Lia Silva de Castilho

Prescrição de medicamentos de uso sistêmico por cirurgiões-dentistas, clínicos gerais

OBJETIVO: Estudar o padrao de prescricao de medicacao antimicrobiana e analgesica/ antiinflamatoria de uso sistemico na clinica odontologica. METODOS: Estudo observacional realizado a partir de questionarios respondidos por uma amostra representativa randomica de 163 cirurgioes-dentistas, clinicos gerais, da Regiao Metropolitana de Belo Horizonte. Alguns dos aspectos verificados foram a prevalencia de prescricoes dessas medicacoes nas duas semanas anteriores a aplicacao do questionario; uso do nome generico nas receitas odontologicas; realizacao de cursos de reciclagem em farmacologia; auto-avaliacao sobre o grau de conhecimento e importância dada a esta disciplina para a pratica profissional e preenchimento de fichas clinicas e registro nestas das prescricoes realizadas. RESULTADOS E CONCLUSOES: Observou-se que os medicamentos sao prescritos pelo nome comercial, com tendencia a prescrever mais frequentemente antiinflamatorios em relacao aos analgesicos. Uma percentagem de 13% de individuos nao realiza ficha clinica para todos os seus pacientes e cerca de 43% da amostra nao registra suas prescricoes. Os cursos de reciclagem em farmacologia parecem nao alterar a auto-avaliacao sobre o nivel de conhecimento em farmacologia e o uso do nome generico.OBJECTIVE The study of the prescription pattern of antibacterial and analgesic/antiinflammatory systemic medication by dentists. METHODS Observational study based in questionnaires answered by a representative, randomly selected sample of 163 general dentists from the Metropolitan Region of Belo Horizonte, Southeastern Brazil. Some of the topics verified were: the most frequently prescribed drugs in the fortnight prior to the study, the use of generic names of drugs in the prescriptions, attendance at refresher courses on pharmacology, self-assessment of degree of knowledge on pharmacology, the importance given to this subject in the dentists professional career, and the filling out of the clinical chart and the registration of the drugs prescribed on it. RESULTS It was observed that the drugs were usually prescribed by their commercial name. There were a trend to prescribe more antiinflamatory than analgesics drugs. A small, but worrying, 13% of dentists didnot fill out the clinical chart for all the patients and 43% of the sample didnot register the drugs prescribed on it. The courses on pharmacology seemed to produce no significant alteration in self valuation as to the degree of knowledge in pharmacology and the use of the generic names of drugs.

Factors associated to endemic dental fluorosis in Brazilian rural communities.

The present paper examines the relationship between hydrochemical characteristics and endemic dental fluorosis, controlling for variables with information on an individual level. An epidemiological survey was carried out in seven rural communities in two municipalities in the state of Minas Gerais, Brazil. The Thystrup & Fejerskov index was employed by a single examiner for the diagnosis of dental fluorosis. A sampling campaign of deep groundwater in the rural communities of interest was carried out concomitantly to the epidemiological survey for the determination of physiochemical parameters. Multilevel modeling of 276 individuals from seven rural communities was achieved using the non-linear logit link function. Parameters were estimated using the restricted maximum likelihood method. Analysis was carried out considering two response variables: presence (TF 1 to 9) or absence (TF = 0) of any degree of dental fluorosis; and presence (TF ≥ 5—with loss of enamel structure) or absence of severe dental fluorosis (TF ≤ 4—with no loss of enamel structure). Hydrogeological analyses revealed that dental fluorosis is influenced by the concentration of fluoride (OR = 2.59 CI95% 1.07–6.27; p = 0.073) and bicarbonate (OR = 1.02 CI95% 1.01–1.03; p = 0.060) in the water of deep wells. No other variable was associated with this prevalence (p > 0.05). More severe dental fluorosis (TF ≥ 5) was only associated with age group (p < 0.05). No other variable was associated to the severe dental fluorosis (p > 0.05). Dental fluorosis was found to be highly prevalent and severe. A chemical element besides fluoride was found to be associated (p > 0.05) to the prevalence of dental fluorosis, although this last finding should be interpreted with caution due to its p value.

