Is drug use associated with the presence of periodontitis and oral lesions? A meta-analysis

PURPOSE

This systematic review investigated whether drug use is associated with the presence of oral lesions and periodontitis.

METHODS

A search was performed for studies that analyzed the presence of periodontitis and/or oral lesions in users of crack, cocaine, and/or marijuana in the PubMed, Scopus, and Web of Science databases. Observational studies in English, Spanish, or Portuguese, without limitation of year, age, and sex, were included. Studies that did not evaluate periodontitis and oral lesions according to the eligibility criteria were excluded. Two authors independently performed study selection and data extraction using a standardized form. The risk of bias of studies included in the meta-analysis was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The meta-analysis included studies that investigated the association of drug use with the outcome.

RESULTS

The initial search resulted in 9,279 articles, from which 16 studies with 15,434 participants were included in the review and 8 studies were included in the meta-analysis. Most studies that evaluated periodontitis in drug users and non-users found a positive association in users. Most studies that analyzed oral lesions reported a higher prevalence, association, or risk of oral lesions in drug users than in non-users. A critical evaluation identified a need to improve the control and reporting of confounding factors in studies on this topic. An association was found between periodontitis and the use of crack, cocaine, and/or marijuana (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.04-3.27; P=0.04) and between oral lesions and the use of these drugs (OR, 2.13; 95% CI, 1.58-2.86; P<0.001).

CONCLUSIONS

Drug users are more likely to develop oral lesions and periodontitis than non-users. However, the results should be interpreted with caution, considering the heterogeneity and quality of the studies included in the analysis.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly.

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014

This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth.

METHODOLOGY

This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression.

RESULTS

For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age.

CONCLUSION

Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

Prevalence of dental implant positioning errors: A cross-sectional study

Purpose

This study evaluated the prevalence of dental implant positioning errors and the most frequently affected oral regions.

Materials and Methods

A sample was obtained of CBCT images of 590 dental implants from 230 individuals who underwent diagnosis at a radiology center using cone-beam computed tomography from 2017 to 2020. The following variables were considered: thread exposure, violation of the minimum distance between 2 adjacent implants and between the implant and tooth, and implant contact with anatomical structures. Descriptive data analysis and the Pearson chi-square test (P<0.05) were performed to compare findings according to mouth regions.

Results

Most (74.4%) of the 590 implants were poorly positioned, with the posterior region of the maxilla being the region most frequently affected by errors. Among the variables analyzed, the most prevalent was thread exposure (54.7%), followed by implant contact with anatomical structures, violation of the recommended distance between 2 implants and violation of the recommended distance between the implant and teeth. Thread exposure was significantly associated with the anterior region of the mandible (P<0.05). The anterior region of the maxilla was associated with violation of the recommended tooth-implant distance (P<0.05) and the recommended distance between 2 adjacent implants (P<0.05). Implant contact with anatomical structures was significantly more likely to occur in the posterior region of the maxilla (P<0.05).

Conclusion

Many implants were poorly positioned in the posterior region of the maxilla. Thread exposure was particularly frequent and was significantly associated with the anterior region of the mandible.

Affect and cognition as antecedents of patients’ trust in the dentist

Aim: to evaluate the association of the patients’ perception about dentist’s affect and cognition on trust and, consequently, on intention to return and patient satisfaction with life. Methods: Analytical cross-sectional study conducted in patients’ adults and elderly at of two dentistry clinics in the south of Brazil. Patients had to have a previous relationship with the dentist (at least one previous consult) and 18 years of age or older. The data were collected through self-administrated questionnaire using measures adapted from other research, using structural equation modeling. We test using a chi-square difference test (p-value<0,05). Results: The mean age of the 197 patients was 37.0 years (σ = 15.5). The affect perceived by the patient at the dentist had a positive effect (β = .53) on the trust that the patient develops in relation to the dentist. The same is true for the effect of the rational or cognitive aspects perceived by the patient at the dentist (β = .41). The trust positively influences the patient’s intention to return to that dentist (β = .82). In addition, the intention to return to the dentist positively influences the patient’s satisfaction with life (β = .49). Conclusions: Affective and cognitive aspects positively influenced the patient’s trust in the dentist. The greater the patient’s trust in the dentist, the greater the intention to return to that dentist. Furthermore, a good relationship with the dentist improve the patient’s satisfaction with life.

Periodontitis and its associated factors in patients at the faculty of southern Brazil: a cross-sectional study

To verify the presence of periodontitis, its severity, and their association with associated factors based on medical records of patients who attended the Dental Clinic of the Faculty of Southern Brazil over 4 years. This is a cross-sectional study, which included 422 medical records of patients aged ≥ 18 years. The clinically analyzed data were: plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Sociodemographic data, dental hygiene, harmful habits and chronic systemic diseases were described. Statistical analysis of binary logistic regression was used to verify the relationship between the severity of periodontitis and the exposure variables. The older adults [odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.23-4.54 – 41 to 55 years and OR = 3.0; 95% CI: 1.49-6.09 – 56 to 87 years], and men (OR = 1.9; 95% CI: 1.18-3.14) showed higher chances of periodontitis severity. Smokers (OR = 3.54; 95% CI: 2.05-6.12), those with hypertension (OR = 2.11; 95% CI: 1.23-3.63) and with diabetes (OR = 2.10; 95% CI: 1.08-4.12) showed higher chances of developing advanced periodontitis. Advanced or severe periodontitis occurred in one-third of the patients. The findings showed that men, older adults, with systemic arterial hypertension, diabetes mellitus, and smokers are more susceptible to severe periodontitis.

