Avaliação de usuários da atenção básica sobre a implantação de protocolo de assistência integral odontológica

Objective: To evaluate the perception of basic attention healthcare users as to the implantation of the Integral Dental Assistance Protocol (PAIO, in Portuguese) and the effect of this program on the oral health condition, oral hygiene, access to and resolubility of the service, in a public basic health unit of João Pessoa-PB. Method: The sample was composed of 32 volunteers, for whom a sixphase intervention was programed: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the health level obtained; and periodic follow-up visits. Data were collected by means of a semistructured interview and a questionnaire, applied before and after PAIO implantation. The interviews were transcribed and analyzed according to the content analysis technique. The effect of PAIO implantation was evaluated by using an increasing scoring system ranging from 1 to 10. The Wilcoxon test was applied with a confidence level of 95%. Results: For the participants that attended the PAIO (n=20), the program contributed to improve oral health condition (100%) and knowledge (100%). The users reported satisfaction (n=12) and had a positive evaluation (n=12), achieved by means of the improvement of oral health condition (n=8), faster and easier access to treatment (n=7), scheduling of dental appoints and warrant of being treated (n=6), welcoming (n=5), motivation for oral care (n=5), and perspective of continuity of PAIO (n=6). The initial evaluation of the users received scores between 5.7 and 7.6. After PAIO implantation, the users' perception was improved (p<0.01), with scores between 9.6 and 9.9. Conclusion: According to the users, the implantation of PAIO contributed to the qualification of health service and oral health care, being a favorable aspect to increase the access to and resolubility of the service.

Daily biofilm control and oral health: Consensus on the epidemiological challenge-Latin American Advisory Panel

Our understanding of dental plaque biofilm has evolved since the nonspecific plaque hypothesis that considered plaque as a nonspecific mass of native microorganisms that, because of lack of oral hygiene, builds up in proportions great enough to overcome the host resistance threshold and affect the tooth structure and tooth supporting tissues. A great diversity of microorganisms-over 700 species-was detected in the oral cavity, and evidence shows that the investigation of specific microorganisms or associations of microorganisms as etiological agents for periodontal diseases and caries is not a simplistic approach. Although clinical evidence shows that oral mechanical hygiene is fundamental to prevent and control caries and periodontal disease, it is important to highlight that optimal control is not achieved by most individuals. Thus the complementary use of chemotherapeutic agents has been investigated as a way to overcome the deficiencies of mechanical oral hygiene habits, insofar as they reduce both plaque formation and gingival inflammation, and represent a valid strategy to change the biofilm and maintain dental and periodontal health. The role of the dental professional is to monitor patients and offer them the best recommendations to preserve oral health throughout their life. With this in mind, chemical control should be indicated as part of daily oral hygiene, together with mechanical procedures, for all individuals who present supragingival and/or subgingival biofilm, taking into account age, physical and/or psychological limitations, allergies, and other factors.

Características epidemiológicas relativas à doença dental e infecção por Helicobacter pylori na cavidade oral de estudantes em Belém-Pará

A infecção pela Helicobacter pylori é uma das mais comuns em humanos e apesar de possuir tropismo pelo estômago, pode ser encontrada na cavidade oral, mantendo uma relação comensal com o hospedeiro, enquanto a cárie dental também é uma doença infecciosa e resulta do metabolismo da placa bacteriana. Ambas as infecções apresentam alta prevalência em países em desenvolvimento, pois estas populações estão mais expostas a fatores ambientais de risco, e normalmente são adquiridas durante a infância. A prevalência destas infecções foi investigada na cavidade oral de escolares assintomáticos para doenças gástricas, provenientes de uma população de Belém-Pa, relacionando-se a alguns parâmetros de higiene e saúde bucal, condição socioeconômica e fatores de susceptibilidade genética como os grupos sanguíneos ABO e Lewis. Foram investigados 104 indivíduos, com idade média de 17 anos. De todos os participantes foram coletadas amostras de saliva e placa dental. A saliva foi coletada para identificação do estado secretor ABO e Lewis e estimação dos parâmetros salivares, e ambas, saliva e placa dental, foram coletadas para analise molecular dos genes 16S RNAr da H. pylori e FUT2. A H. pylori foi detectada em 79,8% dos escolares, com freqüência de 66,35% na placa dental e 58,65% na saliva. A prevalência de cárie foi de 82,8% na população estudada. A avaliação clínica da saúde bucal mostrou que o CPO-D médio encontrado foi de 3,53. Observou-se que a experiência de cárie tende a aumentar à medida que acresce a idade e que a infecção por H. pylori foi maior na primeira infância. O grau de instrução e o número de visitas ao dentista mostraram diferenças significantes em relação a presença de H. pylori. A distribuição fenotípica dos grupos sanguíneos ABO e Lewis não mostrou diferenças significantes entre indivíduos infectados e não-infectados, que expliquem haver maior susceptibilidade genética para infecção por H. pylori e cárie dental. No conjunto desta analise as elevadas freqüências encontradas denotam a necessidade de cuidados e tratamento das doenças dentais, como a cárie e sugere-se que a H. pylori na cavidade oral pode contribuir para a infecção e re-infecção do estômago após tratamento.

