Atenção odontológica no Programa de Saúde da Família de Campos dos Goytacazes

Durante décadas, a política de saúde bucal no Brasil foi centrada na prestação de assistência à doença, e ainda hoje grande parcela da população brasileira não tem acesso a cuidados odontológicos. Pela Portaria nº 1.444, de 28 de dezembro de 2000, o Ministério da Saúde estabelece incentivo financeiro para a reorganização da atenção à saúde bucal aos municípios. Insere-se, assim, a Odontologia no programa e, conseqüentemente, a possibilidade de ampliar e reorientar a atenção odontológica no Brasil. Dentro desse contexto, este estudo teve por objetivo avaliar a situação da equipe de saúde bucal inserida no Programa de Saúde da Família (PSF) do município de Campos dos Goytacazes - RJ, em 2002. Os resultados demonstraram algumas limitações na inclusão e funcionamento da Odontologia no PSF da cidade. A atenção odontológica deve ser inserida no PSF, atendendo aos princípios básicos do Plano de Reorganização das Ações de Saúde Bucal na Atenção Básica, proposto pelo Ministério da Saúde, e à consolidação do Sistema Único de Saúde.

Nível de conhecimento dos cirurgiões-dentistas de São José dos Campos sobre o uso de anti-inflamatórios não esteróides

A prescrição abusiva de medicamentos na odontologia constitui um desafio aos programas de saúde pública que visam corrigir a prescrição inadequada de fármacos. Os anti-inflamatórios não esteróides (AINE) podem alteram a eficácia dos anti-hipertensivos, elevando a pressão arterial, sobretudo em pacientes idosos e/ou com hipertensão arterial sistêmica (HAS). O objetivo foi avaliar o nível de conhecimentos dos cirurgiões-dentistas (CD) da rede pública da saúde da Prefeitura Municipal de São José dos Campos (PMSJC) sobre a prescrição de AINE a pacientes com HAS. Trata-se de estudo descritivo, realizado por meio de questionário aplicado aos 92 CD da PMSJC. Os resultados foram analisados estatisticamente utilizando-se os testes de Wald e de Fisher. A associação entre as variáveis foi estudada por meio da razão de chances (OR) com p-valor<0,05. Os resultados mostraram que o nível de conhecimento para a prescrição de AINE para pacientes com HAS foi insuficiente e as interações medicamentosas entre AINE e anti-hipertensivos são desconhecidas pela quase totalidade da amostra. Concluiu-se que os cursos de atualização em odontologia não estão suprindo as necessidades dos CD no âmbito da farmacoterapia.

Utilização de auxiliares odontológicos em Ortodontia: implicações éticas e legais

INTRODUÇÃO: o mercado de trabalho tem se mostrado saturado de profissionais atuando nos grandes centros urbanos e, por este motivo, as estratégias de produtividade são imprescindíveis. A delegação de funções aos auxiliares odontológicos tem se tornado vital e corriqueira para aqueles que exercem a Ortodontia. OBJETIVO: conhecer o perfil do cirurgião-dentista especialista nesta área e as funções delegadas por ele à equipe auxiliar. METODOLOGIA: foi aplicado um questionário a todos os especialistas em Ortodontia e Ortopedia Facial inscritos no Conselho Regional de Odontologia de Goiás, com atividade em Goiânia e Aparecida de Goiânia. RESULTADOS E CONCLUSÃO: os resultados demonstraram que os ortodontistas, de um modo geral, aproveitam bem a mão-de-obra auxiliar chegando até a ultrapassar os limites ético-legais.

Percepção dos auxiliares odontológicos na clínica ortodôntica quanto aos seus limites de atuação profissional

INTRODUÇÃO: numa época em que o mercado odontológico exige que os serviços prestados possuam qualidade diferenciada, a utilização adequada de profissionais auxiliares constitui uma ferramenta importantíssima para se obter aumento de produtividade no consultório. Para tanto, a correta utilização dessa ferramenta exige que a equipe auxiliar seja tecnicamente capacitada e envolvida num ambiente onde as funções delegadas estejam fundamentadas nos preceitos éticos e nas bases legais que regem a profissão. OBJETIVO: identificação do perfil técnico da equipe auxiliar, analisando-se a percepção destes profissionais quanto ao seu papel nas atividades pertinentes à clínica ortodôntica, com base na legislação vigente. METODOLOGIA: o presente levantamento foi desenvolvido com base num questionário aplicado a todos os profissionais que auxiliam diretamente os ortodontistas regularmente inscritos no CRO-GO, que atendem nas cidades de Goiânia e Aparecida de Goiânia (GO), no período de maio a julho de 2003. RESULTADOS E CONCLUSÕES: verificou-se que diversos procedimentos não estabelecidos nas normas que regem a delegação de funções em Odontologia estão sendo executados pela equipe auxiliar, demonstrando que o conteúdo dessa legislação está sendo ignorado ou descumprido.

Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde

Os levantamentos epidemiológicos são importantes para o conhecimento da prevalência e tipologia das doenças bucais, podendo-se a partir dos dados coletados, planejar, executar e avaliar ações de saúde. É necessário, no entanto, que haja rigor metodológico que garanta reprodutibilidade, validade e confiabilidade, e que haja uniformidade de procedimentos para permitir comparações nacionais e internacionais. A iniciativa da Organização Mundial da Saúde (OMS) na assessoria à realização de levantamentos tem se mostrado extremamente útil, estimulando o estabelecimento de padrões de procedimentos que podem ser utilizados em todos os países. em 1991 foi publicada a edição em português da terceira edição do Oral Health Surveys - basic methods, de 1987, um manual que objetiva fornecer instruções para a realização de levantamentos epidemiológicos e tal publicação passou a servir de base a estudos realizados em diversos locais do Brasil e do mundo. O objetivo deste trabalho, é analisar criticamente a metodologia para Levantamento Epidemiológico em Saúde Bucal da OMS, na tentativa de contribuir para o aperfeiçoamento da mesma. de acordo com a presente análise, foram encontrados pontos relevantes para consideração, referentes à amostragem, à calibração dos examinadores e aos critérios para a avaliação de saúde bucal e necessidades de tratamento. Concluiu-se, em nível de recomendação, que, devido ao caráter dinâmico do conhecimento científico e, levando-se em consideração as diferenças regionais com relação ao padrão de desenvolvimento das doenças bucais, as propostas de padronização de levantamentos devem ser periodicamente revisadas. É provável, ainda, que outros pontos importantes não tenham sido detectados nesta análise, tornando-se premente ampliar esta discussão para toda a comunidade odontológica.

Adhesives with different pHs: Effect on the MTBS of chemically activated and light-activated composites to human dentin

Purpose: To evaluate the bond strength between human dentin and composites, using two light-activated single-bottle total-etch adhesive systems with different pHs combined with chemically activated and light-activated-composites. The tested hypothesis was that the dentin bond strength is not influenced by an adhesive system of low pH, combined with chemically activated or light-activated composites. Material and Method: Flat dentin surfaces of twenty-eight human third molars were allocated in 4 groups (n=7), depending on the adhesive system: (One Step Plus-OS and Prime & Bond NT-PB) and composite (light-activated Filtek Z-100 [Z100] and chemically activated Bisfil 2B [B2B]). Each adhesive system was applied on acid-etched dentin and then one of the composites was added to form a 5 mm-high resin block. The specimens were stored in tap water (37 degrees C/24 h) and sectioned into two axes, x and y. This was done with a diamond disk under coolant irrigation to obtain beams with a cross-section area of approximately 0.8 mm(2). Each specimen was then attached to a custom-made device and submitted to the microtensile test (1 mm.min(-1)). Data were analyzed using two-way ANOVA and Tukey's tests (p<0.05). Results: the anticipated hypothesis was not confirmed (p<0.0001). The bond strengths (MPa) were not statistically different between the two adhesive systems when light-activated composite was used (OS+Z100 = 24.7 +/- 7.1(a); PB+Z100 = 23.8 +/- 5.7(a)). However, with use of the chemically activated composite (B2B), PB (7.8 +/- 3.6(b) MPa) showed significantly lower dentin bond strengths than OS (32.2 +/- 7.6(a)). Conclusion: the low pH of the adhesive system can affect the bond of chemically activated composite to dentin. on the other hand, under the present conditions, the low pH did not seem to affect the bond of light-activated composites to dentin significantly.