Influence of Breastfeeding and Feeding on Children Dental Caries: a Cross-Sectional Study

AbstractThe objective was to investigate the experience of dental caries and associated factors from the children’s and adolescents’ medical records who visited the Children's Dental Clinic of a College of southern Brazil. A cross-sectional study was carried out by analyzing 262 medical records. For data collection, information on demographic data, oral hygiene, food, breastfeeding and oral clinical data were used to investigate. A multivariate analysis was used to estimate the odds ratios (OR) and their 95% confidence intervals, by the exposure variables in a Binary Logistic Regression model (p-value< 0.05). Of the sample, 86.3% had some teeth with experience of dental caries, with only 13.7% free of caries. The average dental caries was 5.3 ± 3.1 in children between 6 and 8 years and 2.0 ± 1.9 between 9 and 12 years. There was a statistically significant association between age and dental caries, with the largest age group being a protective factor for dental caries (OR 0.30; 95%CI 0.17-0.53). Children who were breastfed naturally had a protective factor for caries (OR 0.29; 95%CI 0.10-0.88). The experience of dental caries in children was high, especially in primary teeth, with a higher average of decayed teeth. Breastfeeding and age were a protective factor for dental caries. Keywords: Dental Caries. Breast Feeding. Candy. Oral Hygiene. Diet, Cariogenic. ResumoO objetivo foi investigar a experiência de cárie dentária e fatores associados em prontuários de crianças e adolescentes que procuraram o Ambulatório de Odontologia Infantil de uma Faculdade do Sul do Brasil. Realizou-se um estudo transversal por meio da análise de 262 prontuários. Para a coleta de dados, foram utilizadas informações sobre dados demográficos, higiene bucal, alimentação, aleitamento materno e dados clínicos bucais para investigação. Uma análise multivariada foi utilizada para estimar os odds ratios (OR) e seus intervalos de confiança de 95%, pelas variáveis de exposição em um modelo de Regressão Logística Binária (p-valor <0,05). Da amostra, 86,3% tinham alguns dentes com histórico de cárie dentária, e apenas 13,7% livre de cárie. A média de cárie dentária foi de 5,3 ± 3,1 em crianças entre 6 e 8 anos e 2,0 ± 1,9 entre 9 e 12 anos. Houve associação estatisticamente significativa entre idade e cárie dentária, sendo a maior faixa etária fator de proteção para cárie dentária (OR 0,30; IC95% 0,17-0,53). Crianças amamentadas naturalmente apresentaram fator de proteção para cárie (OR 0,29; IC95% 0,10-0,88). O histórico de cárie dentária em crianças foi elevado, principalmente nos dentes decíduos, com maior média de dentes cariados. O aleitamento materno e a idade foram fatores de proteção para cárie dentária. Palavras-chave: Cárie Dentária. Aleitamento Materno. Doces. Higiene Bucal. Dieta Cariogênica

Factors associated with decision-making of replacing the temporary coronal restoration after endodontic treatment

Aim: This study aimed to evaluate the decision-making by patients to replace temporary restorations with permanent restorations after endodontic treatment and to verify the associated factors and evaluate the quality/integrity of the temporary restorative material within one month. Methods: This is a cross-sectional study using non-probabilistic sampling which analyzed patients after one month of endodontic treatment. The self-administered questionnaire contained sociodemographic, treatment decision-making and endodontic treatment questions. The restoration present in the mouth was evaluated in the clinical oral examination. The Poisson Regression test was used to verify the prevalence ratio. Results: The prevalence failure to perform permanent restorations was 61.1% of patients, and 42.7% reported not having adhered. The reasons are lack of time and not knowing the importance of replacing the restoration with a definitive one. The glass ionomer temporary restorative frequency was higher among those who chose not to replace the temporary restoration with a permanent one (PR=5.19; 95%CI 2.10-12.33). In addition, there was an association between the quality of the restorative material and the type of material, and the best clinical quality of the restoration was statistically associated with glass ionomer and composite resin. Conclusions: The findings show the importance of guidance by the dental surgeon in helping patients decide to replace their temporary restoration.

Prevalence of xerostomia and its association with systemic diseases and medications in the elderly: a cross-sectional study

BACKGROUND

Dry mouth syndrome or xerostomia is defined as decreased salivary flow or hypofunction of salivary glands. Its origins are multicausal and might be the result of a change in the salivary glands or a systemic imbalance.

OBJECTIVE

To ascertain the prevalence of self-reported xerostomia and to identify associated factors.

DESIGN AND SETTING

Cross-sectional study on the entire population of 293 elderly people over 60 years of age living in a Brazilian municipality.

METHODS

Data were gathered from a questionnaire that asked about demographic data, chronic diseases and use of continuous medications, and which used the Xerostomia Inventory (XI) to evaluate dry mouth sensation. Our analysis consisted of multivariate regression and estimation of odds ratios (OR) and their respective 95% confidence intervals (CI) in binary logistic regression models.

RESULTS

The prevalence of self-reported xerostomia was 19.1%. Elderly people with diabetes had higher odds of having self-reported xerostomia (OR: 3.59; 95% CI: 1.48-8.68; P < 0.001) as did those who had chronic diseases and used continuous medication (OR: 2.3; 95% CI: 1.19-4.67; P = 0.009). Elderly people who used continuous medication for the gastrointestinal tract were more likely to have xerostomia (OR: 2.14; 95% CI: 1.03-1.44; P = 0.030).

CONCLUSIONS

Elderly people with diabetes and chronic diseases who were using continuous medication were more likely to have dry mouth. Use of continuous medications for the gastrointestinal tract led to a greater chance of having self-reported xerostomia.

Postoperative Pain in Endodontically Treated Teeth: A Cross-sectional Study of Retrospective Data

AIM

This study aimed to assess the occurrence of postoperative pain and associated factors in patients treated endodontically at a Postgraduate Center in Endodontics in Southern Brazil.

MATERIALS AND METHODS

The evaluation was performed using the medical records of 658 patients. Pulp conditions, postoperative pain, pain intensity, edema, number of sessions (single or multiple), and medication administration in the postoperative period were analyzed. For data analysis, descriptive analyses and univariate and multiple regressions were performed. In the multiple analyses, odds ratios (OR) and their respective 95% confidence intervals were estimated, crude and adjusted for exposure variables in a binary logistic regression model (p-value < 0.05).