Factors associated with dental caries in the primary dentition of children with cerebral palsy.

The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria, excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without caries experience and subcategorized into the following age groups: one year; two to three years; and four to five years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first appointment was the only factor associated with caries experience among two-to-five-year-old children with cerebral palsy.

Perceptions of adolescents and young people regarding endemic dental fluorosis in a rural area of Brazil: psychosocial suffering.

Severe dental fluorosis is endemic in some rural areas of Brazil. This paper describes the psychosocial consequences of this condition and how it has affected the self-esteem of adolescents and young people in a rural area in Brazil. Semi-structured, face-to-face interviews were carried out with 23 adolescents and young people affected by severe dental fluorosis and 14 of their teachers. The study revealed the affected individuals were embarrassed to smile at strangers due to a presumed association between fluorosis and a lack of dental hygiene. Further findings include conflicts between affected and non-affected students at school, problems in pursuing a romantic relationship and uncertainties regarding a professional future. Disbelief and scepticism were observed regarding the ethical position that science can offer a solution to the problems stemming from the disease. Lesions from severe dental fluorosis appear to be a stigmatizing factor and have contributed toward suffering and self-exclusion among an entire generation of adolescents and young people.

Möbius Syndrome: A Case With Oral Involvement

Möbius syndrome is a rare congenital condition that is characterized clinically by paralysis of a group of cranial nerves. It presents diverse manifestations that can have negative repercussions on the quality of life of affected individuals. This article presents a clinical case of a child with the syndrome and addressed the clinical manifestations and difficulties experienced during dental treatment. Knowledge of the etiopathological aspects and clinical manifestations of the condition is essential to perfecting treatments that aim to improve the quality of life of such individuals and their families.

Fatores de risco para a cárie em dentes decíduos de portadores de necessidades especiais

Resumen pt: Objetivo: Investigar a influencia do uso de mamadeira, da idade, da escolaridade dos pais, da medicacao de uso cronico, do genero, da higienizacao real...

Cornelia de Lange Syndrome: A Case Report of a Brazilian Boy

Cornelia de Lange syndrome is a rare multisystem disorder characterized by a distinctive facial appearance, delayed growth and psychomotor skills, behavioral problems, malformation of the upper limbs, and impairment on the quality of life of affected subjects. This article reports a case of a child with the syndrome, emphasizing the orofacial manifestations. Knowledge on the etiopathological aspects and characteristic features of this condition is essential so that professionals can provide health care and help improve the quality of life of affected individuals and their families.

