Clareamento interno em dentes despolpados como alternativa a procedimentos invasivos: relato de caso

The increasing interest of patients for a better aesthetic appearance of their smile, associated with the development of new materials and techniques, encouraged by media couverage of this concept of beauty, provided an important evolution of cosmetic dentistry. As the darkness of a single anterior tooth or a group of teeth, in most cases, impairs the appearance of the smile and there is growing appreciation of the less invasive procedures, the technique of tooth bleaching is an important option for aesthetic treatment. To have success in the bleaching treatment, it is important to have knowledge of the origin, nature and composition of the stain. Among the causes of color changes acquired post-eruptive, dental trauma, with or without pulp necrosis, is one of the most commonly encountered etiologies, characterized by a reddish-brown color. Current techniques of bleaching for teeth treated endodontically employ oxidative agent hydrogen peroxide. The objective of this paper is to describe the immediate technique of bleaching non-vital tooth by presenting a clinical case.

Fragment reattachment after atypical crown fracture in maxillary central incisor

Background. Fracture by trauma is one of the most common types of dental injury in the permanent dentition among children and teenagers. Aim. The aim of this study was to report the treatment performed to an atypical dental trauma case in a maxillary central incisor of a young patient by means of reattachment of the tooth fragment. Case Description. A 12-year-old male patient suffered a vertical crown fracture to the maxillary right central incisor. After clinical and radiographic examinations, a conservative restorative treatment which consisted in the reattachment of the tooth fragment with flow resin was performed in order to preserve the dental element and to obtain maximum aesthetics. Conclusion. The reattachment of fractured fragment is a fast and easy technique that can be used successfully as an option to restore dental element which suffered trauma. Clinical Significance. This technique restores the aesthetics and function of the dental element with minimal discomfort to the patient.

Conhecimento de mães sobre os procedimentos de emergência nos casos de avulsão dentária

Introduction: Despite tooth avulsion following trauma being relatively common in children, the available studies show that adults have limited knowledge about it. Aim: The purpose of this study was to assess, by a questionnaire, the mothers’ general knowledge about the immediate management of tooth avulsion. Material and method: This descriptive study was carried out on a convenient sample of mothers (n= 65) who participated of the “Pastoral da Criança”, from Araraquara, SP, Brazil. The questionnaire comprised 15 questions about personal data and knowledge on tooth avulsion management. Results: Participants were, on average, 35 years old. A total of 30.8% of the mothers reported that their children suffered dental trauma. The majority had never received advice on this subject (76.9%); and did not know how teeth are kept in the dental arch (69.2%). Almost a half of the sample believed that an avulsed tooth can be replanted (49.2%). In relation to the management of tooth avulsion, 40% of them would clean the avulsed tooth with water, even if it was not dirty (38.5%). Most of them (69.2%) would take the tooth by hand for cleaning purposes, regardless the tooth region; and believed that brushing the tooth was important to take the dirty out (67.7%). Conclusion: The general knowledge of mothers about the immediate management of tooth avulsion was considered inadequate endangering the successful treatment of tooth avulsion.

Replantation as treatment for extrusive luxation

In the treatment of extrusive luxation cases, it is important that the repositioning of extruded tooth in the socket is done as soon as possible. If this does not occur, periapical clot becomes organized and makes replantation difficult reposition. In this article the patient referred to the Clinics for dental trauma sustaining extrusive luxation of the maxillary right central incisor. The patient reported having suffered a bicycle accident 12 days before, which caused traumatic tooth injuries. The repositioning was attempted without success and an alternative form of treatment was necessary to solve the case. Intentional tooth replantation, which is the deliberate extraction of the tooth and its replantation, was indicated. This technique allows clot removal and correct repositioning of the extruded tooth. Care should be taken as endodontic treatment is required for the prevention of subsequent infection-related resorption. Intracanal dressing with calcium hydroxide was used for 30 days before final root filling. Splint, systemic antibiotics and avoidance of further damage to the root surface is also important. After 49 months, showed clinical and radiographic characteristics of normality and demonstrates the availability of this technique to adversity in trauma.