RESULTS

To perform the adjusted logistic regression, all variables associated with p-value <0.10: gender, edema, and pulp condition (bio- and necropulpectomy) entered the crude model. After the multivariate analysis, a statistically significant association was found between the outcome variable of the presence of postoperative pain and the independent variable of pulp condition, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp and edema with greater chances of postoperative pain.

CONCLUSION

It was concluded that the pulp condition and edema affected postoperative pain.

CLINICAL SIGNIFICANCE

The occurrence of postoperative pain was around 30% in both single and multiple sessions, and it was considered relevant for the dental clinic. Pulp condition affected postoperative pain, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp.

Oral colonization by Candida spp. in liver transplant patients: Molecular identification and antifungal susceptibilityOral colonization by Candida spp. in liver transplant

Candida species are commensal to normal oral microbiota; however, they can cause infections if immune functions are reduced. The aim of this study was to investigate oral colonization, identify species, and test the susceptibility profile to antifungals. A descriptive study included 97 liver transplant patients who attended the transplant center of a referral hospital in southern Brazil. Two oral swab collections were performed, with a 6-month gap between collections. The samples were identified by sequencing the internal transcribed spacer ITS region of the ribosomal DNA. The sensitivity test was performed with fluconazole, amphotericin B, and micafungin using a broth microdilution method recommended by Clinical and Laboratory Standards Institute document M27-A4. Eighty-two patients were investigated and 15 were excluded for presenting clinical infection. The identification of yeasts showed colonization in 66% and 61.9% in collections A and B, respectively. Candida albicans was the most prevalent species in both collections (n = 29/50 and n = 27/49, respectively). In 31 (62%) patients, the yeast species remained the same for 6 months, and in 19 (38%) the colonizing species was substituted. Thirty-two isolates from collection A were sensitive (S) to Fluconazole, 13 sensitive dose-dependent (SDD), and five resistant (R). In collection B, 32 were S, 12 SDD, and 5 R. For amphotericin B and micafungin, all isolates were sensitive. With knowledge of the species and identification of strains resistant to fluconazole, useful information can be alerts about the emergence of antifungal resistance strains.

LAY SUMMARY

Study of great importance because it is the first investigation that identifies Candida in the oral cavity of liver transplant patients, allowing an understanding of epidemiology and contributing to the knowledge about strains resistant to fluconazole.

Assessment of Apical Extrusion using Rotary and Reciprocating Systems during Root Canal Retreatment

AIM

The objective of this study was to assess apical extrusion after filling material removal using two systems, one rotary and one reciprocating.

MATERIALS AND METHODS

A total of 34 extracted mandibular premolars with single roots were selected and, posteriorly, prepared and filled. Following material aging for 60 days, teeth were divided into two groups, according to the method used to remove root filling material: group I, ProTaper® Universal Retreatment instruments plus refining with the Hero 642® sequence and group II, WaveOne® instruments. The teeth were fixed in an apparatus designed to collect the extruded material during removal procedure. Data on the amount of debris extruded (mg/weight) were analyzed using the Student's t test with a significance level of 5%.

RESULTS

No significant differences were found between the groups with regard to the amount of material extruded during root canal retreatment.

CONCLUSION

The present findings suggest that the extrusion of debris during apical root canal retreatment does not depend on the instrument design or the protocol employed.

CLINICAL SIGNIFICANCE

Regardless of root canal clearance techniques, debris extrusion eventually occurs during endodontic retreatment and may be related to postoperative pain.

Academic performance and use of psychoactive drugs among healthcare students at a university in southern Brazil: cross-sectional study

BACKGROUND

People have been using psychoactive substances for a long time. Over the last few years, this practice has spread among university students, who use these substances to improve their academic performance, relieve stress and increase concentration and memory.

OBJECTIVES

To estimate the use of psychoactive drugs among healthcare students at a higher education institution in the city of Passo Fundo (RS), Brazil, and to ascertain the associated demographic and lifestyle factors.

DESIGN AND SETTING

Cross-sectional study in a higher education institution.

METHODS

We included 287 undergraduate medicine and dentistry students in this study. They answered a self-administered questionnaire regarding sociodemographic, lifestyle and health variables. The statistical analysis used univariate and bivariate analyses with Pearson's chi-square test (P-value < 0.05). -Multivariate analyses were used to estimate odds ratios (OR) and their respective 95% confidence intervals. The SPSS software, version 20.0, was used.

RESULTS

The prevalence of use of psychoactive substances among the students was 24.7%. Among these students, high frequencies of psychoactive drugs had been prescribed by physicians (95.8%) and for the purpose of relaxation or stress relief (73.2%). Women, medical students (compared with dental students) and participants with lower academic performance were more likely to use psychoactive drugs. After the multivariate adjustment, the "course" and "academic performance" remained associated with use of psychoactive drugs.

CONCLUSION

There was high prevalence of psychoactive drug use among the students at the higher education institution investigated. Some variables (female sex, medical students and low academic performance) were associated with the outcome.

Emotional, physical and sexual violence against female students undergoing medical, dental and psychology courses in South Brazil

Violence against women is a hot topic in the spotlight of contemporary science. In the academy, most of the courses are structured in a hierarchical system, in which students-especially female-become potentially vulnerable to emotional, physical and even sexual harm. This study aimed to describe the prevalence and the study-associated factors of emotional, physical and sexual violence against female students in medical, dental and psychological courses in South Brazil. A questionnaire-based survey was performed combining two previously validated tools for the investigation of workplace violence. The questionnaires were digitally provided to women undergoing medicine, dentistry and psychology courses in South Brazil. The study was conducted between April and July, 2018. The final sample consisted of 241 students (57 medical students; 91 dental students and 93 psychology students). Reports of general violence reached a prevalence rate of 45.2%. In particular, emotional violence reached 78.9% of the cases, whilst physical and sexual violence reached 4.6% and 8.3%, respectively. Amongst the identified offenders, professors figured as the most prevalent (18.4%). Alarming rates of violence against women were detected in this study. Institutional preventive strategies must be designed to protect female students in their study/workplace and enable a safe routine of academic activities.

