção Social da Prefeitura do Município de são Bernardo do Campo, a partir de agosto de 1979. Ele se propunha a priorizar o atendimento da faixa etária acima mencionada, para integrar os recursos odontológicos municipais com os do Serviço Dentário Escolar do Estado e, com isto, obter uso mais racional dos recursos disponíveis, de forma a propiciar cobertura mais ampla do atendimento de saúde bucal á população infantil, do Município. Procura-se aqui fazer a análise dos aspectos administrativos do Programa, desde sua formulação até as etapas de implementação; estuda-se os resultados obtidos em uma amostra da população alvo do Programa depois de um ano e meio de vigência do mesmo. Para tanto são utilizadas, como referencial teórico, a evolução da organização dos serviços odontológicos, a teoria dos sistemas e as técnicas de planejamento e avaliação. Neste trabalho procuramos analisar e avaliar as fases de planejamento e implementação do Programa, buscando principalmente os aspectos administrativos envolvidos no problema.

Dois novos crocodilos (Crocodyliformes, Mesoeucrocodylia) do Mato Grosso, Bacia dos Parecis : descrição e relações filogenéticas com os "Notossúquios"

São descritos dois novos táxons de Crocodyliformes do Cretáceo do Mato Grosso, que apresentam: crânios curtos; dentição heterodonte composta por dentes com lado labial mais convexo que o lado lingual e serrilhados; dentes anteriores do dentário procumbentes; presença de uma superfície distintamente lisa, acima da margem alveolar, na superfície lateral da maxila, acima da qual ocorrem forames neurovasculares; e vértebras anficélicas. Estes novos materiais foram informalmente chamados Crocodilo I e Crocodilo II. O Crocodilo I apresenta as seguintes características: fenestra pré-orbitária pequena; barra palatina posterolateral em forma de bastão; dente caniniforme hipertrofiado na pré-maxila; 6 dentes maxilares; dentes anteriores do dentário levemente voltados para trás; junta quadrado-articular localizada ventralmente à fileira dentária. O Crocodilo II, por sua vez, apresenta: focinho tubular em seção; amplo palato secundário; espleniais fusionados; 5 dentes maxilares; mandíbula com região sinfiseal alongada e espatulada. Em ambos os casos, a morfologia geral aponta muitas semelhanças com os “notossúquios”: postura elevada, regiões diferenciadas na coluna, dentição heterodonte, palato secundário relativamente amplo e cavidade nasal relativamente ampla. Para testar as relações filogenéticas dos dois táxons, bem como o próprio monofiletismo dos “notossúquios”, foi construída uma matriz de dados com 27 táxons (incluindo, tanto quanto possível, todos aqueles que já foram ou são considerados “notossúquios”) e 60 caracteres. Com base nos mesmos, foi efetuada uma análise de parcimônia utilizando Paup 3.1.1 (“stepwise addition” - “random”, com 100 repetições e “tree-bisection-reconnection”) e Nona 2.0 (algoritmo heurístico, com 10 replicações e TBR - mult*max*) que apontou uma relação dos dois novos táxons como grupos irmão sucessivos de Notosuchus e Mariliasuchus (Crocodilo II (Crocodilo I (Notosuchus, Mariliasuchus))). Em comparação com outros crocodiliformes do Cretáceo da América do Sul, África, Madagascar e China, é possível assumir que ambos são notossúquios (sensu Pol & Apesteguia, 2005). Em nossa análise, os notossúquios formam um grupo, à exceção de A. buitreraensis, mais proximamente relacionado aos Eusuchia. Na análise ordenada, A. buitreraensis, A. patagonicus e Anatosuchus aparecem mais proximamente relacionados a Eusuchia e Lybicosuchus aloca-se junto a Baurusuchus e Sebecus. Paralelamente, são discutidas análises filogenéticas prévias envolvendo notossúquios, nas quais foram introduzidas modificações, levando a diferentes topologias. A partir disso, propõe-se uma discussão acerca da influência das escolhas e procedimentos de cada autor no resultado final de análises filogenéticas.

