Cláudia Silami de Magalhães

Impacto da perda dentária na qualidade de vida

In order to evaluate the impact of tooth loss in patients quality of life, 50 volunteers were selected among patients who use the Public Health Services in treatment for their complete dentures placement or replacement. The Oral Health Impact Profile (OHIP-14) and a socio-demographic data collection were applied before treatment. The values were founded through the weight of each question in association with Likerts Scale. As higher was the score, higher was the impact in the quality of life. In this survey 82% were female, 52% of patients between 41 and 60 years old (average: 59.1), and 34% married. The higher values of OHIP-14 dimensions in patients quality of life were: Psychological Discomfort (122), Physical Pain (121), Psychological Disability (113), Physical Disability (109), Functional Limitation (93), Handicap (82) and Social Disability (76). As it could be observed, the lost of teeth or the use of inadequate prosthesis could bring negative impacts in lifes quality, especially regarding preoccupation, stress with mouth problems and shame, although people perceive minor impacts in social relationships and development of their daily activities. This information can be relevant to prepare dentists to raise their knowledge about edentulous people and how to work with them.

Periodontal therapy and risk for adverse pregnancy outcomes

Periodontitis has been associated with adverse pregnancy outcomes. Results from intervention studies are few and controversial. The present study assessed the effects of non-surgical periodontal treatment in the occurrence of adverse pregnancy outcomes. Two hundred forty-six eligible women were randomly divided into two groups: periodontitis intervention (n = 122; undergoing non-surgical treatment during gestation) and periodontitis control (n = 124; not treated during gestation). Univariate analysis was performed and estimates of relative risk were reported. Data from 225 women were analyzed. No differences for preterm birth (p = 0.721), low birth weight (p = 0.198), and preterm low birth weight (p = 0.732) rates were observed. Relative risk estimates for preterm birth, low birth weight, and preterm low birth weight in the periodontitis intervention group were 0.915 (95% CI 0.561–1.493), 0.735 (95% CI 0.459–1.179), and 0.927 (0.601–1.431), respectively. Non-surgical periodontal treatment during the second semester of gestation did not reduce the risk for preterm birth, low birth weight, and preterm low birth weight.

Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin

OBJECTIVE The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development. METHODS One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0mm-deep and 1.5mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F(-) (Sensodyne Baking Soda) or without F(-) (Sensodyne Original) (n=18). After surface polishing, a 1mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHN(i)) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHN(f)) were measured. RESULTS The differences between KHN(i) and KHN(f), and the covariate KHN(i) were considered by the ANCOVA and Tukeys test (alpha=0.05). The interaction between restorative system and dentifrice was statistically significant (p=0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)(a), Fj: 41.9(1.02)(b), F2: 43.3(1.04)(c), Su: 43.5(1.00)(c), Z2: 44.0(1.02)(c); and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)(a), Fj: 44.7(1.01)(b), F2: 45.2(1.09)(bc), Su: 46.0(0.99)(c), Z2: 46.6(0.99)(c) (statistical differences were expressed by different letters). CONCLUSION The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000.

Perfil dos cuidadores de idosos nas instituições de longa permanência de Belo Horizonte, MG

The purpose of this cross-sectional study was to determine the profile of caregivers of elderly in long-term care facilities. The studied population included 181 randomly selected caregivers, 98 from philanthropic and 83 from private institutions in the city of Belo Horizonte. Data were collected applying structured questionnaires. The variables evaluated were sex, age group, educational level, marital status, income, economic condition, time of work in the facility, and professional experience. The data were compared using Chi-square and Fishers exact tests. There was no statistically significant difference between caregivers from the two facilities with regard to sex (p=0.62) and income (0.77). In the philanthropic facilities we observed more caregivers aged 50 years or more, widowers, with less than 4 years of study, socio-economic level D and who were working as caregivers in the facility for more than two years (p<0,05). The results of this study are relevant for discussing developing and implementing public policies aimed at qualifying the caregivers in long-term care institutions for elderly in Belo Horizonte.

Perda dentária e expectativa da reposição protética: estudo qualitativo

This qualitative research analyses the repercussions of total dental loss on peoples quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing peoples statements, it was possible to verify that dental loss had strong negative consequences on peoples life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

Complete removable prostheses: from expectation to (dis)satisfaction

OBJECTIVE The purpose of this survey was to increase our knowledge on the experience and feelings of edentulous people, 6 months after having acquired and worn a pair of complete removable prostheses. BACKGROUND The incorporation of conventional, complete removable prostheses may be an appropriate treatment which can result in an improvement in the quality of life of people who have lost their teeth. METHODS The 12 patients of the sample were interviewed individually according to a semi-structured questionnaire so as to create an atmosphere for open conversation regarding the subject matter. For each participant, photographs, before dental treatment and after the use of the prostheses, were taken. The images of the prostheses were reviewed and impressions were collected. RESULTS The analysis of participants statements allowed one to verify if the complete removable prostheses improved the quality of life; however, difficulties encountered could lead users to abandon their prostheses. CONCLUSION Appropriate investment on the part of health professionals, together with the clarification of information and the monitoring of patients, may well minimise these difficulties.