Quality of Prenatal Care in Brazil: National Health Research 2013

This study aimed to assess the adequacy of prenatal care in Brazil associated with sociodemographic determinants. The study included a data analysis from the National Health Research performed in Brazil in 2013. Two outcomes on the adequacy of prenatal care were assessed: the Kessner index modified by Takeda index that, in addition to the former, assessed whether blood pressure and weight were measured in all appointments, as well as the performance of blood and urine tests and ultrasound. Both quality indicators were assessed for Brazil and for its macro-regions. According to Outcome 1, 80.6% of women received adequate prenatal care. When adding the performance of tests (Outcome 2), the rate dropped to 71.4%. Adequate prenatal care was more frequent among white women who performed prenatal care in the private health sector. The northern region had the lowest rate of adequate prenatal care, while the southeast region showed the highest rates. Despite the extensive coverage, prenatal care in Brazil still presents inequities and low service quality, especially for women from the poorest regions of the country.

Evaluation of anxiety levels and their characteristics in dental care: Cross-sectional study

Context

Anxiety is defined as an emotion produced by a set of feelings and physical changes. Many patients are afraid of some procedures involved in dental therapy.

Aim

The objective of this study was to verify the anxiety of patients regarding the visits to dental clinics of a higher education institution, as well as to observe the moment of greatest anxiety.

Settings and Design

It is a cross-sectional observational study including 94 patients from the dental clinics of an educational institution in a city of southern Brazil.

Materials and Methods

The Corah Dental Anxiety Scale, composed of four questions, was used to evaluate the dental anxiety levels of all patients. The sample universe included registered patients under treatment in the clinics of the studied institution, from August to November of 2016. We included only healthy patients over 18-year old who were subjected to surgical and nonsurgical procedures.

Statistical Analysis

The data were analyzed through descriptive statistic to verify the frequency distribution of all variables. Pearson's Chi-square test, at 5% significance level and 95% confidence interval, was used to evaluate the association between the dependent variable (dental treatment anxiety) and the independent variables (demographics), aided by the SPSS software 20.0. Results: It was found that most of the participants were not anxious (69.1%) and the moment of greatest anxiety reported was before local anesthesia. In addition, statistics showed no correlation among gender, age group, and type of procedure performed. It was possible to conclude that the level of anxiety of the patients regarding the dental care performed in the clinics of the studied institution was low for both surgical and nonsurgical procedures.

Conclusion

This survey revealed that the moment of greatest anxiety for the patients was before the anesthetic procedure, and gender, age, and type of procedure did not influence the level of anxiety felt by the patient.

Periodontal conditions in adolescents and young brazilians and associated factors: Cross-sectional study with data from the brazilian oral health survey, 2010

Background:

Diseases of the gingival tissues are considered a global public health problem concern. These diseases show great differences in their distribution and prevalence in the different localities investigated. This study aimed to estimate the prevalence of the periodontal conditions of gingival bleeding and dental calculus in Brazilian adolescents and young people, as well as to verify the associated factors.

Materials and Methods:

This is a cross-sectional population-based study that used secondary data from the National Oral Health Survey (SB Brazil 2010) performed by the Ministry of Health. This study assessed 7328 adolescents aged 12 years and 5445 young people aged 15–19 years. The characteristics of the periodontal conditions were obtained by the community periodontal index, which provided the outcome variables of gingival bleeding and dental calculus. The predictor variables were demographic, socioeconomic, and oral clinical data.

Results:

The results showed a high prevalence of gingival bleeding (32%) and dental calculus (33.1%) in the individuals assessed. In addition, as observed after adjusting to the Poisson regression model, the variables of 12 years of age, no tooth loss, fewer household residents, >6 years of education, and no need for dental treatment were considered protective factors for gingival bleeding and dental calculus.

Conclusions:

The variables of nonwhite skin color, certain regions of the country, and low monthly household income were considered risk factors for the outcomes. Boys presented a higher prevalence of dental calculus than girls.

Presence of Candida spp. and candidiasis in liver transplant patients

BACKGROUND

Candidiasis is the most common opportunistic fungal infection of the oral cavity caused by fungi of the genus Candida and usually associated with immunosuppressed individuals.

OBJECTIVES

To evaluate the presence of oral candidiasis and identify the presence of Candida spp. in liver transplant recipients and assess the association between the presence of the fungus and sociodemographic variables, dietary habits and environmental exposure.

METHODS

A cross-sectional study was performed with 49 patients who had undergone liver transplants at Hospital São Vicente de Paulo in Passo Fundo - RS. Patient information was collected to obtain sociodemographic data, eating habits and environmental exposure. Fungal infections were screened by oral clinical examination and the presence of Candida spp by the collection of oral samples with a sterile swab, seeded in Sabouraud Dextrose Agar, incubated at 25°C and observed at 48 hours. To identify Candida albicans, the germ tube test was performed.

RESULTS

In 49 patient samples, 39% had the yeast of the genus Candida isolated and, of these patients, 12% had candidiasis, 66% of atrophic type and 34% pseudomembranous. Eleven yeast species were (58%) Candida non-albicans and eight (42%) Candida albicans.

STUDY LIMITATIONS

The present study presents as a limitation the inclusion of patients in different stages of immunosuppression.

CONCLUSION

The high incidence of Candida non-albicans in the oral cavity of transplant patients with a long period of transplantation is warning to a more effective control of the health of these individuals, especially those with older age.

Self-perceived quality of health and satisfaction by elderly seen by the Family Health Strategy team

OBJECTIVE

To verify the profile of elderly followed up by Family Health Strategy teams and the influence of self-reported chronic diseases on demographic variables, describing self-perception and satisfaction with quality of health.

METHODS

This is a cross-sectional population- based study carried out with 301 elderly residents in two areas of a city in southern Brazil. Data were collected through a questionnaire based on the Health, Well-Being, and Aging Study adapted by researchers, and a playful scale to assess satisfaction with health. For the statistical analysis, the χ2 test was used (p<0.05).

