Sensibilidade do colo dental. Uma nova alternativa terapêutica.

The cervical hypersensitivity tooth was analysed and treated by application of a varnish with high fluoride ions content (Duraphat) and of a glass ionomer cement usually indicated to cavity lining (XR-ionomer-Kerr). This technique was applied in sixty-seven teeth of Clinic Graduation patients (Faculdade de Odontologia de Araçatuba) and demonstrated a high index of satisfactory results. The clinical findings of this study relate that, this technique is more one method of choose by clinicians.

Presença de detritos na região apical de dentes de cães apos o preparo biomecánico com ou sem o emprego de substância auxiliar cremosa.

The subject of this work is to observe if the employment of a cream (ENDO-PTC) during the root canal preparation contributes or not to the condensation of debris in the apical region. Twenty root canals of dogs teeth were divided into two experimental groups: in the first one, the biomechanical preparation was carried out up to the n. 50 Kerr file by using irrigation and aspiration with sodium hypochlorite. In the second experimental group the canal negotiation was done in the same way but using a cream (ENDO-PTC) with sodium hypochlorite as a lubrication substance. A final irrigation and aspiration with sodium hypochlorite was also done in this group. The animal was killed and the pieces prepared for histological analysis. The histological results show us that the employment of a cream during the negotiation of the root canal contributes to a higher condensation of debris in the apical area.

Radiographic and microbiologic evaluation of posttreatment apical and periapical repair of root canals of dogs' teeth with experimentally induced chronic lesion

The objective of the present study was to evaluate radiographically and bacteriologically apical and periapical repair in dogs' teeth with induced chronic periapical lesions with the use of two different operative techniques (techniques 1 and 2). The study was conducted on 40 root canals of upper and lower premolars from two dogs aged approximately 12 months. Periapical lesions were induced by leaving the root canals exposed to the oral environment for 5 days and then sealing them with zinc oxide-eugenol for 45 days. After this period, radiographic examination revealed the occurrence of a radiolucent lesion and endodontic treatment was started. The two techniques did not differ in terms of chemomechanical preparation, final filling, or type of cement, but differed in terms of irrigating solution and the presence of an antibacterial dressing. Thus 4% to 6% hypochlorite and hydrogen peroxide (10 volumes) were used in technique 1 during chemomechanical preparation and an antibacterial dressing based on calcium hydroxide was applied between sessions, whereas Dakin's fluid (0.5% sodium hypochlorite solution) and a final filling with no antibacterial dressing were used in technique 2. After chemomechanical preparation, the root canals were filled with gutta-percha cones and Sealapex (Sealapex-Sybron, Kerr, Sao Paulo, Brazil), and the animals were killed 270 days after the final filling. Blocks were cut into 6-μm sections and stained by the Brown and Brenn method. Radiographic, histomicrobiologic and statistical analysis permitted us to conclude the following: radiographically there was a marked reduction or even the disappearance of the radiolucent area present before treatment with greater success in the group treated with technique 1 (group I) than in the group treated with technique 2 (group II); the extent of bacterial invasion of dentinal tubules was greater and more intense in group II than in group I; and the amount of microorganisms detected in the ramifications of the apical delta and in the lumen of the root canal was intense in group II and mild or absent in group I. © 1994.

Disfagia e alterações emocionais

Swallowing function may be impaired by a number of conditions involving primary or associated emotional distress. When psychogenic dysphagia is suspected, routine investigation using radiological and manometric examination is inappropriate. These cases demand an evaluation of the individual as a whole, interesting the disease as well as the patient's personal problems and concerns. Five cases of patients complaining of swallowing difficulty and showing concurrent emotional distress were studied. Four individuals were anxious and one was depressed. Because of our approach, a close medical-patient-relationship was established. Afterwards, an explanation about the normal swallowing mechanisms and the role of the emotions on it was provided. All patients showed improvement of the symptom in the following 24 hours. Dysphagia can be found in anxiety, depression and conversion hysteria, with high incidence in the urban population of the third world countries. However, several professionals are unaware of these disorders. Our results suggest that this plain approach is an useful tool in managing dysphagic patients and it has validity even in individuals bearing dysphagia due to comproved organic disease. The results also emphasize the importance of the medical patient relationship and the utility of a hollistic evaluation of the disease.

