Cristiane de Cássia Bergamaschi

Use of Phytotherapy in Dentistry

Over the past decade, interest in drugs derived from medicinal plants has markedly increased. This study was aimed at a literature review focusing on studies investigating herbal drugs and other natural products, as well as their therapeutic application, side effects and possible drug interactions. Few studies were found to support their rational use in dentistry. Since there is an increasing use of phytotherapeutic agents in dentistry, further studies are needed to evaluate their safety and effectiveness for clinical use. Copyright

Liposome-encapsulated ropivacaine for topical anesthesia of human oral mucosa.

BACKGROUND:The elimination of pain caused by needle insertion for local anesthesia would be a significant advance in dentistry. METHODS:In this blinded cross-over study we evaluated the efficacy of liposome-encapsulated ropivacaine for topical anesthesia. Thirty healthy volunteers received 60 mg topical anesthetics: Liposome-encapsulated 1% ropivacaine, 1% plain ropivacaine, 2.5% lidocaine and 2.5% prilocaine mixture (EMLA), and 20% benzocaine gel, in the buccal fold of the upper-right canine for 2 min in different sessions. After insertion of 30-G needles, pain was rated on a visual analog scale (VAS). A pinprick test was used to measure the duration of topical anesthesia. The pulpar response was assessed by an electric pulp tester. RESULTS:VAS median and interquartile range (in cm) were 0.8 (0.4–1.5), 1.6 (0.8–2.6), 1.1 (0.3–2.7), 2.2 (0.9–2.9) for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. The liposome-encapsulated ropivacaine group showed lower VAS mean values when compared with the benzocaine group (P = 0.0205). The median values and interquartile range for the duration of soft tissue anesthesia were 11 (7–14), 6.5 (4–11), 14 (11–16), and 7 (6–9) min for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. EMLA and liposome-encapsulated ropivacaine were just as efficient for reducing pain, and showed longer soft tissue anesthesia when compared to the other local anesthetics (P = 0.0001). CONCLUSION:Liposomal-encapsulated 1% ropivacaine gel was equivalent to EMLA® for reducing pain during needle insertion and for the duration of soft tissue anesthesia. None of the topical anesthetics was effective for inducing pulpal anesthesia.

Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in intraosseous injections in symptomatic irreversible pulpitis of mandibular molars: anesthetic efficacy and cardiovascular effects

OBJECTIVE The aim of this study was to compare the cardiovascular effects and the anesthetic efficacy of intraosseous injections of 4% articaine with 1:100,000 epinephrine (EPI100) or 4% articaine with 1:200,000 epinephrine (EPI200). STUDY DESIGN In this prospective, randomized, double-blind study, 0.9 mL EPI100 and EPI200 solutions were administered for endodontic treatment of mandibular molars with symptomatic irreversible pulpitis in 60 patients. The anesthetic success and pain during anesthesia were evaluated by visual analog scale. The cardiovascular parameters evaluated were heart rate, diastolic/systolic blood pressure, pulse oximetry, and electrocardiogram changes. RESULTS Both solutions provided high anesthetic efficacy (96.8% and 93.1% for EPI100 and EPI200, respectively; P > .05), and the cardiovascular parameters showed minimal incidences of significant differences throughout the clinical procedure. CONCLUSIONS The epinephrine concentration did not affect the efficacy of 4% articaine, and both solutions produced a high success level of pulpal anesthesia. Intraosseous delivery by slow speed of injection did not induce significant clinical changes in cardiovascular parameters.

Vitamin D and respiratory infections

Vitamin D or 1,25-hydroxyvitamin D (1,25(OH)2 D) has a well-established role in calcium homeostasis. In recent years, the discovery of vitamin D-metabolizing enzymes and vitamin D receptor (VDR) in the lungs and various cells of the immune system has led to numerous studies conducted to evaluate its role in respiratory functions and, in particular, upper respiratory tract infections (URTIs). A PubMed literature search was done using vitamin D and respiratory infections as key words. Only clinical studies were considered. This study aimed to review recent clinical and epidemiological studies conducted in adults and children, and to evaluate the functional role of vitamin D in respiratory infections. The evaluated studies show an important immunomodulatory role of vitamin D, which reduces the incidence and risk of URTIs, both in children and in adults. Combating URTIs can be done prophylactically, associating the use of vaccines against Streptococcus pneumoniae with strengthening the immune system through supplementation with vitamin D. These actions can significantly contribute to reducing the number of URTIs, the use of antibiotics, and consequently, the rates of antimicrobial resistance.

Concentrations of metronidazole in human plasma and saliva after tablet or gel administration

The aim of this study was to determine the pharmacokinetic profile of metronidazole (Mtz) tablet and to compare Mtz gel and tablet concentrations in both blood plasma and saliva.

Oral herbal medicines marketed in Brazil for the treatment of osteoarthritis: A systematic review and meta-analysis

Herbal medications are commonly used to manage symptoms associated with osteoarthritis (OA). This systematic review evaluated the effectiveness and safety of oral medications used in Brazil for the treatment of OA. Randomized clinical trials involving adults with OA treated by a herbal medicine or a control group were eligible. The primary outcomes measured were pain, physical function, swelling, stiffness and quality of life; and the secondary outcomes were adverse events, activity limitations and treatment satisfaction. Sixteen studies were included (n = 1,741 patients) in the systematic review and nine studies in the meta‐analysis, representing 6 of the 13 herbal medicines studied: Boswellia serrata (n = 2), Curcuma longa (n = 3), Harpagophytum procumbens (n = 1), Salix daphnoides (n = 3), Uncaria guianensis (n = 2) and Zingiber officinale (n = 5). B. serrata was more effective than both placebo and valdecoxib for improvement of pain and physical function. No difference was observed for H. procumbens, C. longa and U. guianensis compared with control. Z. officinale showed improvement of pain over placebo. The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low. This study guides managers of the Brazilian public health system and prescribers in decision‐making regarding the use of these herbal medicines for OA. Copyright