RESULTS

Regarding cognitive assessment, the majority was classified as independent (86.4%), not requiring caregiver assistance to answer the questionnaire. The population was predominantly female (55.8%), White (64.8%), married (51.2%), and catholic (82.1%). A total of 47.5% considered their current health status as regular. Regarding satisfaction with health, 72.4% were happy, even reporting having at least one chronic health problem (58.5%).

CONCLUSION

The presence of chronic diseases was reported by most respondents, and the practice of self-medication is significantly more frequent among the aged. Nevertheless, the degree of satisfaction with their health status was predominantly positive, both related to the previous year and compared to others of the same age.

Nível de fluoretação na água de abastecimento de Passo Fundo

A fluoretação da água de abastecimento é uma das principais medidas preventivas de saúde pública para controle de cárie dentária. O objetivo do presente trabalho foi conhecer o nível de fluoretação da água de abastecimento da cidade de Passo Fundo. O presente trabalho possui uma abordagem quantitativa, cujo delineamento foi transversal e teve como objetivo verificar os níveis de fluoretação da água de abastecimento da cidade de Passo Fundo, Rio Grande do Sul, Brasil. Os dados foram coletados de relatórios públicos da Corsan, constando os valores mínimos, máximos e médios de flúor na água, nos anos de 2014 e 2015 totalizando 72 amostras. As avaliações consideradas inadequadas não ultrapassaram 5% do total de análises realizadas. Concluindo que a média da concentração de flúor apresentou-se de acordo com a legislação vigente durante os dois anos pesquisados.

Implementation of dental specialty centers: a descriptive analysis of the current status in the Brazilian territory

This study aimed to assess the current implementation status of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEO) in Brazil. The sample included CEOs implemented up to November 2015 in the 27 Brazilian federative units. Data were obtained directly from the database of the Informatics Department of the Brazilian Unified Health System, according to the National Registry of Health Facilities (NRHF) of Dental Specialty Centers of all Brazilian regions. Primary care data were also collected from the cities with implemented CEOs, including coverage status of the Family Health Strategy (FHS) and number of Oral Health Teams (OHT) I and II, at 2 collection periods (January 2006 and November 2015). There were 1019 CEOs implemented in Brazil, which were unequally distributed among the Brazilian states, with prevalence of implementation of CEOs type II (n=503, 49.4%). The statistical analysis showed significant difference between the three types of CEO (I, II, and III) and the variables of coverage rate (FHS) and number of teams (OHT I, OHT II) at both data collection periods. Although presenting an evolutionary aspect in the implementation of CEOs, the implementation of medium-complexity care in Brazil is disorganized.

Oral health evaluation in special needs individuals

Objective

To identify the prevalence of the main oral problems present in special needs children and to relate the underlying conditions with the clinical and demographic variables.

Methods

The study was based on the physical examination of 47 students from the Associação de Pais e Amigos dos Excepcionais diagnosed as Down syndrome, cerebral palsy and intellectual deficit. For data collection, we used a self-administered questionnaire that included indices of dental caries and oral hygiene, Angle classification, malposition of dental groups and oral hygiene habits.

Results

The predominant age group was 12-25 years (46.8%) and most patients were male (55.3%). Regarding daily brushing, 63.8% reported brushing their teeth three times a day, and 85.1% did it by themselves. A total of 48.9% were rated as Angle class I, and 25.5% had no type of malocclusion. A high dental carries index (decayed, missing, filled >10) was observed in 44.7%, and 53.2% had inadequate oral hygiene (zero to 1.16). There was a statistically significant difference between cerebral palsy and the act of the participants brushing their teeth by themselves.

Conclusion

There was a high decayed-missing-filled teeth index and malocclusion class I, as well as inadequate oral hygiene. The type of underlying condition of the participants influenced the act of brushing teeth by themselves.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study

CONTEXT AND OBJECTIVES:

Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care.

DESIGN AND SETTING:

Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil.

METHODS:

Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used.

RESULTS:

40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%).

CONCLUSION:

Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

Identification and management of elder physical abuse in the routine of dentistry - a systematic review

OBJECTIVE

To perform a systematic search in the literature in order to verify whether the dentists are able to identify and manage cases elder physical abuse.

BACKGROUND

Dentists may play an important legal role contributing to the management of abused patients through the identification of injuries in their face, head and neck.

MATERIALS AND METHODS

The present systematic review was performed following the PRISMA Statement and was registered in the PROSPERO database. A search was conducted in the following electronic databases: PubMed, LILACS, SciELO, Embase, Web of Science, OpenGrey, Google Scholar. Specifically, the last two databases were used to search the 'grey literature'. The research question was based on the PVO strategy for systematic exploratory review. Two examiners determined the eligibility criteria for selecting the studies and performed all the research steps.

RESULTS

The initial search resulted in 842 studies, from which eight were considered eligible. Six studies used questionnaires to assess the perception, knowledge and attitudes of dentists towards the identification and management of cases of elder abuse, while two studies assessed this information through personal interviews. Two studies were rated as high quality, while six studies reached moderate quality. Male and female dentists were assessed separately in six studies. Only three studies specified the aggressor.

CONCLUSION

The dentists revealed insufficient knowledge on elder abuse. Most of the dentists are not able to identify and manage these cases in the clinical routine.

Impact of dental orientation given to mothers during pregnancy on oral health of their children

Objective

To analyze the perception of mothers about oral health of their children, as well as to check the influence of demographic variables, perception and preventive practice in oral health of mothers regarding guidance received during pregnancy.

Methods

Quantitative and cross-sectional field study, with a non-probability sample formed by all mothers who attended the primary healthcare unit of Ijuí (RS), Brazil, from January to July 2014, comprising a sample of 79 women. Self-applied questionnaires were given to these mothers. Data analysis was carried out using descriptive and inferential statistics, the χ² test at a significance level of 5%.