Bond strength of resin modified glass ionomer cement to primary dentin after cutting with different bur types and dentin conditioning

The aim of this in vitro study was to evaluate the effect of different bur types and acid etching protocols on the shear bond strength (SBS) of a resin modified glass ionomer cement (RM-GIC) to primary dentin. Forty-eight clinically sound human primary molars were selected and randomly assigned to four groups (n=12). In G1, the lingual surface of the teeth was cut with a carbide bur until a 2.0-mm-diameter dentin area was exposed, followed by the application of RM-GIC (Vitremer - 3M/ESPE) prepared according to the manufacturer's instructions. The specimens of G2, received the same treatment of G1, however the dentin was conditioned with phosphoric acid. In groups G3 and G4 the same procedures of G1 and G2 were conducted respectively, nevertheless dentin cutting was made with a diamond bur. The specimens were stored in distilled water at 37 degrees C for 24h, and then tested in a universal testing machine. SBS. data were submitted to 2-way ANOVA (= 5%) and indicated that SBS values of RM-GIC bonded to primary dentin cut with different burs were not statistically different, but the specimens that were conditioned with phosphoric acid presented SBS values significantly higher that those without conditioning. To observe micromorphologic characteristics of the effects of dentin surface cut by diamond or carbide rotary instruments and conditioners treatment, some specimens were examined by scanning electron microscopy. Smear layer was present in all specimens regardless of the type of rotary instrument used for dentin cutting, and specimens etched with phosphoric acid presented more effective removal of smear layer. It was concluded that SBS of a RM-GIC to primary dentin was affected by the acid conditioning but the bur type had no influence.

In vitro evaluation of root canal preparation using oscillatory and rotary systems in flattened root canals

Objective: the aim of this study was to evaluate the biomechanical preparation of flattened root canals using the following systems: Endo-Eze AET stainless steel oscillatory instruments (Ultradent) and RaCe rotary NiTi instruments (FKG Dentaire). Materials and Methods: Twenty extracted human mandibular incisors were randomly assigned to two groups: Group I Instrumentation with oscillatory Endo-Eze AET files (oscillatory technique); Group 2 - Instrumentation with rotary NiTi RaCe files (rotary technique). The teeth were decoronated, had their apices and coronal openings sealed with sticky wax and were embedded in crystal-clear orthophtalic polyester resin. The roots were sectioned transversally with diamond discs at 10 mm (middle third) and 5 mm (apical third) from the apex and the segments were reassembled for instrumentation. The sections were photographed before and after root canal instrumentation and evaluated with respect to whether the original root canal shape was modified by instrumentation. To evaluate the differences in the root canal shape before and after biomechanical preparation, scores were given regarding the instruments touch on the intracanal walls. Results: In middle third of the root canals instrumented with the rotary system, there was a change in the original canal anatomy (p < 0.05), with formation of a protuberance in the mesiodistal direction. This protuberance did not occur when the oscillatory instrumentation was used. The oscillatory system had better results in the middle and apical thirds as evaluated by Dunn's multiple-comparison test (p > 0.05). Conclusion: Under the tested conditions, Endo-Eze oscillatory system yielded the instrumentation of all flattened oot canal walls, maintaining the canal original shape throughout the biomechanical preparation, and was more effective than RaCe rotary system.

Localized mechanics of dentin self-etching adhesive system

The bond strength of composite resins (CRs) to dentin is influenced by the interfacial microstructure of the hybrid layer (HL) and the resin tags (TAG). The contemporary self-etching primer adhesive systems overcame the inconvenient of the etch-and-rinse protocol. Studies, however, have demonstrated that HL thickness and TAG length vary according to the wetting time and additional use of acid-etching prior to self-etching primers. This study investigated the localized stress distribution in the HL and the dentin/adhesive interface. Two HL thicknesses (3 or 6 mu m), two TAG lengths (13 or 17 mu m) and two loading conditions (perpendicular and oblique-25 degrees) were investigated by the finite element (FE) analysis. Five two-dimensional FE models (M) of a dentin specimen restored with CR (38 x 64 mu m) were constructed: M1 - no HL and no TAG; M2 - 3 mu m of HL and 13 mu m of TAG; M3 - 3 mu m of HL and 17 mu m of TAG; M4 - 6 mu m of HL and 13 mu m of TAG; and M5 - 6 mu m of HL and 17 mu m of TAG. Two distributed loadings (L) (20N) were applied on CR surface: L1 - perpendicular, and L2 - oblique (25 degrees). Fixed interfacial conditions were assigned on the border of the dentin specimen. Ansys 10.0 (Ansys (R), Houston, PA, USA) software was used to calculate the stress fields. The peak of von Mises (sigma(vM)) and maximum principal stress (sigma(max)) was higher in L2 than in L1. Microstructures (HL and TAG) had no effect on local stresses for L1. Decreasing HL decreased sigma(vM) and sigma(max) in all structures for L2, but the TAG length had influence only on the peributular dentin. The thickness of HL had more influence on the sigma(vM) and sigma(max) than TAG length. The peritubular dentin and its adjacent structures showed the highest sigma(vM) and sigma(max), mainly in the oblique loading.