Saúde bucal de pacientes com desordens neurológicas e nutrição enteral: análise microbiológica, bioquímica e protocolo de prevenção

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Plaque control improves the painful symptoms of oral lichen planus gingival lesions. A short-term study

BackgroundLichen planus is a mucocutaneous disease with manifestation in the oral mucosa, the gingiva being one of the most affected regions. In some cases, the lesion may be painful and lead to fragility of the tissues, so that precise diagnosis and adequate treatment are indispensible factors for improving the clinical condition. The aim of this study was to evaluate the effectiveness of plaque control in the improvement of clinical features and painful symptoms of oral lichen planus with gingival involvement.MethodsTwenty patients diagnosed with gingival lichen planus confirmed by histopathological examination were selected. The patients were evaluated by a trained examiner, with regard to the clinical features of the lesions [Index of Escudier etal. (Br J Dermatol, 157, 2007, 765)]; painful symptoms (Visual Analog Scale); and periodontally, as regards the visible plaque and gingival bleeding indices. Periodontal treatment consisted of supragingival scaling and oral hygiene instruction, with professional plaque removal afterward for a period of 4weeks. The entire sample was evaluated at the baseline and at the conclusion of treatment, and the results were analyzed by the Wilcoxon nonparametric test.ResultsThe data demonstrated that the majority of patients were women (90%), with a mean age of 55.9years. Periodontal treatment resulted in statistically significant reduction (P<0.05) in the periodontal indices, with consequent improvement in the clinical features and painful symptoms of the lesions.ConclusionsIt was demonstrated that plaque control was effective in improving the clinical features and painful symptoms of oral lichen planus with gingival involvement.

In-Office dental bleaching efficacy assessment in function of the light exposure regime by digital colometric reflectance spectroscopy

In-office dental bleaching has been subject of several studies. Generally those studies quantify through visual analysis, the shade reduction of the teeth submitted to different bleaching protocols (light sources, bleaching agent concentrations and irradiation time). The objective of this work is the determination of the influence of four irradiation protocols on the obtainment of better aesthetic results using a colorimetric spectrophotometer that quantifies color changes in each situation imposed. Forty bovine incisors were selected in function of similar anatomic characteristics; a concentrated coffee solution was used to stain the teeth. A commercial spectrophotometer was used to measure the color changes during evolution of the experiment (stain and bleaching phases) and the obtained data was analyzed by the ANOVA test. The obtained data showed the evolution of teeth color during the staining period, as well as, the color reduction that each bleaching protocol achieved. Based on our findings it is possible to conclude that bleaching protocols with larger irradiation periods did not showed significant differences when compared with shorter irradiation protocols, in that way the use of protocols with 30 min or more of consecutive irradiation are not clinically justified and also can cause several side effects.

Oral cleft research: intraobserver agreement in the use of questionnaires.

In epidemiological studies, when the data is collected by interview, it is of importance to analyse the reliability of the information. This study was carried out with the purpose of examining the self-agreement of mothers in answering questions about variables of interest in oral cleft researches on two different occasions. A sample of 91 mothers of oral cleft babies were interviewed on two different occasions. The capacity of giving the same answer to questions related to heredity, type of clefts, period of gestation of the mother and birthweight were studied. The statistics type kappa (k) and intraclass correlation coefficient (r) by point and by 95% of confidence interval were applied. The intra-observer agreement for the variables history of oral clefts in the family, type of cleft, period of gestation of the mother and birthweight of the newborn was, respectively, k=0.9492, k=1.0000, k=0.9281 and r=0.9996. We concluded that the background on oral cleft in the family history of patients with this anomaly is a variable with an excellent degree of reliability. Also, the information given by the mothers related to the period of gestation, type of the baby’s cleft and birthweight are reliable.

Aumento de gengiva queratinizada em mucosa peri-implantar

Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation.

Manutenção em próteses implantossuportadas: higiene oral

The maintenance of Implant-supported Prosthesis is essential to the success of dental implants. Therefore, the aim of the study was to conduct a review the literature addressing maintenance Implant-Supported Prosthesis in order to guide planning for the longevity of oral rehabilitation. We conducted a detailed search strategy for the Pubmed / Medline Dentistry and Oral Science, used as descriptors: “Oral Hygiene“ and “Dental Implant until July, 2013. The results were grouped together in topics (Clinical Exam and Oral Hygiene) and discussed. Conclusion: A regular maintenance program for oral patient implantprosthesis is essential to the longevity of the treatment. Different methods and devices are effective for cleansing. However one orientation (in writing) must be offered to patients, since inadequate cleaning can create regions of abrasion on the surfaces of abutments and dental implants.