Oral health among institutionalized elderly in Belo Horizonte, Minas Gerais State, Brazil

This study assessed the oral health of the institutionalized elderly in Belo Horizonte, Minas Gerais State, Brazil. A sample of 335 individuals over 60 years of age was randomly selected. Data were collected through interviews, review of medical records, and clinical examination by a single researcher. Oral health was evaluated in terms of oral hygiene, caries, and periodontal disease. Bacterial plaque was present on 76% of the dental surfaces, and 57% of the elderly using upper dentures presented plaque on at least one of its surfaces. DMF-T index was 30.8, with the missing component representing 94.2%. Missing sextant was the worst periodontal finding in 78.2% of the elderly. Among the valid sextants, there was a higher prevalence of 4 to 5mm periodontal pocket and attachment loss from 4 to 5mm (47%). According to the findings, institutionalized elderly suffer from precarious oral health, with deficient oral hygiene, high caries rate, tooth loss, and periodontal pocket.

Effectiveness and efficiency of chemomechanical carious dentin removal

The aims of this in vitro study were both to determine the time necessary for removal of carious dentin (efficiency) and the Knoop Hardness Number (KHN) of the remaining dentin (effectiveness), using a chemomechanical method (Carisolv) or hand excavation. Thirty human molars were bisected through occlusal carious lesions into two equal halves. Each half was randomly excavated by hand in circular movements with a spoon excavator or using Carisolv gel according to the manufacturers instructions. The duration of carious dentin removal was recorded. Tooth sections were resin-embedded, ground flat and polished. Dentin KHN was determined at distances of 100, 200, 300, 400 and 500 microm from the cavity floor. Data were analyzed by Wilcoxons test (alpha= 0.01), ANOVA and Students t test (alpha= 0.05). The median of the time necessary for chemomechanical excavation was significantly greater than for hand excavation. KHN means (+/- SD) at 100, 200, 300, 400, 500 microm for chemomechanical method were, respectively: 15.6 (+/- 4.96), 18.0 (+/- 6.22), 21.3 (+/- 9.30), 24.3 (+/- 9.25), 28.5 (+/- 11.80); and for hand excavation were: 21.2 (+/- 10.26), 23.4 (+/- 9.49), 28.2 (+/- 11.62), 31.0 (+/- 12.17), 34.3 (+/- 11.95). It may be concluded that hand excavation presented higher efficiency and effectiveness than chemomechanical excavation.

Biomechanical evaluation of screw- and cement-retained implant-supported prostheses: A nonlinear finite element analysis

STATEMENT OF PROBLEM The mechanical stability of the prosthetic components in the implant-prosthesis complex is essential to the long-term success of the restorations. However, little is known about the differences in the biomechanical behavior of screw- and cement-retained prostheses. PURPOSE The purpose of this study was to compare the preload maintenance, stresses, and displacements of prosthetic components of screw- and cement-retained implant-supported prostheses by using the finite element method in a nonlinear analysis. MATERIAL AND METHODS Two 3-dimensional models were constructed: implant-supported fixed partial prostheses with 3 elements retained either by screws (SFP) or cement (CFP). After the simulation of screw tightening, the preload was calculated for both prostheses. Then vertical and oblique loads (100 N) were applied on the models. The preload was identified, the maximum von Mises equivalent stresses (SEQV) were obtained on the screws, and the displacement among the abutment, the implant, and screw was identified by observing the penetration and gap in the contact interfaces. RESULTS Under vertical load, there was a higher decrease in the preload and in the SEQV on the screw in the SFP. Under oblique load, the SEQV was 24% higher on the screw of the SFP. In the displacement analysis under vertical load, penetration was concentrated in the threads of the screw in the SFP and between the abutment and implant in the CFP. The gap was 118% greater for the SFP and was concentrated on the abutment extension. Under oblique load, the displacement pattern was similar for both prostheses, but with values 66% higher for penetration and 96% higher for gap for the SFP. CONCLUSIONS The SFP showed a higher biomechanical risk of failure than the CFP.

The association between occlusal factors and noncarious cervical lesions: A systematic review

OBJECTIVES This study aimed to systematically review the scientific evidence for the association between noncarious cervical lesions (NCCL) and occlusal risk factors (ORF) [occlusal interferences in excursive movements; occlusal force; premature contacts; type of guidance; skid of centric occlusion to maximum intercuspidation] in adults. SOURCES Pubmed, Web of Science, Cochrane, Lilacs, Clinical Trials, National Research Register and National Institute for Health were searched. STUDY SELECTION From 1082 potentially eligible studies, 106 were selected for full text analysis. Two independent reviewers (Kappa=0.8; p<0.001) selected the studies, abstracted information and assessed quality based on standardised scales. Six cross-sectional, two case-controls and one clinical trial were included. Several occlusal variables were analysed among the studies, but there was no standardisation of the units used in the analysis of occlusal factors. The majority of studies did not find significant associations between NCCL and ORF. Three studies found associations between NCCL and some variables (occlusal contact area, right canine guidance, premature contacts in centric relation and working side) (p<0.05). The methodological quality varied across studies, and there was high heterogeneity among them. CONCLUSION Current scientific evidence does not support an association between ORF and NCCL. Further prospective studies with standardised methods are vital to strengthen the evidence. CLINICAL SIGNIFICANCE Understanding the risk factors for NCCL is important to control the causes and to help the dentist choose the best approach for the patient. The evidence does not support intervention to alter some occlusal factors for the prevention or control of the progression of NCCL.