Antimicrobial effect of intracanal substances

In some situations, endodontic infections do not respond to therapeutic protocol. In these cases, it is suggested the administration of an alternative intracanal medication that presents a wide spectrum of action and has an in-depth effect on the root canal system. The purpose of this study was to assess the antimicrobial action of ciprofloxacin, metronidazole and polyethylene glycol and natrosol vehicles with different associations and concentrations. The minimum inhibitory concentration (MIC) was determined by using the agar dilution method. The culture media (Muller-Hinton agar) were prepared containing antimicrobial agents at multiple two-fold dilutions of 0.25 to 16 mu g/mL, and with the vehicles at the concentrations of 50, 45, 40, 35, 30 and 25%. Twenty-three microbial strains were selected for the study. Metronidazole was not capable of eliminating any of the tested microorganisms. The association of ciprofloxacin with metronidazole resulted in a reduction of the MIC. The vehicle polyethylene glycol inhibited the growth of 100% of the tested strains, while natrosol inhibited 18% of the strains. Ciprofloxacin formulations with polyethylene glycol presented better effects than those of formulations to which metronidazole was added. It was possible to conclude that ciprofloxacin presented antimicrobial action against all tested bacteria] strains, and its association with metronidazole was synergic. The vehicle polyethylene glycol showed antimicrobial effect and the ciprofloxacin/polyethylene glycol association was the most effective combination for reducing the tested bacteria and yeasts.

Analysis of Escherichia coli isolated from bovine mastitic milk

Rangel P. & Marin J.M. 2009. Analysis of Escherichia coli isolated from bovine mastitic milk. Pesquisa Veterinaria Brasileira 29(5): 363-368. Departamento de Morfologia, Estomatologia e Fisiologia, Faculdade de Odontologia de Ribeirao Preto, Universidade de São Paulo, Avenida do Cafe s/n, Campus USP, Ribeirao Preto, SP 14040-904, Brazil. E-mail: jmmarin@forp.usp.brMastitis has been recognized for some time as the most costly disease in dairy herds. From February to November 2004, 670 samples of bovine mastitic milk from which 231 Escherichia coli strains were isolated, were collected from two Brazilian states. The strains were screened for the presence of Shiga toxin-producing (stx 1 and stx 2) and intimin (eae) genes. Twenty (8.6%) strains were detected by PCR to harbor the Shiga toxin genes (8 the stx 1 gene, 12 the stx 2 gene and none both of them). Two (0.8%) of the Escherichia coli strains studied were eae positive non Shiga toxin-producing. The strains were also examined for resistance to 12 antimicrobial agents. The predominantly observed resistance was to tetracycline (92.2%), streptomycin (90.4%), nalidixic acid (88.3%), amikacin (86.5%) and cephalothin (84.8%). Multidrug resistance was found among 152 isolates (65.8%).

Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient.

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Biocompatibility of different intracanal medications in rat buccal submucosa tissue

The aim of this study was to analyze the buccal tissue responses of Wistar rats to 2% chlorhexidine solution, calcium hydroxide and the association of both products. For this purpose, 30 specimens were randomly implanted in the filtrum of the four upper and lower hemiarches with a polyethylene tube containing one of the following substances: 2% chlorhexidine solution, calcium hydroxide and 2% chlorhexidine solution (test groups); calcium hydroxide and distilled water and distilled water (control groups). Ten rats each were distributed according to time interval of evaluation at 7, 15 and 30 days. The histological sections were stained with Harris hematoxylin and eosin. Analysis was per-formed with an optical microscope at x100, x200 and x400 magnifications by an expert examiner blinded to the materials. The sections were classified by scores attributed to inflammatory events and by a ranking determined according to the severity of the inflammation. The results of the inflammatory events and severity ranking were submitted to the Kruskal-Wallis test at a 0.05 level of significance. No statistically significant difference occurred among the tested materials; however, all materials showed a decreased of severity with respect to longer time intervals.