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Prevalência de oclusopatias e caracteríticas cefalométricas e dentais de escolares cearense da cidade de Fortaleza

The people of Ceará state are descended from miscegenation between the Portuguese colonizers and the native population, resulting in a different facial pattern from other populations. It is important that this pattern be thoroughly understood, along with its minimum and maximum values so that they can be assessed and respected, allowing professionals who deal with the craniofacial complex to work more efficiently and scientifically. Aim: To characterize the morphological pattern of individuals from Ceará state, whose father and grandfather are also native from Ceará, in the 10-12 year age group, not submitted to previous orthodontic treatment, in order to determine: 1) the prevalence of occlusal pattern; 2) the prevalence of dental anomalies (DA) and, 3) the skeletal and dental cephalometric characteristics of individuals that present with normal occlusion and harmonious facial pattern. Methodology: A list of 10-12 year-olds was obtained from 515 schools containing 162,713 students (Education Secretariat of Ceará State), from which 234 individuals were examined (107 boys and 157 girls). The assessment criteria adopted were: 1) Angle s Classification System to determine occlusal pattern. The occlusal characteristics were measured through overbite, overjet, crowding and interincisal diastema. 2) DA are anomalies of number, shape, size, eruption and structure and, 3) in the group that presented with normal occlusion, we used cephalometric analysis measures proposed by Downs, Steiner, Tweed, Holdaway, Jacobson and McNamara. Results: 1) 25.8% of the schoolchildren had normal occlusion, 47.5% class I malocclusion, 22.3% class II malocclusion and 4.2% class III malocclusion. No statistically significant difference was found between the age group studied and sex. Thirty percent of the individuals had normal overbite, while 36.7% and 19.7% had increased and reduced overbite, respectively. Normal overjet was found in 33.7% of the individuals, increased overjet in 50% and reduced in 16.3%. Dental crowding was observed in 62.5% of the individuals and the presence of interincisal diastema in 14.8%. 2) The prevalence of DA was 56.1%, 6.8% in the number, 10.8% in shape, 4.1% in size, 34.5% in eruption, 26.4% in structure and 17.4% had more than one DA. No association was found between DA and sex, but DA was significantly associated to malocclusion (p<0.05); 3) there was no association between sex or facial type between the measures of nasal-labial angle, position and effective maxillary length, effective mandibular length and the sagittal relationship between the molars, overjet and overbite, position of upper incisors, lower incisors and between the incisors themselves. There was a difference between sex, on the VERT index and in lower anterior facial height, upper incisor inclination and line-H, between facial types for the occlusal plane angles, mandibular plane, facial axis, lower incisor inclination, mandibular position, upper incisor position, lower anterior facial height, ANB and line-H. It was concluded that: 1) the most prevalent occlusal type was class I malocclusion, with no distinction for sex or age group, and the assessment of occlusal characteristics showed that excessive overbite and overjet were the most predominant findings, along with a high occurrence of tooth crowding; 2) a high prevalence of DA was found, particularly eruption anomalies, not influenced by sex but significantly associated to malocclusion and 3) individuals from Ceará are predominantly brachyfacial, exhibiting a number of similarities inherent to their facial pattern, such as a convex profile, retracted jaw, reduced lower third and protruded lower incisors. This study was multidisciplinary, involving researchers from the areas of epidemiology, radiology and dentistry, thereby meeting the multidisciplinarity requirements of the Postgraduate Program in Health Sciences

Efetividade do uso tópico de fluoreto e da escovação no controle de cáries produzidas "in vivo"