Results

The mothers who received dental orientation during pregnancy had greater perception of oral health of their children. The mean age of mothers was 26 years, most of them attended high school education (32.9%) and worked outside the home (60.8%). There was a statistically significant relation between the outcome variable, dental orientation during pregnancy, and the independent variables: schooling level of mothers, occupation, baby’s first visit to the dentist, duration of breastfeeding, beginning of baby’s tooth brushing and knowledge about dental decay (p<0.005).

Conclusion

Mothers with higher schooling levels and who worked outside the home had more knowledge about oral care, because they received dental orientation during pregnancy. The dental guidance during pregnancy influences the mother in the procedures adopted with their children, as to early oral hygiene, first dentist appointment, duration of breastfeeding, knowledge about the factors that lead to dental decay.

Differential diagnosis of dental fluorosis made by undergraduate dental students

OBJECTIVE

To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment.

METHODS

Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes.

RESULTS

Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree.

CONCLUSION

Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

Satisfação com a vida, experiência odontológica e autopercepção da saúde bucal entre idosos

Resumo O objetivo deste artigo é analisar a relação existente entre a satisfação com a vida e a autopercepção em saúde bucal e a experiência com cirurgiões-dentistas. A pesquisa tem um delineamento epidemiológico transversal, com uma amostra de 326 idosos acima de 60 anos de idade, moradores de um município do norte do Rio Grande do Sul, Brasil. Para o instrumento de coleta de dados foi utilizado um questionário autoaplicativo com questões referentes à autopercepção em saúde bucal (OHIP – Perfil de Impacto na Saúde Oral), Escala de Satisfação com a Vida e dados sociodemográficos. Os resultados mostraram que idosos com maiores níveis de satisfação com a vida apresentaram uma melhor percepção de sua própria saúde bucal, bem como possuem uma melhor imagem percebida dos cirurgiões-dentistas e sentem menos ansiedade em relação à experiência com o dentista. Comprova-se que tanto a autopercepção que os idosos possuem da saúde bucal quanto a experiência com cirurgiões-dentistas possuem uma associação com a satisfação com a vida. Os resultados possuem implicações importantes para tomadores de decisões e formuladores de políticas públicas.

Association between anterior open bite and pacifier sucking habit in schoolchildren in a city of southern Brazil

OBJECTIVE: The objective of this study was to verify from a school-based epidemiological survey, the prevalence of anterior open bite, analyzing the influence of pacifier habit in the school. METHODS: The first step was a questionnaire for the parents, and later clinical examinations in 237 school children, 3-14 years old, in the city of Santo Expedito do Sul/RS, Brazil. RESULTS: The population gender distribution was 50.3% boys and 49.4% girls with a mean age of 8.63 years, and 16% had primary dentition, 50.2% mixed dentition and 33.8 % permanent dentition. There was a 22.8% prevalence of anterior open bite, obtaining a significant association between anterior open bite and the pacifier sucking habit on the three dentitions. CONCLUSION: The duration and frequency of the habit were strongly associated with anterior open bite malocclusion in the deciduous and mixed dentitions.

Reforço da resina acrílica para restaurações provisórias utilizando diferentes formatos e posições do fio ortodôntico

Objetivos. Avaliar a influência do forma do fio ortodôntico e sua posição vertical no reforço de uma resina acrílica utilizada para próteses parciais fixas provisórias.Método. Foram confeccionadas 70 barras (25 x 3 x 3 mm) utilizando resina acrílica à base de polimetilmetacrilato com diferentes reforços (n = 10). Dois diferentes formatos da secção transversal do fio foram avaliados: circular (C) e retangular (R). Três posições verticais do fio também foram avaliadas: superior (S), mediana (M), inferior (I). Espécimes do grupo controle foram avaliados sem reforço. As diferentes condições experimentais foram avaliadas em teste de resistência à flexão por 3 pontos em máquina universal de ensaios. Os dados foram analisados utilizando a análise de variância ANOVA (1-fator) seguido pelo teste de Tukey (α = 0,05).Resultados. Os valores médios de resistência à flexão e desvio padrão foram:  RI = 171±15a; CI = 125±15b; RM = 117±11bc; RS = 108±13cd; CM = 99±7d; controle = 90±4d; e CS = 89±10d.Conclusão. A utilização de fio ortodôntico retangular na posição inferior do material apresentou a melhor condição de reforço da resina acrílica para prótese parcial fixa provisória.

Overdentures on implants placed in bone augmented with fresh frozen bone

AIM

In the last decade several studies have been performed to evaluate the clinical outcome of one or two stage loaded implants supporting overdentures. Since fresh frozen bone (FFB) has an ever-increasing number of clinical applications and few reports are available on implants inserted into FFB, we performed a retrospective study on fixtures inserted in FFB and bearing overdentures.

METHODS

In the period between December 2003 and December 2006, 17 patients (14 females and 3 males with a median age of about 56 years) were grafted and 60 implants inserted thereafter. A total of 17 overdentures were delivered: 8 in the mandible and 9 in the maxilla. Multiple implant systems were used: 22 Double etched, 7 SLA, 9 Anodic oxidized, and 22 CaPo4 ceramic-blasted. Implant diameter ranged from 3.25 to 4.3 mm and length from 11.5 to 16.0 mm. Implants were inserted to replace 23 incisors, 9 cuspids, 20 premolars and 8 molars.

RESULTS

No implants were lost (i.e., survival rate=100%) and no differences were detected among the studied variables. Kaplan Meier algorithm and Cox regression did not reveal any statistical differences among the studied variables also as regards the success rate.

CONCLUSION

Implants inserted FFB and bearing overdentures have a high survival rate and success rates, which are comparable to those of implants inserted in non-grafted bone. FFB bone is a reliable material for alveolar ridge augmentation. No difference was detected among removable prostheses supported by two or more implants.

