RESUMO
CLINICAL RELEVANCE: The new formulations of nano-silver fluoride caused less dentin staining than the already available commercial agents 35% silver fluoride and silver diamine fluoride at 30% and 38%. SUMMARY: The objective of this study was to evaluate the dentin staining potential of nano-silver fluoride (NSF 600 and 1500 ppm) compared with the following commercially available cariostatic agents: Advantage Arrest (Elevate Oral Care, West Palm Beach, FL, USA), Riva Star (SDI, Victoria, Australia), and Cariestop (Biodinâmica, Paraná, Brazil). Seventy-five extracted human molars were sectioned at the cementoenamel junction, and the occlusal enamel was removed for exposure of coronary dentin. The samples were divided among the five agents tested (n=15). The dentin staining (ΔE/ΔL) was analyzed with a digital spectrophotometer (VITA Easyshade, VITA Zahnfabrik, Bad Säckingen, Germany) at three different time points (before application, after two weeks, and after four weeks). Photographic images were also performed. The Kruskal-Wallis and Mann-Whitney tests compared the mean ΔE and ΔL values between groups. The NSF 600 and 1500 ppm resulted in the smallest color change (ΔE=1.02 and 1.53) and dentin staining after four weeks (ΔL=-0.76 and -1.2). The new formulations differed significantly from the commercial cariostatic agents (p<0.001). NSF might be an alternative to silver diamine fluoride since it does not compromise esthetics.
Assuntos
Dentina , Fluoretos , Brasil , Humanos , Compostos de Prata , Coloração e RotulagemRESUMO
OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.
Assuntos
Humanos , Artrite Reumatoide , Artroplastia de Quadril , Artroplastia do Joelho , Ortopedia , Piperidinas/uso terapêutico , Artrite Juvenil , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Reumatologia , Espondilite Anquilosante , Produtos Biológicos , Doenças Reumáticas , Doenças Reumáticas/tratamento farmacológico , Antirreumáticos/uso terapêutico , Assistência Perioperatória , Inibidores de Proteínas Quinases/uso terapêutico , Glucocorticoides/uso terapêutico , Imunossupressores , Lúpus Eritematoso Sistêmico/tratamento farmacológicoRESUMO
Imiquimod is a topical immune response modifier used to treat anogenital warts. Although considered a safe drug, mild to moderate local and systemic side-effects may occasionally occur. We report three cases of local and systemic adverse effects related to imiquimod, including one case that mimicked meningitis, which promptly resolved with drug cessation.
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Aminoquinolinas/efeitos adversos , Antivirais/efeitos adversos , Condiloma Acuminado/tratamento farmacológico , Indutores de Interferon/efeitos adversos , Alphapapillomavirus/isolamento & purificação , Aminoquinolinas/uso terapêutico , Antivirais/uso terapêutico , Condiloma Acuminado/virologia , Humanos , Imiquimode , Indutores de Interferon/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Is there a relationship between enamel defects and early childhood caries? METHODS: A total of 275 children participated in a cohort study from birth to 54 months of age. Enamel defects were determined by the development defects enamel index and dental caries was registered according to the WHO criteria. Data were analyzed using descriptive, analytical techniques, multivariate analysis, and evidence-based tools as number needed to harm (NNH). RESULTS: In the follow up, 224 children were still in the study, 81.3% presented at least one tooth with enamel defect and 44.2% had dental caries. An association was found between enamel defects and dental caries (P = 0.0091). Multivariate analysis showed that night bottle-feeding, absence of fluoride and enamel defects were predictors of dental caries at 18 months (P < 0.05). Enamel defect was the only statistically significant variable to influence the development of caries at 24, 30, 36, and 42 months. At 48 months, the use of fluoride toothpaste had effect on the decrease of caries (P < 0.05). The NNH for enamel defects in relation to dental caries was 3.0, at 24 months and 5.0 at 54 months. CONCLUSION: Enamel defect is a predisposing factor for ECC.