Verificação da dispersão de respingos durante o trabalho do cirurgião-dentista

The professionals and patients involved in dental examinations are at risk for infection by various disease-causing bacteria, viruses, and fungi, such as those responsible for hepatitis, tuberculosis, herpes, and AIDS. It is known that aerosols and spatter containing pathogenic microorganisms can spread during an examination. Nevertheless, some dental clinics are designed to have multiple examination areas in the same room, with no physical barriers between them. The objective of this study was to verify the reach of spatter resulting from the use of a triple syringe and high-rotation turbine during five simulated exams in a collective clinic, bearing in mind that spatter can contain the patients saliva and blood. To facilitate tracking of the spatter, aniline dye (pink, blue, yellow, green, and brown) was added to the water in the appropriate receptacle in each of the five units. The room, the equipment, and the patients and operators clothing were covered with white paper. A high concentration of spatter was observed on the chair, the operator, and the floor of each unit, and it also appeared on the chairs and trays of the surrounding units. The maximum distance reached by spatter was 1.82 m from a point on the chair corresponding to the position of the patients mouth. During real simultaneous examinations, the surrounding chairs and their patients and operators, as well as the trays containing sterilized instruments, are within spatter range. Therefore, there is a real possibility of cross-infection, and physical barriers should be placed between the units. This study also confirmed the need for protection of the operators face, body, hair, and arms, since these regions were heavily affected by spatter.Todas as pessoas envolvidas em um atendimento odontologico estao sujeitas a contaminacao por bacterias, virus e fungos que podem causar diversas enfermidades, dentre as quais se destacam a hepatite, a tuberculose, o herpes e a AIDS. Sabe-se que, durante um atendimento, ha possibilidade de ocorrer dispersao de respingos e aerossois contendo microrganismos patogenicos. No entanto, algumas clinicas odontologicas sao projetadas com varios consultorios no mesmo ambiente, sem divisorias entre eles. O objetivo deste trabalho foi verificar qual o alcance dos respingos provenientes da utilizacao de seringa triplice e turbina de alta rotacao em cinco atendimentos clinicos simulados em uma clinica de atendimento coletivo, considerando que estes respingos podem conter saliva e sangue do paciente. Para isso, anilina de diferentes cores (rosa, azul, amarela, verde e marrom) foi adicionada a agua do reservatorio de cada um dos cinco equipamentos. Todo o ambiente fisico, assim como a roupa do operador e do paciente, foram cobertos com papel crepom branco. Constatou-se grande concentracao de respingos sobre as cadeiras, sobre o operador, sobre o piso, cadeiras vizinhas e bandejas clinicas das unidades vizinhas. A distância maxima atingida pelos respingos foi de 1,82 m, medindo-se a partir do ponto correspondente a boca do paciente. Durante um atendimento real, coletivo e simultâneo nesta clinica, as cadeiras vizinhas e seus respectivos pacientes e operadores, bem como as bandejas clinicas contendo instrumental esterilizado situam-se dentro da area de abrangencia dos respingos. Portanto, existe uma possibilidade real de ocorrer contaminacao cruzada, havendo necessidade de colocacao de barreiras fisicas entre os equipamentos. O estudo evidenciou tambem a necessidade de protecao de toda a face, o corpo, o cabelo e os bracos do operador, uma vez que estas foram regioes muito atingidas pelos respingos.

Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: an in vivo study.

The aim of this in vivo study was to validate the DIAGNOdent laser fluorescence method and the International Caries Detection and Assessment System (ICDAS) for caries classification against the gold standard, histological examination, for detecting occlusal caries on permanent molars; the thresholds used were the outer enamel (D1), the inner enamel and outer third of the dentine (D2), and the inner two-thirds of the dentine (D3). Patients with non-impacted third molars (n = 43) were recruited from a university clinic. A trained examiner performed the examinations. After the teeth were extracted, the histological criterion was used to determine the severity of the lesions. Intra-examiner agreement (weighted kappa) for ICDAS was 0.60 and reliability (intraclass correlation coefficient) for DIAGNOdent was 0.968. The correlations with the histological reference were weak for DIAGNOdent (rs = 0.369) and moderate for ICDAS (rs = 0.515). The areas under the receiver-operating characteristics (ROC) curve at D1, D2, and D3 were 0.60, 0.69, and 0.91, respectively, for ICDAS and 0.55, 0.65, and 0.92, respectively, for DIAGNOdent. ICDAS and DIAGNOdent proved to be reproducible methods with similar performance in the detection of occlusal carious lesions in dentine. The ability of DIAGNOdent to detect initial enamel lesions was higher than that of ICDAS, but with low specificity. The usefulness of DIAGNOdent as an adjunct method for assessment of initial occlusal caries in permanent molars is questionable.

Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil

It is observational, analytical and cross-sectional aimed to evaluate the association between severity and prevalence of fluorosis and dental caries in rural communities with endemic dental fluorosis in the north state of Minas Gerais, Brazil, with fluoride concentrations in water up to 4.8 mg/L. Data were collected by one examiner (intra-examiner kappa, 0.96 to 0,95 for caries and fluorosis) after toothbrushing. The study included 511 individuals aged 7 - 22 years, categorized according to age: 7 - 9 years (n = 227), 10 to 12 years (n = 153), 13 to 15 years (n = 92), 16 to 22 years (n = 39). For the diagnosis of dental caries used the criteria of the World Health Organization to measure indices DMFT. For fluorosis used the index Thylstrup and Fejerskov (TF), dichotomized according to prevalence (TF = 0 and TF > 0) and severity (TF < 4 and TF > 5). In the two younger groups, the DMFT and its decay component were higher in the group with more severe fluorosis (p < 0.001). This association was not found among adolescents and adults (p > 0.05). The association was found between the conditions more severe fluorosis and caries in individuals under 12 years.