Pharmacokinetic profile of liposome-encapsulated ropivacaine after maxillary infiltration anaesthesia

O objetivo do presente estudo foi determinar os parâmetros farmacocineticos da ropivacaina encapsulada em lipossomas apos anestesia local em 14 voluntarios sadios. Neste estudo randomizado, cruzado e duplo-cego, os voluntarios receberam anestesia infiltrativa na maxila de ropivacaina a 0,5% encapsulada em lipossomas e ropivacaina 0,5% com epinefrina a 1:200.000 em duas sessoes distintas. Amostras de sangue foram coletadas antes e apos (de 15 a 1440 min) a administracao das formulacoes de ropivacaina. A quantificacao da concentracao plasmatica de ropivacaina foi feita por meio de HPLC com deteccao por UV. Os parâmetros farmacocineticos AUC0-24 (area sob a curva de concentracao × tempo do tempo 0 ate 24 horas) , AUC0-∞ (area sob a curva de concentracao x tempo do tempo 0 ate o infinito), Cmax (concentracao maxima da droga), CL (clearance renal), Tmax (tempo em que ocorre a concentracao maxima); t1/2 (meia vida de eliminacao) e Vd (volume de distribuicao) foram analisados pelo teste de Wilcoxon. Nenhuma diferenca (p > 0,05) foi observada entre as duas formulacoes em cada parâmetro farmacocinetico avaliado e as concentracoes plasmaticas de ropivacaina, considerando cada periodo de tempo. Ambas as formulacoes apresentaram perfil farmacocinetico semelhante, indicando que a formulacao lipossomal poderia ser uma opcao mais segura para o uso deste anestesico local, devido a ausencia de vasoconstritor.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

Effects of Antibiotic Prophylaxis in Patients with Open Fracture of the Extremities: A Systematic Review of Randomized Controlled Trials

Background:The purpose of the present study was to perform a systematic review and meta-analysis of the use of alternative antibiotic regimens—including (A) antibiotic prophylaxis versus no prophylaxis, (B) longer versus shorter duration of antibiotic prophylaxis, and (C) alternative drugs—for patients with open fracture of the extremities. Methods:Data sources included CINAHL, EMBASE, MEDLINE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane database of systematic reviews from 1965 to December 2013. All randomized controlled trials comparing the effectiveness of antibiotic prophylaxis in patients with open fracture of the extremities were eligible. Results:We identified 329 potentially eligible articles, of which seventeen proved to be eligible. In four randomized controlled trials involving 472 patients, we found a significantly lower infection rate in patients receiving antibiotic prophylaxis compared with those not receiving antibiotic prophylaxis (risk ratio = 0.37 [95% confidence interval, 0.21 to 0.66]; absolute risk reduction = 9.6% [95% confidence interval, 5.2% to 12.1%]). In three studies involving 1104 patients, we found no difference in the infection rate when a longer duration of antibiotics (three to five days) was compared with a shorter duration (one day) (risk ratio = 0.97; 95% confidence interval, 0.69 to 1.37). Confidence in the estimates for both questions was low to moderate. Individual comparisons of alternative drugs yielded estimates warranting only low to very low confidence. Conclusions:Results of randomized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days, although the evidence warrants only low to moderate confidence. Given current practice, a large, multicenter, low risk of bias, randomized controlled trial enrolling representative populations and addressing the duration of antibiotics may be the next optimum step in investigation. Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Prescrição de benzodiazepínicos para adultos e idosos de um ambulatório de saúde mental

The aim of this study was to compare benzodiazepine (bzd) prescriptions for adults and older adults regarding appropriate use indicator. It is a cross-sectional study for collecting data on patients treated at the Citys Mental Health Clinic in Sorocaba/SP, between March and December 2013. Appropriate use indicators were used: appropriate drug, with adequate posology and period of use; as well as the use of a single bzd, as anxiolytic for less than 3 months in depression treatment with antidepressants, use for less than 2 months if associated to an antidepressant and no use of long-acting bzd in older adults. From the 330 participants, most were women, with a family history of mental disorders and bzd use, without monitoring of a psychologist and using other psychotropic and polypharmacy (p>0.05).The minority of prescriptions had indication for the use of bzd (37.5% for older adults and 32.4% for adults) (p>0.05). Only 5.8% of the prescriptions for older adults and 1.9 for adults were rational (p>0.05). The chronic use was observed in all adults and older adults with depressive and anxiety disorders (p>0.05). A minority of prescriptions for adults and older adults was appropriate.The aim of this study was to compare benzodiazepine (bzd) prescriptions for adults and older adults regarding appropriate use indicator. It is a cross-sectional study for collecting data on patients treated at the City’s Mental Health Clinic in Sorocaba/SP, between March and December 2013. Appropriate use indicators were used: appropriate drug, with adequate posology and period of use; as well as the use of a single bzd, as anxiolytic for less than 3 months in depression treatment with antidepressants, use for less than 2 months if associated to an antidepressant and no use of long-acting bzd in older adults. From the 330 participants, most were women, with a family history of mental disorders and bzd use, without monitoring of a psychologist and using other psychotropic and polypharmacy (p>0.05).The minority of prescriptions had indication for the use of bzd (37.5% for older adults and 32.4% for adults) (p>0.05). Only 5.8% of the prescriptions for older adults and 1.9 for adults were rational (p>0.05). The chronic use was observed in all adults and older adults with depressive and anxiety disorders (p>0.05). A minority of prescriptions for adults and older adults was appropriate.