Stress distribution in delayed replanted teeth splinted with different orthodontic wires: a three-dimensional finite element analysis

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

Histological analysis of healing process after rat teeth replantation maintained in Resveratrol dissolved in dimethyl sufoxide (DMSO)

Tissue repair after replantation of avulsed teeth is directly related to the extent of damage to the cells of the periodontal ligament. Thus, immediate replantation is the treatment of choice for avulsed permanent teeth. To achieve more favorable prognostics, adequate storage media must be used to preserve periodontal ligament cells. A series of storage media are studied and show good results, such as saliva, milk, Hank's balanced solution (HBSS) and ViaSpan. However, recent studies were performed using news and promising storage media. Resveratrol has been extensively studied because of its antioxidant properties and its ability to prolong life of many organisms from yeast to mammals. One of its limitations is its poor solubility in aqueous vehicles. For this reason, the aim of this study was to evaluate the healing repair process after replantation of teeth of rats kept in Resveratrol using dimethyl sulfoxide (DMSO) as a vehicle. This study was approved by the Ethics Committee on Research with Animals, of the School of Dentistry of Araçatuba, Univ. Estadual Paulista, UNESP, Araçatuba, SP, Brazil. Were used 40 male rats, under general anesthesia upper right incisor were extracted and replanted. Treatments were done, dividing in four groups, of 10 animals each. In group I, the teeth were be extracted and immediately replanted into their sockets of origin (positive control). In group II, the teeth were immersed in 50 mL of resveratrol in DMSO (0.0512 g / ml) for 60 minutes. In group III teeth were kept for 60 minutes in 50 ml of DMSO. In group IV, the teeth were kept in dry for the same period (negative control). Then the teeth of animals in Groups II, III and IV were replanted in their sockets. Systemic antibiotics were administrated in all groups, and 60 days post-operative the animals were euthanized. The specimens were processed and stained in HE for histomorphological analysis. The results showed that resveratrol as storage media, was not able to improve the rep

Efeito da antibioticoterapia sistêmica com amoxicilina e tetraciclina no processo de reparo da injúria de luxação extrusiva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Relevant methodological issues from the SBBrasil 2010 Project for national health surveys

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Influence of children's oral health-related quality of life on school performance and school absenteeism

Objective: This study assessed the relation of child oral health-related quality of life with school performance and school absenteeism. Methods: We followed a cross-sectional design with a multistage random sample of 312 12-year-old schoolchildren living in Brazil. The participants completed the child perceptions questionnaire (CPQ1114) that provides information about psychological factors, while their parents or guardians answered questions on their socioeconomic status measured by parents' education level and household income. A dental examination of each child provided information on the prevalence of caries and dental trauma. Data on school performance, which included the results of baseline Brazilian language (Portuguese) tests, and school absenteeism (school days missed) were obtained from the school register. Multilevel linear regression was used to investigate the association among psychological and socioeconomic status and children's school performance. Results: In the multiple model, after adjusting for individual covariates, being a girl was associated with higher school performance (P < 0.05), whereas low household income (P < 0.05), higher mean of CPQ1114 (P < 0.05), and higher school days missed (P < 0.001) were identified as individual determinants of lower school performance. When the school-level covariates were included in the model, the association between subjects' level characteristics and school performance still persisted. Conclusion: Children's school performance and absence were influenced by psychological and socioeconomic conditions.

Movimento ortodôntico depois de tratamento endodôntico, inclusive com perfuração: 30 dias

Um questionamento muito frequente: qual o tempo que se deve esperar para movimentar um dente submetido a tratamento endodôntico, inclusive os de perfuração radicular? A extrapolação dos fenômenos observados em outras regiões da raiz e a fundamentação experimental com base em situações correlatas permitem afirmar que 30 dias correspondem a um período mais do que razoável para o reparo periapical estar em fase avançada de maturação e síntese. As forças ortodônticas são muito leves e dissipantes - muito mais do que o traumatismo dentário, o trauma oclusal e as forças mastigatórias normais -, e não devem interferir na patogenicidade e virulência das microbiotas envolvidas nas necroses e lesões periapicais crônicas, assim como não devem interferir nos fenômenos celulares e teciduais durante a reorganização dos tecidos apicais e periapicais.

Bleaching of nonvital teeth: a clinically relevant literature review

Today, the bleaching of nonvital, discolored teeth is a low-risk routine treatment for improving esthetics. This review article focuses on the etiology of tooth discolorations, different treatment techniques, and risks of bleaching procedures. Some tooth discolorations in endodontically treated teeth are caused by dental treatments. The three most popular techniques for nonvital tooth bleaching are the walking bleach technique, inside/outside bleaching, and in-office bleaching. The walking bleach technique is a relatively reliable, fairly simple technique for dentists and patients. Inside/outside bleaching can be used additionally when internal and external bleaching must be combined. Inoffice bleaching seems to be a short-term solution, the effects of which can largely be attributed to dehydration of the teeth. There are still some open questions concerning the bleaching agents. Improved safety seems desirable with regard to adding thiourea as a scavenger of radicals or newer materials such as sodium percarbonate. The thermocatalytic technique, insufficient cervical sealing, and high concentrations of bleaching agents should be avoided, as this can increase the risk of cervical root resorptions. Patients should be informed about the low predictability of bleaching success and the risk of recurrent discoloration. The risk of cervical root resorption should be discussed with the patient. There is a strong correlation between root resorption and dental trauma.