The objective of this clinical study was to evaluate the effectiveness of the toothbrushing with and without fluoride and the daily fluoride rinse (NaF 0.05%) on produced white spot, in vivo. This was a clinical study, controlled, randomized and triple blind. Thirty patients were selected for orthodontics reasons from Orthodontics Specialization Course at the Brazilian Dental Association - Section of Rio Grande do Norte. In this study it was used 4 bicuspid upper and lower. They had orthodontic reason for extractions, in 35 days, at least. The sample had one hundred and twenty teeth that received orthodontic bands. The bands were fixed with polycarboxylate cement, and there was a space standardized between bands and one surface of teeth. The four bicuspid of each patients were randomized and nominated as A, B, C and D. These nominations determinated the sequence of the extractions and what was done in each tooth. All the patients had been submitted to the toothbrushing with or without fluoride for 35 days. After this period, the A tooth of each patient was extracted to serve as control. The others teeth (B, C and D) were extracted one by each week. The entire sample was analyzed through the clinical examination and by laser fluorescence (DIAGNOdent®) in three different times: before orthodontic bands, 28 days after fixed and then removed the bands and, the last one, 07 days after one of the three treatments (toothbrushing with or without fluoride, tooth paste with fluoride and mouth rinse with fluoride). At the beginning all groups (A, B, C and D) had the same conditions, no significant difference was found. The same situation was found in a clinical examination. The results of the DIAGNOdent® for the groups that used tooth paste without fluoride, with fluoride and mouth rinse with fluoride, after 28 days, there was no significant difference. Clinically, the white spot was formed in all teeth after 28 days. When it was compared the three treated groups, the group without fluoride in tooth paste had worst result than the others groups. But there was no significant association between the number of active and inactive white spots and the type of treatment that the teeth had received. The demineralization of the enamel surface, under the orthodontic bands, it happened in a few weeks. The exposition of the white spots in oral environmental resulted in an improvement, but it was not enough to return to the values from the base line, either for the toothbrushing and/or the use of fluorite mouth rinse. Mouth rinse and toothpaste with fluoride have showed to reduce the incidence of demineralization in the enamel, but none seems to be superior to another one in an in vivo study

Meios de resgatar a saúde bucal e autoestima de idosos

O presente estudo objetivou analisar as características epidemiológicas das condições de saúde bucal de 98 idosos de uma Instituição de Longa Permanência para Idosos (ILPI) e de 125 participantes de Grupos de Convivência, de bairros periféricos, socialmente semelhantes, de Fortaleza, Ceará, Brasil, para orientação do tratamento odontológico. Investigou-se a autopercepção em saúde bucal desses idosos a fim de realizar uma avaliação comparativa entre eles e com os levantamentos epidemiológicos de base nacional (SB Brasil) e de base estadual (SB Ceará). Devido a alguns idosos da ILPI recusarem o tratamento dentário e a identificação do elevado percentual de demenciados, optou-se por realizar uma avaliação cognitiva, o Mini Exame do Estado Mental (MEEM) visando identificar os aptos à reabilitação oral. Métodos: abordagem epidemiológica do tipo transversal, sendo a coleta de dados realizada por cinco examinadores, utilizando os critérios recomendados pela OMS (1997). Resultados: O CPO-D médio encontrado na ILPI, foi de 29,88, com predomínio do componente perdido (93,27%) enquanto o CPO-D médio dos não institucionalizados fixou-se em 30,17, com predomínio do componente perdido (63,70%). Também se avaliou o uso e a necessidade de prótese dentária: dos residentes na ILPI, 10,20% usavam prótese superior e 3,06%, inferior; 94,90% necessitavam de prótese superior e 97,96% de inferior; sendo a prótese total foi o tipo mais prevalente, 88,78% para ambos os arcos. O percentual do uso de prótese dos não institucionalizados foi 71,20% no arco superior, sendo 66,40% prótese total; já para o arco inferior, 32,80%, das quais 31,20% era prótese total. No presente estudo, tanto para uso quanto para necessidade, considerando ambos os arcos, a diferença entre os idosos institucionalizados e não institucionalizados foi estatisticamente significativa pelo teste Qui - quadrado (p<0,001). Como resultado do MEEM, observou-se deterioração cognitiva (escore ≤ 12) em 37,25% dos entrevistados, bem como um declínio cognitivo com o avanço da idade. Conclusões: Os resultados apontam que há um maior percentual de uso de prótese total no arco superior e maior frequência quanto à ausência de próteses de qualquer tipo no arco inferior. Evidenciou-se que os idosos pesquisados foram submetidos a tratamento mutilador e, como consequência necessitam de reabilitação oral, o que pressupõe a necessidade de políticas públicas para que isso ocorra efetivamente. Os participantes deste estudo caracterizam-se por uma autopercepção positiva da sua saúde bucal, a despeito das condições clínicas insatisfatórias e de precária saúde bucal, com acentuada prevalência de cárie dentária e edentulismo. O MEEM revelou deficiência cognitiva na maioria dos idosos, confirmando que a sua aplicação, previamente à reabilitação oral pode evitar desperdícios financeiros.Tais achados refletem a necessidade de implantação de políticas reabilitadoras em saúde bucal voltadas para o idoso; baseadas na perspectiva da integralidade como princípio doutrinário do Sistema Único de Saúde, o que redundaria numa melhor qualidade de vida, tanto pela melhor mastigação, digestão e nutrição, pelo maior aproveitamento dos alimentos, quanto pelo favorecimento à comunicação, pela dicção e fala, contribuindo para a socialização e consequente elevação da autoestima dessa clientela.

Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

Biomecânica e otimização topológica com H-adaptatividade em implantes dentários nitretados a plasma em cátodo oco

In recent years there has been a significant growth in technologies that modify implant surfaces, reducing healing time and allowing their successful use in areas with low bone density. One of the most widely used techniques is plasma nitration, applied with excellent results in titanium and its alloys, with greater frequency in the manufacture of hip, ankle and shoulder implants. However, its use in dental implants is very limited due to high process temperatures (between 700 C o and 800 C o ), resulting in distortions in these geometrically complex and highly precise components. The aim of the present study is to assess osseointegration and mechanical strength of grade II nitrided titanium samples, through configuration of hollow cathode discharge. Moreover, new formulations are proposed to determine the optimum structural topology of the dental implant under study, in order to perfect its shape, make it efficient, competitive and with high definition. In the nitriding process, the samples were treated at a temperature of 450 C o and pressure of 150 Pa , during 1 hour of treatment. This condition was selected because it obtains the best wettability results in previous studies, where different pressure, temperature and time conditions were systematized. The samples were characterized by X-ray diffraction, scanning electron microscope, roughness, microhardness and wettability. Biomechanical fatigue tests were then conducted. Finally, a formulation using the three dimensional structural topology optimization method was proposed, in conjunction with an hadaptive refinement process. The results showed that plasma nitriding, using the hollow cathode discharge technique, caused changes in the surface texture of test specimens, increases surface roughness, wettability and microhardness when compared to the untreated sample. In the biomechanical fatigue test, the treated implant showed no flaws, after five million cycles, at a maximum fatigue load of 84.46 N. The results of the topological optimization process showed well-defined optimized layouts of the dental implant, with a clear distribution of material and a defined edge

Fatores associados à condição de saúde bucal de pacientes internados em hospitais públicos do município de Natal-RN

The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition

Detecção de bactérias periodontopatogênicas cultiváveis e não cultiváveis em placas ateromatosas

Periodontal infections consist of a group of inflammatory conditions caused by microorganisms that colonize the tooth surface through the formation of dental biofilm. Chronic infections such as periodontitis have been associated to the development and progression of atherosclerosis. AIM: Detect cultivatable and non-cultivatable periodontopathogenic bacteria in atheromatous plaques; search for factors associated to the presence of these bacteria in the atheromatous plaques and characterize the presence of cultivatable and non-cultivatable bacteria in these plaques. METHODOLOGY: A cross-sectional study was performed with a sample of 30 patients diagnosed with atherosclerosis in the carotid, coronary or femoral arteries and surgically treated with angioplasty and stent implant, bypass or endarterectomy. The plaques were collected during surgery and analyzed using the PCR molecular technique for the presence of the DNA of the cultivatable bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Treponema denticola and of the non-cultivatable Synergistes phylotypes. The patients were examined in the infirmary, after the surgery, where they also responded to a questionnaire aimed at determining factors associated to the presence of periodontopathogenic bacteria in the atheromatous plaques. RESULTS: All patients with tooth (66,7%) possessed disease periodontal, being 95% severe and 65% widespread. No periodontopathogenic bacteria were found in the atheromatous plaques. However, four samples (13.3%) were positive for the presence of bacteria. Of these, three participants were dentate, being two carriers of widespread severe chronic periodontite and one of located severe chronic periodontitis. None of them told the accomplishment of procedures associated to possible bacteremia episodes, as treatment endodontic, extraction the last six months or some procedure surgical dental. CONCLUSION: The periodontopathogenic bacteria studied were not found in the atheromatous plaques, making it impossible to establish the prevalence of these pathogens or the factors associated to their presence in plaques, the detection of positive samples for bacteria suggests that other periodontal and non-periodontal pathogens be studied in an attempt at discovering the association or not between periodontal disease and/or others infections and atherosclerosis, from the presence of these bacteria in atheromas