Um programa de saúde mental: A experiência do Projeto UNI de Botucatu

The aim of this paper was to assess the Projeto UNI (Kellogg Foundation) in one of the Mental Health Centers (ARE) of Botucatu, SP, Brazil. We analysed 20% of the charts and the number of patients seen by psychiatrists and other mental health professionals before and after. Our results showed that: 1) the service users were mainly of neurotic patients (anxious, dysthymiacs, ICD-9 V code), followed by psychotics (schizophrenics, affectives) and organics (epileptics, mental deficients, demented patients); 2) there were more treatment options after the Projeto UNI implementation and over 2,495 group consultations were made in one year (as opposed to 90 in the year prior the project); 3) medical and nurse students are evaluating the program favourably; 4) there is a clear necessity of reassessing and changing some prescription practices: 43% of the patients were taking drug associations, there was an excessive use of benzodiazepines (54%) and low use of mood stabilizers (5%). There is also a need for more availability of depot neuroleptics, other antidepressants and better quality psychotropic drugs, and 5) there is a necessity of improving quality and quantity of charts information.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Abuso sexual, transtornos mentais e doencas fisicas

Objective: to review and describe the different organic and psychic consequences of sexual abuse. Methodology: 71 papers were sorted in a ten-year literature search (1987-1997) in MedLine and Lilacs (South American Literature Index), besides 14 books in the subject. Results: sexual abuse is much less frequent (or less reported) in Brazil: 7% of the population, while in the USA the prevalence is 12.9% to 28% of women and 2% to 9% of men. Results showed women being more frequently sexually abused but less differences in physical abuse were found between genders. There was a significant association between sexual abuse and the following: eating disorders, depression, irritable bowel, chronic pain (mainly pelvic), neurological, rheumatic and venereal disorders. This association was not observed in chronic constipation, Chron disease and dissociative disorders. Conclusions: although it is important to think of sexual/physical abuse as a predisposing factor to several illnesses, caution is necessary specially in cultures with different moral and ethical values. Research in this subject in Brazil should be conducted with patients in treatment, using control groups, in order to take advantage of the existing rapport. It would be also quite important to separate acute and chronic abuse effects, as well as getting to know the meaning of the experienced abuse to each person.

Adaptação para o Português do questionário de auto-avaliação de percepção de saúde física e mental da mulher de meia-idade - Questionário da Saúde da Mulher

The objective of this study is to translate to Brazilian Portuguese, and validate (criterion) it to the Brazilian population, the Women's Health Questionnaire (WHQ), questionnaire was developed by Hunter (1992) in order to evaluate physical and mental symptoms, which were experienced by women, along their climacteric transition. A sample of 63 women, from 45 to 65 years old, was selected from the HC-UNESP staff and HC-Community Health School Center users. The WHQ and the General Health Questionnaire - GHQ (Goldberg-1972 - 60 items) were answered by all of them. The GHQ was used as reference. Pearson correlation coefficient, sensitivity and specificity were calculated for assessing the validity of the questionnaire. Cut-off points were determined in the WHQ by linear regressions (the reference was GHQ's cut-off points - higher than 2). Outcomes highlighted a general index of sensitivity of 0.83, specificity of 0.87, and correlation of - 0.82 and reliability of 0.89. The study sample does not portray the general population because the persons interviewed had high level of education. As the WHQ is easy to be applied and analyzed, it could be used in general, gynecologic, oncology and psychiatric practice.

Energy and angular momentum of the gravitational field in the teleparallel geometry

The Hamiltonian formulation of the teleparallel equivalent of general relativity is considered. Definitions of energy, momentum and angular momentum of the gravitational field arise from the integral form of the constraint equations of the theory. In particular, the gravitational energy-momentum is given by the integral of scalar densities over a three-dimensional spacelike hypersurface. The definition for the gravitational energy is investigated in the context of the Kerr black hole. In the evaluation of the energy contained within the external event horizon of the Kerr black hole, we obtain a value strikingly close to the irreducible mass of the latter. The gravitational angular momentum is evaluated for the gravitational field of a thin, slowly rotating mass shell. © 2002 The American Physical Society.

Atividades psiquiátricas no campo dos transtornos devidos ao uso de substâncias psicoativas

There are a large number of institutions, proposals and publications in the field of disorders resulting from the use of psychoactive substances. There is no corresponding progress in results obtained in clinical treatments. Concepts and appropriate points of view are indispensable. The vision of the world drug addicts is not only determined by the biochemical effects of intoxication, but also by the experience they go through, by their own way of living. By accepting such postulate, we may conceptualize the problem, thus benefiting research studies and more efficient treatments. Preventing intoxication, upon the onset of dependence, depends on educational, social, legal and other measures, which can neither be studied nor practiced by medicine.

Psychiatric disorders and psychiatric consultation in a general hospital: A case- control study

Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD- 10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Polymerization shrinkage evaluation of three packable composite resins using a gas pycnometer.