Prevalencia de defectos óseos en elementos dentarios con anquilosis o reabsorción por reemplazo extraídos tempranamente

En la mayoría de los casos de dientes anquilosados la opción de tratamiento aceptado ha sido la remoción quirúrgica, la cual es frecuentemente acompañada por la rotura traumática del hueso alveolar, particularmente en los casos de la presencia de una delgada tabla vestibular del maxilar. Como en la mayoría de los casos de trauma dental y reimplantación dentaria con la subsiguiente anquilosis se involucran zonas anteriores del maxilar, tales extracciones traumáticas de los dientes anquilosados pueden llevar a deformaciones estéticas de la cresta osea, las que podrían interferir en un óptimo tratamiento protético.

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Abordagem de pacientes autistas em Odontopediatria

O autismo é uma condição que faz parte de um grupo de perturbações do desenvolvimento global das funções cerebrais e que, por regra, é diagnosticada no início da infância. A dificuldade na linguagem e comunicação, o défice na interação social, as esteriotipias e os interesses específicos e comportamentos repetitivos caracterizam os indivíduos portadores desta patologia. A saúde oral das crianças autistas é geralmente precária e as necessidades de tratamento dentário elevadas. No entanto, os problemas comportamentais destes doentes fazem com que os pais não recorram às consultas de medicina dentária, outras vezes quando recorrem à consulta as dificuldades de colaboração impedem a prestação de cuidados de saúde oral adequados a estas crianças. Pretendeu-se assim, com este trabalho, realizar uma revisão sistemática de literatura científica, publicada nos últimos 15 anos, acerca dos problemas orais que atingem os pacientes autistas, e simultaneamente, compilar diretrizes de atuação clínica para orientar o médico dentista no atendimento destes doentes. Para isto, durante os meses de Outubro de 2014 a Outubro de 2015, procedeu-se a uma pesquisa bibliográfica nas bases de dados PubMed e B-on, sendo consultados também outros bancos de dados como LILACS – BIREME, SciELO, utilizando as seguintes palavras-chave: “autism”, “pediatric dentistry”, “Asperger Syndrome”, “Rett Syndrome”, “Childhood Disintegrative Disorder”, “prevalence”, “neurobiology”, “etiology”, “diagnosis”, “diagnostic criteria”, “comorbidity”, “oral health”, “dental caries”, “periodontal disease”, “oral habits”, “bruxism”, “self-injury”, “dental trauma”, “dental injury”, “malocclusion”, “behavior management techniques” separadas ou associadas pelo operador de pesquisa booleano AND. Na pesquisa foram empregues os seguintes limites: artigos publicados nos últimos 15 anos, abstract disponível, estudos em humanos e artigos e língua inglesa, francesa, portuguesa e espanhola. Desta pesquisa resultou um total de 150 artigos que foram selecionados primeiramente pelos títulos, seguidamente pela leitura dos abstracts e, finalmente, do artigo por inteiro, obtendo-se assim 95 artigos, para revisão. Foram ainda considerados artigos de referência publicados em anos anteriores, livros de texto médicos e publicações portuguesas com dados epidemiológicos sobre as Perturbações do Espetro do Autismo em Portugal. As doenças orais encontradas nas crianças autistas são semelhantes às das crianças sem qualquer perturbação mental, contudo a preferência por alimentos cariogénicos, a diminuição do fluxo salivar induzida pelos fármacos, associadas a uma pobre higiene oral, justificam uma maior prevalência de cárie. As doenças periodontais, também muito prevalentes neste grupo, desenvolvem-se em virtude da combinação da falta de hábitos de higiene oral, com os efeitos secundários de fármacos administrados a estes doentes, como os anticonvulsivantes. No seu atendimento na consulta dentária recorre-se às mesmas estratégias de orientação de comportamento aplicadas nas crianças saudáveis, para contornar os sentimentos de medo, ansiedade, desconfiança e a incapacidade de interação social, e assim evitar comportamentos de recusa durante a consulta dentária. É no entanto de salientar que os distúrbios comportamentais, o défice da comunicação e a falta de capacidades de interação social, caraterísticas do autismo impossibilitam a eficácia das técnicas de controlo do comportamento comunicativas, obrigando, muitas vezes, ao uso de técnicas de controlo de comportamento avançadas para prestação de cuidados de saúde oral com eficácia e em segurança. É importante uma grande motivação de pais/responsáveis para a saúde e higiene oral das crianças com Perturbações do Espetro do Autismo, e que todos os profissionais de saúde envolvidos no cuidado destes doentes contribuam para a aprendizagem de comportamentos que promovam a saúde oral destes doentes.