Avaliação da desadaptação das selas de próteses parciais removíveis após 1 a 5 anos de uso

The non-adaptation of the removable partial prosthesis (RPP) base to fibromucosal tissue is caused by resorption of residual ridges (RRR). The onset of bone resorption, which occurs after tooth extraction and continues throughout life, is accelerated by local or systemic factors. Aim: Assess the degree of non-adaptation of removable partial prosthesis saddles and the factors that influence it. Methodology: A sectional study was conducted with 81 patients using RPP who had their prostheses installed between 2003 and 2007 (1 to 5 years of use) at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Norte (UFRN). After anamnese and clinical examination, a cast was made with polyether-based material, using the base of the prosthesis to make the impression. The base of the saddle was loaded with the casting material and positioned in the mouth, applying pressure on the supports. After polymerization, the material was removed from the saddle and measurements were taken at 3 different points using a pachymeter. Results: The non-adaptation of the saddle increased significantly with years of use (p = 0.005). The tooth-tissue supported prostheses obtained higher mean non-adaptation values than those of tooth supported prostheses (p < 0.001). Flaccid mucosa showed the worst non-adaptation results, which were statistically different from resilient mucosa (p < 0.001). The greater the extension of the saddle, the greater the non-adaptation (p < 0.001). The natural tooth antagonistic arch yielded better results than did RPP and total prosthesis (p < 0.001). Saddle non-adaptation at the free end was less near the pillar tooth and greater in the more posterior region (p < 0.001). When adaptation of the supports to the niches was poor, greater saddle non-adaptation occurred than when it was good or fair (p < 0.001). Saddles located in the posterior region of the arch had greater non-adaptation than those in the anterior region (p = 0.023). Conclusion: The mean non-adaptation of the saddle to the residual ridges was 0.27 mm. It can be concluded that, even with the use of RPP, bone height reduction was slight within the 1-5-year period of use. The following are factors that influence adaptation of the RPP saddle base: years of use, age, force transmission path to the alveolar bone, location of the toothless area, antagonistic arch, type of mucosa, adaptation of supports to the niche and extension of the saddle

Avaliação clínica da relação entre o índice de placa, índice gengival, alinhamento dental, mucosa ceratinizada, tipo de periodonto e distúrbios oclusais com a ocorrência de recessão gengival

This study clinically evaluated the relationship of gingival recessions with the periodontal index of gingival and plaque, dental alignment, keratinized mocous, type of periodontal, and occlusal disorders. Study participants were individuals aged between 19 and 33 years. The evaluations were performed by using questionnaires and clinical examinations. In subjects examined, the teeth were assessed and divided into groups (Molars, premolars, canines and incisors). The gingival recession were measured in the central region of the teeth and individuals were subject to disclosure to the plate and observing the poll of plaque and gingival index, respectively. 558 teeth were examined, with 24.1%, 135 had gingival recession greater than or equal to 1mm. Through the combination of tests used to evaluate the average of the recession and its relationship with the variables studied, we observed that the degree of recession of the elements assessed dental showed, almost for the most part, when higher values associated with the index plaque (p = 0.101), Gingival Index (p = 0.053), dental alignment (p = 0.962), width of keratinized mocous (p = 0.004) and type of periodontium (p = 0.033), however statistically significant difference could only be considered when related the recessions in the keratinized mocous and the type of the periodontium. Although we identify, when we evaluate the whole set of teeth that occlusal disturbances (p = 0.002) were more strongly associated with cases of gum recession that the gingival index (p = 0.006), however, these two conditions were correlated with the cases of recession, contributing to its occurrence