Modern restorative dentistry has been playing an outstanding role lately since composite resins, allied to adhesive systems, have been widely applied on anterior and posterior teeth restorations. The evolution of composite resins has mostly been verified due to the improvement of their aesthetic behavior and the increase in their compressive and abrasive strengths. In spite of these developments, the polymerization shrinkage inherent to the material has been a major deficiency that, so far, has been impossible to avoid. Using a gas pycnometry, this research investigated the polymerization shrinkage of three packable composite resins: Filtek P60 (3M), Prodigy Condensable (Kerr), and SureFil (Dentsply/Caulk), varying the distance from the light source to the surface of the resins (2 mm or 10 mm). The pycnometer Accupyc 1330 (Micromeritics, USA) precisely records helium displacement, allowing fast and reliable measurements of the volume of composite resin immediately before and after polymerization, without interference of temperature or humidity. Results were not found to be statistically different for the three tested resins, either for 2 mm or 10 mm-distance from the light source to the composite surface.

Surface roughness of packable composite resins polished with various systems

Purpose: The aim of this study was to evaluate the surface roughness of four packable composite resins, SureFil™ (Dentsply, Petrópolis, Rio de Janeiro, Brazil), Prodigy Condensable™ (Kerr Co., Orange, CA, USA), Filtek P60™ (3M do Brasil, São Paulo, Brazil), and ALERT® (Jeneric/Pentron, Inc., Wallingford, CT, USA) and one microhybrid composite resin (Filtek Z250™, 3M do Brasil) after polishing with four finishing systems. Materials and Methods: Twenty specimens were made of each material (5 mm in diameter and 4 mm high) and were analyzed with a profilometer (Perthometer® S8P, Perthen, Mahr, Germany) to measure the mean surface roughness (Ra). The specimens were then divided into four groups according to the polishing system: group 1 - Sof-Lex™ (3M do Brasil), group 2 - Enhance™ (Dentsply), group 3 - Composite Finishing Kit (KG Sorensen, Barueri, São Paulo, Brazil), and group 4 - Jiffy Polisher Cups® (Ultradent Products, Inc., South Jordan, UT, USA). The specimens were polished and then evaluated for Ra, and the data were subjected to analysis of variance, analysis of covariance, and Tukey's test (p = .05). Results: The mean Ra of SureFil polished with Sof-Lex was significantly lower than that of KG points. Prodigy Condensable polished with Enhance showed a significantly less rough surface than when polished with Sof-Lex. Filtek P60 did not exhibit a significant difference with the various polishing systems. For ALERT the lowest mean Ra was obtained with Sof-Lex and the highest mean Ra with KG points. Regarding Filtek Z250, polishing with KG and Jiffy points resulted in a significantly lower mean Ra than when polished with Enhance. Conclusions: Packable composite resins display variable roughness depending on the polishing system used; the Sof-Lex disks and Jiffy points resulted in the best Ra values for the majority of the materials tested.

Scanning electron microscope analysis of internal adaptation of materials used for pulp protection under composite resin restorations

Purpose: The aim of this study was to evaluate the interfacial microgap with different materials used for pulp protection. The null hypothesis tested was that the combination of calcium hydroxide, resin-modified glass ionomer, and dentin adhesive used as pulp protection in composite restorations would not result in a greater axial gap than that obtained with hybridization only. Materials and Methods: Standardized Class V preparations were performed in buccal and lingual surfaces of 60 caries-free, extracted human third molars. The prepared teeth were randomly assessed in six groups: (1) Single Bond (SB) (3M ESPE, St. Paul, MN, USA); (2) Life (LF) (Kerr Co., Romulus, MI, USA) + SB; (3) LF + Vitrebond (VT) (3M ESPE) + SB; (4) VT + SB; (5) SB + VT; (6) SB + VT + SB. They were restored with microhybrid composite resin Filtek Z250 (3M ESPE), according to the manufacturer's instructions. However, to groups 5 and 6, the dentin bonding adhesive was applied prior to the resin-modified glass ionomer. The specimens were then thermocycled, cross-sectioned through the center of the restoration, fixed, and processed for scanning electron microscopy. The specimens were mounted on stubs and sputter coated. The internal adaptation of the materials to the axial wall was analyzed under SEM with × 1,000 magnification. Results: The data obtained were analyzed with nonparametric tests (Kruskal-Wallis, p ≤ .05). The null hypothesis was rejected. Calcium hydroxide and resin-modified glass ionomer applied alone or in conjunction with each other (p < .001) resulted in statistically wider microgaps than occurred when the dentin was only hybridized prior to the restoration. ©2005 BC Decker Inc.