Oral Lesions in Renal Transplant

To prevent rejection of kidney transplants, patients must be kept in immunosuppressive therapy for a long time, which includes the use of drugs such as cyclosporine, azathioprine, cyclophosphamide, and prednisone. The action of these drugs reduces the general immune response of transplant patients and thus increases their susceptibility to infections. Moreover, these drugs increase the potential of developing lesions. Therefore, oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. The aim of this study was to investigate oral lesions in a group of 21 kidney transplant patients under immunosuppressive therapy attended during a 1-year period in the Nephrology Department of the Federal University of Sergipe, Brazil. Data related to sex, age, etiology of renal disease, types of renal transplant, time elapsed after transplantation, immunosuppressive treatment, use of concomitant agents, and presence of oral lesions were obtained. All patients received a kidney transplant from a living donor, and the mean posttransplantation follow-up time was 31.6 months; 71.5% used triple immunosuppressive therapy with cyclosporine A, azathioprine, and prednisone. Ten patients were also treated with calcium-channel blockers. Of the 21 transplant patients, 17 (81%) presented oral lesions. Gingival overgrowth was the most common alteration, followed by candidiasis and superficial ulcers. One case of spindle cell carcinoma of the lower lip was observed. Oral cavity can harbor a variety of manifestations related to renal transplantation under immunosuppressive therapy.

Influence of Roux-en-Y Gastric Bypass Surgery on Vitamin C, Myeloperoxidase, and Oral Clinical Manifestations: A 2-Year Follow-Up Study

Background: Bariatric surgery influences the intake and absorption of nutrients. The serum concentrations of vitamin C, myeloperoxidase (MPO) and oral clinical manifestations were examined in patients two years after Roux-en-Y gastric bypass (RYGB). Methods: Clinical prospective-study with control-group (CG; n = 26), assessed only once, and the bariatric-group (BG; n = 26), assessed in the basal period and at 12 and 24 months after surgery. The mean ages in the CG and BG were 37.8 +/- 1.51 and 39.6 +/- 1.93 years, respectively, and their body mass indices were 22.07 +/- 0.29 and 45.62 +/- 1.46 kg/m2, respectively. Results: At 12 months after surgery, increased episodes of vomiting (P < .001) and dental hypersensitivity (P=.012) were observed, with a reduction in the saliva buffering capacity of 21.3 2.9% (P=.004). At 24 months after RYGB, we detected a significant reduction in serum vitamin C (32.9 +/- 5.3%, P < .001) and MPO values were higher than in the basal period (P = .032). With regard to oral hygiene habits, 92.3% of patients reported frequent tooth brushing and 96.1% used fluoride, which were similar across the two years. However, dental hypersensitivity (P = .048) was significantly increased than baseline. Conclusions: The results demonstrated that vitamin C deficiency and increased vomiting after RYGB for morbid obesity may contribute to increased periodontal disease. The fact it is impossible to determine which factors (diet, poor compliance with supplementation, vomiting, poor oral hygiene) contributed to the dental problems in these patients is a shortcoming of the report. (Nutr Clin Pract. 2012; 27: 114-121)

Microbiota in the oral subgingival biofilm is associated with obesity in adolescence

To test the hypothesis whether microbiota in oral biofilm is linked with obesity in adolescents we designed this cross-sectional study. Obese adolescents (n = 29) with a mean age of 14.7 years and normal weight subjects (n = 58) matched by age and gender were examined with respect to visible plaque index (VPI%) and gingival inflammation (bleeding on probing (BOP%)). Stimulated saliva was collected. They answered a questionnaire concerning medical history, medication, oral hygiene habits, smoking habits, and sociodemographic background. Microbiological samples taken from the gingival crevice was analyzed by checkerboard DNA-DNA hybridization technique. The sum of bacterial cells in subgingival biofilm was significantly associated with obesity (P < 0.001). The link between sum of bacterial cells and obesity was not confounded by any of the studied variables (chronic disease, medication, VPI%, BOP%, flow rate of whole saliva, or meal frequency). Totally 23 bacterial species were present in approximately threefold higher amounts, on average, in obese subjects compared with normal weight controls. Of the Proteobacteria phylum, Campylobacter rectus and Neisseria mucosa were present in sixfold higher amounts among obese subjects. The association between obesity and sum of bacterial cells in oral subgingival biofilm indicates a possible link between oral microbiota and obesity in adolescents.