Avaliação de lesões brancas de cáries: um estudo de prognóstico

Objective: The aim of the present study is to assess the current situation of white enamel lesions on vestibular surfaces of permanent upper incisors, diagnosed 6 years ago, without clinical intervention. Methods: A prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by duly calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene, and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using a SPSS software. In this analysis the chi-squared test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (p = 0.003) was found between initial DMFS and prognosis of white enamel lesion. Conclusions: We observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures

Bioética e odontologia: um perfil dos problemas éticos vividos por cirurgiões-dentistas

Bioethics studies human behavior in the fields ofbiological sciences and health care. Tt strives for humanization in health services along with promoting the rights of patients. In view of the lack of dental research dealing with this topic, the present study was undertaken to identify, from the viewpoint of dental surgeons, ethical problems experienced in dental practice,understand how they occur and how professionals deal with them. It is a descriptive exploratory investigation within a qualitative approach. Empirical material was collected through semi-structured interviews performed with 15 dental surgeons who work both in private and public practice in the state of Rio Grande do Norte, Brazil. The content of the interviews was systemized and organized, resulting in the identification of topics, from which were grouped the ethical problems reported by the participants. The resu1ts indicate that many of the ethical problems coincide with infringements of the norms and mIes of the Dental Code of Ethics, confirming a dental ethic acquired during professional formation and therefore, inadequate for solving the problems that emerge in professional practice. Other questions stand out such as low salaries, competition and poor working conditions. Associated to these problems are lack of commitment and professional responsibility with the patients. Concem with maintaining user autonomy, guaranteeing access to specialized services, and the need for performing only procedures for which they are technically qualified arise in the responses, leading to difficulties in consolidating the principIes proclaimed by bioethics: autonomy, justice, nonmaleficence and beneficence. We concluded that the ethical problems identified in professional practice need to be understood beyond the dental dimension, towards a human approach. It is therefore necessary to incorporate health care management technologies into health practices, including dentistry, which implies recognizing the difTerent dimensions that surround individuaIs, that is, social, economic, political and cultural

Validação de um método auxiliar de diagnóstico como preditivo da presença de cárie de dentina em dentes decíduos

Esse estudo se propôs a avaliar um método auxiliar de diagnóstico (DIAGNOdent®) na predição de cárie de dentina em dentes decíduos, através de validação histológica e de microdureza. Verificando possíveis diferenças entre os valores obtidos através do método auxiliar, além de determinar um ponto de corte para parada de remoção de tecido cariado. A amostra do estudo foi de 15 crianças que apresentaram 21 cavidades de cárie, tratadas e analisadas desde antes da realização da restauração até quando da exodontia do elemento dentário. Os espécimes foram analisados através do DIAGNOdent® antes da abertura das cavidades, após a remoção do tecido cariado e depois da reabertura das cavidades que se deu após a exodontia dos elementos dentários. Posteriormente, receberam preparo metalográfico para realização de testes de microdureza e microscopia óptica que serviram como forma de validação para as mensurações obtidas pela fluorescência a laser. Houve diferença significativa entre os valores DIAGNOdent® encontrados antes da abertura da cavidade e os demais (p < 0,0001). Havendo correlação significativa (r = 0,432 ; p = 0,019) apenas para as aferições obtidas antes da abertura das cavidades e quando do término da remoção do tecido cariado. Para a microdureza, as médias axiais foram significativamente maiores que as pulpares, existindo correlação entre a microdureza pulpar e os valores do DIAGNOdent® após a reabertura (r = - 0,472 ; p = 0,002). Valores de 15,38% para a sensibilidade, 100% para a especificidade, 100% para o valor preditivo positivo e 71,79% para o valor preditivo negativo, foram obtidos quando se utilizou um ponto de corte de 30 para fluorescência a laser, tendo como padrão-ouro a microdureza pulpar. Partindo da média dos valores de fluorescência a laser obtidos após a remoção do tecido cariado e acrescentando-se um desvio-padrão a esta, o método indicou o valor de 19 como ponto de corte para cessar a remoção de dentina. Concluiu-se que, nas condições analisadas, o método auxiliar de diagnóstico (DIAGNOdent®) é um método acurado na predição de cárie de dentina em dentes decíduos. Além disso, o método comprovou que o padrão usual de remoção de dentina garante a remoção do tecido cariado