Assuntos
Cárie Dentária/etiologia , Esmalte Dentário/anormalidades , Alimentação com Mamadeira , Aleitamento Materno , Cariostáticos/administração & dosagem , Pré-Escolar , Estudos de Coortes , Índice CPO , Hipoplasia do Esmalte Dentário/complicações , Sacarose Alimentar/administração & dosagem , Fluoretos/administração & dosagem , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Fatores de Risco , Escovação Dentária , Cremes Dentais/administração & dosagemRESUMO
OBJECTIVES: The aim of this paper is to evaluate the prevalence of enamel defects in infants from a socially and economically poor population and the possible association of these defects with disturbances occurring in the pre-, peri- and postnatal periods of human development. PARTICIPANTS: 117 infants aged between 16 and 18 months old were included in four groups based on gestational age and whether part or full term pregnancy. METHOD: The data were collected in two stages: hospital-based, where gestational and birth records were examined, and home-based, where dental examinations and nutrition were evaluated. The teeth were cleaned and dried with gauze and examined in the open air, avoding direct sunlight in the knee-to-knee position. The enamel defects were coded according to the modified Developmental Defects of Enamel Index. Besides this, body weight and height were considered as anthropometric measures for the evaluation of nutritional status by the National Center for Health Statistics standards. MAIN OUTCOME MEASURES: The data were analyzed using the chi-square and Fisher Exact tests. Besides these tests, logistic regression models were used. RESULTS: The prevalence of enamel defects was 49.6%, higher in the group of male infants (p<0.001). The most frequent type of defect and the most affected surface were, respectively, diffuse opacity (9.5%) and the buccal surface (83.3%), located in the gingival half (6.7%). The logistic regression model showed that educational level, gestational age and intrauterine growth retardation (IUGR), besides a lack of breastfeeding, increased the probability of enamel defects up to level of 5%. CONCLUSIONS: The association between enamel defects and the etiologic factors shown in this study suggest the existence of social influences regarding oral health and teeth development.
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Esmalte Dentário/anormalidades , Estado Nutricional/fisiologia , Odontogênese/fisiologia , Anormalidades Dentárias/epidemiologia , Dente Decíduo/anormalidades , Antropometria , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos de Coortes , Comorbidade , Esmalte Dentário/patologia , Inquéritos de Saúde Bucal , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Gravidez , Cuidado Pré-Natal , Prevalência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Anormalidades Dentárias/classificação , Anormalidades Dentárias/patologia , Dente Decíduo/patologiaRESUMO
OBJECTIVE: To evaluate the cumulative incidence of enamel defects (ED) and its correlation with life course events such as malnutrition and pre- and postnatal infections, in a cohort of children of low socioeconomic status. METHODS: The children were registered at birth and examined from 12 to 36 months of age. At the baseline, 246 were examined and in the follow-up, 228. The teeth were examined under natural light and dried with gauze. ED was determined by the DDE index. RESULTS: Results show that gender was not significant. The cumulative incidence of ED at the last recall examination was 78.9%. The most prevalent type of defect was diffuse opacity, present on the gingival half of the buccal surface (p < 0.001). For logistic regression analysis maternal infections, intrauterine growth retardation (IUGR), malnutrition and postnatal infections were selected as predictor variables for the occurrence of enamel defects. CONCLUSIONS: The results indicate that life course events such as undernutrition and childhood infections during teeth development may be associated with enamel defects in socioeconomically underprivileged communities and may compromise the oral health-related quality of life.
Assuntos
Esmalte Dentário/anormalidades , Dente Decíduo/anormalidades , Infecções Bacterianas/complicações , Brasil , Pré-Escolar , Estudos de Coortes , Hipoplasia do Esmalte Dentário/etiologia , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Seguimentos , Transtornos do Crescimento/complicações , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Longitudinais , Masculino , Desnutrição/complicações , Estado Nutricional , Odontogênese/fisiologia , Pobreza , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Classe Social , Populações VulneráveisRESUMO
The purpose of this study was to evaluate the influence of enamel defects in the development of dental caries and their association with feeding practices and oral health behaviors in a cohort study of low-socioeconomic children from birth to 36 months of age in northeastern Brazil. Subjects were registered at birth and examined from 12 to 36 months of age. At baseline, 246 children were examined and at follow-up 228. The teeth were clinically examined and dried with gauze under natural light. Enamel defects were determined using the Developmental Defects of Enamel (DDE) index. Dental caries was determined using WHO criteria. Data were analyzed using descriptive and analytical techniques. At 36 months 78.9% infants presented at least one tooth with enamel defects and 25% of the children had at least one decayed tooth. A total of 16.9% teeth with enamel defects had become decayed (p = 0.0001). Opacity with enamel hypoplasia was the defect most frequently associated with dental caries (p = 0.001). Only 0.9% of the teeth without enamel defects developed caries. Multivariate analyses revealed that enamel defects, night breast-feeding and poor oral hygiene habits were predictors of dental caries at 18 and 24 months (p < 0.05). Considering the risk factors evaluated at 30 months of age, the presence of enamel defects was the single predictor of caries development at 36 months (p = 0.0001). Enamel defects are strongly associated with early childhood caries and, therefore, this correlation must be considered when focussing on low-socioeconomic communities.
Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária/complicações , Hipoplasia do Esmalte Dentário/complicações , Esmalte Dentário/anormalidades , Alimentação com Mamadeira , Brasil , Aleitamento Materno , Pré-Escolar , Estudos Transversais , Cárie Dentária/patologia , Esmalte Dentário/fisiopatologia , Dieta Cariogênica , Humanos , Lactente , Modelos Logísticos , Estudos Longitudinais , Higiene Bucal , Pobreza , Reprodutibilidade dos Testes , Fatores de Risco , Classe SocialRESUMO
OBJECTIVES: The purpose of the present study was to evaluate early childhood caries among 12-36-month-old children from families living in poor socio-economic conditions in the city of Recife, Brazil, its association with the type and duration of feeding (e.g. natural, sugared, bottle and glass), as well as the relationship between a supplementary diet and the occurrence of this type of caries. METHODS: The present study consisted of a visual clinical examination of teeth that had been previously cleaned with gauze. This was carried out under natural light in a waiting room. Four calibrated examiners performed the examination and the kappa test value was 8.0. The parents or guardians were interviewed for the following information: name, address, age, type of feeding, number of sugary meals, sugar intake and habitual diet. Some 468 children were included in this study. Their ages ranged from 12 to 36 months. The sample was comprised of 222 (47.4%) males and 246 females (52.6%). RESULTS: Of the 468 children included in this study, 133 (28.4%) had caries. Only 59 (12.6%) of the children examined had been breast-fed, 20 (33.9%) of whom presented with caries. Three hundred and twenty-seven (69.9%) subjects had been bottle-fed with sugared milk, 86 (26%) of whom had caries. Two hundred and eight children had five or more sugary meals per day, 70 (33.6%) of whom had caries. No statistically significant relationship was seen between breast-feeding and the prevalence of tooth decay. CONCLUSIONS: The results of the present study show that the prevalence of early childhood caries in 12-36-month-old children from poor backgrounds in Recife is in accordance with the rate found in other Brazilian cities and is extremely high compared with that of the world population as a whole. Early childhood caries was not clearly related to the type of feeding in this sample. The prevalence of early childhood caries increased with age, and the number of sugary snacks between meals and a cariogenic diet were strongly related to early childhood caries. The lack of fluoridated water and high rates of early childhood caries in lead the authors to suggest that fluoride dentifrice should be introduced at 12 months of age as a fluoride supplement and an important aid in the prevention of childhood caries. Additional studies in different cultures and societies need to be undertaken before a definitive conclusion can be drawn.
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Aleitamento Materno/estatística & dados numéricos , Cárie Dentária/epidemiologia , Fatores Etários , Animais , Alimentação com Mamadeira/estatística & dados numéricos , Brasil/epidemiologia , Pré-Escolar , Dieta Cariogênica , Sacarose Alimentar/administração & dosagem , Suplementos Nutricionais/estatística & dados numéricos , Comportamento Alimentar , Feminino , Humanos , Lactente , Masculino , Leite , Pobreza/estatística & dados numéricos , Prevalência , Classe SocialRESUMO
OBJECTIVES: To investigate whether formocresol, in Buckley's original formulation, is mutagenic in vivo to lymphocyte cultures obtained from the peripheral blood of children aged from 5 to 10 years old. These children were recruited from those attending the dental clinics of Recife City Council and the University of Pernambuco School of Dentistry, Brazil. METHODS: The sample comprised 20 children who had primary teeth with cariously exposed vital pulps. Two venous blood samples were collected (6-8 ml) from each child, the first prior to vital pulpotomy (control group) and the second 24 h after pulpotomy (treated group). This research is a case-control study. The peripheral lymphocytes were grown in a complete culture medium consisting of 78% RPMI 1640 medium (a), supplemented with streptomycin (0.01 mg/ml), penicillin (0.005 ml(-1)), 20% fetal bovine serum (b) and 2% phytohemagglutinin (c). The lymphocytes were assessed for chromosomal aberrations via a previously published method which was modified. The cytogenetic analysis was performed in a blind test, where the slides were codified by an annotator and the scorers did not know which group they were analyzing. For each sample, this envolved the analysis of 200 metaphases. The level of significance adopted in the statistical test was 5.0% (p<0.05). RESULTS: There was no statistically significant difference in clinical doses between the control and treated groups, using Wilcoxon's Signed Ranks test, for the chromosomal aberrations (P=0.251) and for the total chromosomal breaks (P=0.149). Although there were no statistically significant differences between the control and treated groups, Buckley's formocresol was mutagenic for one patient, raising doubt about the desirability of its use for pulpotomies in children. CONCLUSIONS: The results revealed that, from a statistical standpoint, formocresol is not mutagenic. However, further investigations are required, preferably with a larger sample, in patients needing more than one pulpotomy in order to observe whether an increase in the quantity of the drug would increase the quantity of chromosome aberrations and also to verify individual susceptibility to chromosome alterations with the use of formocresol.