Short-term effects of hygiene education for preschool (kindergarten) children: a clinical study

AIM: To evaluate the outcomes of short (15 minutes) oral hygiene vs. hand hygiene education for preschool children 4 weeks after these interventions. MATERIALS AND METHODS: Sixty-one preschool children (age range 4-6 years) attending four kindergarten classes participated in a 15-minute health education programme on the importance of body cleanliness for general health. In addition, specific instructions on oral hygiene were provided for two randomly selected classes (30 children), while the remaining two classes (31 children) were given instruction of hand and nail cleaning. The oral hygiene status was assessed usingthe plaque control record (PCR). The cleanliness of the hands and fingernails was determined using a hand hygiene index (HHI) and a nail hygiene index (NHI). All three parameters were assessed before the intervention as well as 4 weeks thereafter. RESULTS: Four weeks after education, the PCR had improved for all children from 79.95% to 72.35% (p < 0.001). The NHI had improved from 74.91% to 61.71% (p < 0.001). In addition, the mean PCR of the children given oral hygiene instruction decreased from 83.67% to 72.40%, while the mean PCR of the children given hand and nail cleaning instruction decreased from 76.23% to 72.29% (interaction effect 'time x type of instruction': p = 0.044). Girls' PCR improved significantly more than boys' PCR (Girls, 80.98 vs. 69.71; boys, 78.33 vs. 75.31; p = 0.021). CONCLUSIONS: The results of the study show that even a short, school-based educational intervention at an early age may affect children's oral health promotion significantly. Teachers should, therefore, be encouraged to educate children from an early age about oral hygiene promotion.

Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants

OBJECTIVES: To assess the bleeding on probing (BOP) tendency and periodontal probe penetration when applying various probing forces at implant sites in patients with a high standard of oral hygiene with well-maintained peri-implant tissues. MATERIAL AND METHODS: Seventeen healthy patients with excellent oral hygiene in a maintenance program after having been treated for periodontitis or gingivitis were recruited. Missing teeth had been replaced using oral implants. The BOP and probing depth (PPD) were assessed at the mid-buccal, mid-oral, mesial and distal aspects of the buccal surfaces of each implant. Moreover, contralateral teeth were designated and assessed for BOP and PPD in the same locations and at the same observation visits. At each visit, implants and contralateral teeth were randomly assigned to one of the standardized probing forces (0.15 or 0.25 N). The second probing force was applied at the repetition of the examination 7 days later. RESULTS: Increasing the probing pressure by 0.1 N from 0.15 N resulted in an increase of BOP percentage by 13.7% and 6.6% for implants and contralateral teeth, respectively. There appeared to be a significant difference of the mean BOP percentage at implant and tooth sites when a probing pressure of 0.25 N was applied. A significantly deeper mean PPD at implant sites compared with tooth sites was found irrespective of the probing pressure applied. CONCLUSIONS: The results of the present study demonstrated that 0.15 N might represent the threshold pressure to be applied to avoid false positive BOP readings around oral implants. Hence, probing around implants demonstrated a higher sensitivity compared with probing around teeth.

A systematic review examining the relationship between oral health care practices and the oral lesions commonly associated with HIV/AIDS, and the implications for people living in developing countries

Oral lesions, which may be bacterial, fungal or viral in nature may be characteristic of HIV/ AIDS, and have been observed on the oral mucosa as early signs of underlying disease. Some studies have suggested that there may be a correlation between poor oral hygiene, and the oral lesions seen among people living with HIV/AIDS.^ The objective of this study was to assess the nature of the relationship between oral health care practices, and the occurrence of oral lesions commonly seen in association with HIV/AIDS. A systematic review of the literature was conducted, and the databases searched were Medline and PubMed. Concepts that made up the search were oral hygiene promotion, HIV/AIDS and oral health care. Out of the 410 items identified through the search, only 11 met the inclusion criteria.^ The use of 0.12%–2% chlorhexidine gluconate, was found to be effective in reducing oral Candida counts in some studies, while other studies did not find such an association. However, 0.12%–2% chlorhexidine gluconate was consistently found to be effective in the management of periodontal lesions in people infected with HIV/AIDS. ^ Dental procedures such as treatment and filling of dental cavities, scaling and polishing, and use of fluoridated tooth paste were also found to be effective in the management of oral lesions seen in association with HIV/AIDS.^ The overall findings from the studies reviewed, suggest that effective oral health care may be necessary to reduce the morbidity, and mortality associated with the oral lesions seen among people living with HIV/AIDS. However, better designed studies with larger sample sizes need to be developed in order to ascertain the effectiveness of routine oral hygiene, and health care practices among people living with HIV/AIDS.^