[Study on the dental fluorosis in a Southern city of Brazil]

The objective of this article is to determine the frequency and severity of dental fluorosis, as well as to verify possible associations with dental caries, gender, age, ethnicity and geographic location of schools in schoolchildren of 12 years old and from 15 to 19 years in the city of Passo Fundo, Rio Grande do Sul State, Brazil. A total of 633 schoolchildren of both genders at the cited ages, enrolled in 26 public schools of fundamental teaching were involved in the epidemiological study. The inspection was performed by three examiners previously trained to apply Dean's Index. The prevalence of dental fluorosis in the studied group was of 32.8%. Predominant degree was the very light (78.4%), followed by light (11.1%), questionable (8.7%) and moderate (1.9%). The prevalence of dental fluorosis was expressive in this population, however, with a low degree of severity. Factors such as age and dental caries index showed to be related to the variable response.

Experiência de cárie dentária na primeira dentição em município com fluoretação das águas

OBJETIVOS: determinar a prevalência e gravidade da cárie dentária e a necessidade de tratamento em pré-escolares de cinco e seis anos de idade em um município com fluoretação de águas. MÉTODOS: o desenho do estudo foi do tipo transversal caracterizado por um censo, sendo examinadas 432 crianças de cinco e seis anos, de ambos os sexos, das escolas da rede municipal de Passo Fundo, Rio Grande do Sul. O levantamento epidemiológico foi realizado por meio de exames clínicos e dados relativos às questões demográficas referentes aos pré-escolares, segundo metodologia proposta pela Organização Mundial da Saúde. Os examinadores foram devidamente treinados e calibrados, obtendo resultado do teste Kappa de 0,91. A pesquisa foi encaminhada e aprovada pelo Comitê de Ética em Pesquisa do Instituto de Cardiologia de Porto Alegre-RS. RESULTADOS: o índice ceo-d foi de 4,1 (±3,73) e somente 106 (24,5%) das crianças estavam livres de cárie dentária na dentição decídua; a prevalência da necessidade de tratamento de cárie foi de 69,9%. CONCLUSÕES: alta prevalência de cárie dentária e grande necessidade de tratamento foram encontradas, denotando que as estratégias de promoção de saúde bucal do município ainda não estão sendo efetivas.

Solitary neurofibroma of the palate. A case report

The neurofibroma is a benign tumor of neuronal origin not frequently located in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as Von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. The diagnosis is, in most cases, quite complex, because of the neurofibroma's strong similarities with a great number of benign neoformations of the connective tissue, of the epithelium, and of the bone. The histology represents, therefore, the fundamental diagnostic criterion, in particular, through the use of appropriate immunohistochemical analysis. This articles presents the case of a solitary neurofibroma, subtype I (common Schwann cell type), detected on the left-hand side of the posterior region of the palate in a 56-year-old woman, which presented itself as an otherwise non-symptomatic ulcerated mass. After a careful anamnesis, an incisional biopsy was performed in order to establish the histological nature of the neoformation. The immunohistochemical test, which resulted positive for S-100 and negative for the epithelial membrane antigen and keratin, allowed the diagnosis of a presumably benign lesion deriving from a neural differentiation. The surgical excision of the entire mass was accompanied by the extraction of the upper left-hand second molar, which was attached to the mass through its palatal root.

Electronic dental anaesthesia for third inferior molar surgery

AIM

The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery.

METHODS

Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05.

RESULTS

Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed.

CONCLUSION

EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

Alcohol and smoking as risk factors in chronic pancreatitis and pancreatic cancer

The aim of this study was to compare alcohol and smoking as risk factors in the development of chronic pancreatitis and pancreatic cancer. We considered only male subjects: (1) 630 patients with chronic pancreatitis who developed 12 pancreatic and 47 extrapancreatic cancers; (2) 69 patients with histologically well documented pancreatic cancer and no clinical history of chronic pancreatitis; and (3) 700 random controls taken from the Verona polling list and submitted to a complete medical check-up. Chronic pancreatitis subjects drink more than control subjects and more than subjects with pancreatic cancer without chronic pancreatitis (P<0.001). The percentage of smokers in the group with chronic pancreatitis is significantly higher than that in the control group [odds ratio (OR) 17.3; 95% CI 12.6-23.8; P<0.001] and in the group with pancreatic carcinomas but with no history of chronic pancreatitis (OR 5.3; 95% CI 3.0-9.4; P<0.001). In conclusion, our study shows that: (1) the risk of chronic pancreatitis correlates both with alcohol intake and with cigarette smoking with a trend indicating that the risk increases with increased alcohol intake and cigarette consumption; (2) alcohol and smoking are statistically independent risk factors for chronic pancreatitis; and (3) the risk of pancreatic cancer correlates positively with cigarette smoking but not with drinking.

Alcohol and smoking as risk factors in chronic pancreatitis and pancreatic cancer

The aim of this study was to compare alcohol and smoking as risk factors in the development of chronic pancreatitis and pancreatic cancer. We considered only male subjects: (1) 630 patients with chronic pancreatitis who developed 12 pancreatic and 47 extrapancreatic cancers; (2) 69 patients with histologically well documented pancreatic cancer and no clinical history of chronic pancreatitis; and (3) 700 random controls taken from the Verona polling list and submitted to a complete medical check-up. Chronic pancreatitis subjects drink more than control subjects and more than subjects with pancreatic cancer without chronic pancreatitis (P<0.001). The percentage of smokers in the group with chronic pancreatitis is significantly higher than that in the control group [odds ratio (OR) 17.3; 95% CI 12.6-23.8; P<0.001] and in the group with pancreatic carcinomas but with no history of chronic pancreatitis (OR 5.3; 95% CI 3.0-9.4; P<0.001). In conclusion, our study shows that: (1) the risk of chronic pancreatitis correlates both with alcohol intake and with cigarette smoking with a trend indicating that the risk increases with increased alcohol intake and cigarette consumption; (2) alcohol and smoking are statistically independent risk factors for chronic pancreatitis; and (3) the risk of pancreatic cancer correlates positively with cigarette smoking but not with drinking.

Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent acute pancreatitis

Manometry is considered the gold standard for evaluating sphincter of Oddi dysfunction. It has recently been demonstrated that the ultrasound (US) secretin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddi dysfunction yields a substantial percentage of pathological findings in patients with acute recurrent pancreatitis. The aim of this study was to compare the results of the US secretin test with sphincter of Oddi manometry findings in a consecutive series of patients with recurrent acute pancreatitis. Forty-seven patients admitted to our gastrointestinal unit suffering from recurrent acute pancreatitis underwent ultrasonographic measurement of the main pancreatic duct at baseline and for 60 min after maximal stimulation with secretin at 1 IU/kg. According to the US secretin test findings in 35 healthy control subjects, the test results were considered to indicate pathology when the duct was still dilated after 20 min. Within three to seven days the same patients underwent perendoscopic manometry. Thirty-six patients (17 men, 19 women; mean age 41 +/- 15 years) had a successful US secretin test and sphincter of Oddi manometry. Eleven patients (30.6%) presented normal manometric findings. Two of these had an abnormal US secretin test. Twenty-five patients had abnormal manometry findings, revealing stenosis in 19 (52.7%) (17 with abnormal US secretin test) and dyskinesia in six (five with an abnormal US secretin test). Compared to manometry findings, the US secretin test sensitivity and specificity for sphincter of Oddi dysfunction were 88% and 82%, respectively. In conclusion, most patients with recurrent acute pancreatitis have sphincter of Oddi dysfunction documented by both at the US secretin test and sphincter of Oddi manometry; results of the US secretin test are reliable compared to sphincter of Oddi manometry, and therefore the US secretin test may offer a valid alternative to the more expensive and invasive manometric procedure for assessing sphincter of Oddi dysfunction in patients with recurrent acute pancreatitis.

Ultrasonography-secretin test pattern after acute administration of octreotide in healthy persons and in patients with recurrent acute pancreatitis

The intravenous administration of octreotide stimulates sphincter of Oddi activity and impairs pancreatic flow into the duodenum. Postsecretin ultrasonography (US-S test) has revealed an increase in the caliber of the main pancreatic duct, which disappears in healthy persons approximately 10 minutes later as a result of the opening of the sphincter of Oddi and passage of stimulated fluids into the duodenum. We have assessed US-S test patterns after octreotide in healthy persons and in patients with recurrent acute pancreatitis. The study sample consisted of 16 participants: alcohol-abstinent, nonsmoking, healthy volunteers (four men, three women; mean age: 28 +/- 2.5 years) and nine patients with recurrent acute pancreatitis (six men, three women; mean age: 32.1 +/- 7.1 years). All participants underwent measurement of the main pancreatic duct at 1-min intervals for 60 min after secretin stimulation (1 IU/kg intravenous bolus). On a different day the same persons had repeated US-S tests 1 hour after administration of 0.1 mg octreotide intramuscularly. In both controls and patients with recurrent acute pancreatitis, octreotide administration induced an appreciable dilatation of the main pancreatic duct before secretin stimulation, and the caliber remained significantly increased throughout the duration of the test. These results suggest that a single administration of octreotide at the dose used (a) does not inhibit pancreatic secretion of basal and secretin-stimulated fluid within the first 60 min and (b) probably exerts an inhibitory effect on sphincter of Oddi relaxation. These findings warrant more intensive study given their therapeutic implications for acute pancreatic disease.

Food intake of patients with chronic pancreatitis after onset of the disease

The food intake of 40 male patients with chronic pancreatitis followed up at our center for > or = 10 y were compared with that of 75 healthy control subjects. Patients had significantly lower anthropometric values and serum triacylglycerol and cholesterol concentrations than control subjects (P < 0.001). Subjects with pancreatitis had higher carbohydrate and energy intakes than control subjects but no significant differences were observed in protein, fat, fiber, or cholesterol intakes. The results show that although those with chronic pancreatitis consumed carbohydrates with a more balanced variety of nutrients, they were thinner and had lower serum lipid concentrations, which suggests that they had latent digestion disorders or malabsorption.

Effect of octreotide on sphincter of Oddi motility in patients with acute recurrent pancreatitis: a manometric study

Sphincter of Oddi dysfunction has been reported as a cause of acute idiopathic recurrent pancreatitis (IRP). Octreotide, a long-acting somatostatin analogue, is an antisecretory drug used in the treatment and prevention of acute pancreatitis. Its action on sphincter of Oddi motility is controversial and no data are available for IRP patients. The aim of this study was to assess sphincter of Oddi motor response to acute administration of octreotide in patients with past attacks of acute pancreatitis without identification of any evident aetiological factor. Six patients (four male, two female; mean age +/-SD, 38.8+/-9 years) suffering from acute pancreatitis for at least 3 months before the examination were submitted to sphincter of Oddi manometry. After a basal recording lasting at least 2 min, octreotide, 0.05 mg i.v., was administered and the recording repeated. Intraduodenal pressure was taken as the zero reference and the basal sphincter of Oddi pressure and amplitude and frequency of phasic contractions were calculated before and after octreotide administration. No significant pre- vs post-octreotide differences were observed in basal pressure (41.9+/-24 vs 47.5+/-33 mm Hg, respectively) or in amplitude of phasic contractions (164.6+/-33 vs 170.8+/-18 mm Hg). With a latency of about 1 min, octreotide administration caused a high-frequency phasic activity in all cases (mean frequency, 5.5+/-2.2 contractions/min before and 9.8+/-2 after octreotide; P < 0.04). After the procedure acute pancreatitis (prolonged abdominal pain and serum amylase levels more than three-fold the normal values) developed in five patients. In conclusion, our data suggest that acute administration of octreotide may induce tachyoddia and thus a rise in sphincter of Oddi pressure, with possible impairment of biliary-pancreatic outflow.

Ultrasonographic intra-abdominal depth and its relation to haemostatic factors in healthy males

OBJECTIVE

To examine the relationship of intra-abdominal fat to plasma haemostatic factors.

SUBJECTS

60 healthy, predominantly nonobese, male volunteers aged 38 years.

MEASUREMENTS

Anthropometry, sonographic intra-abdominal depth (IAD), as an indicator of intra-abdominal fat, plasma lipids, plasma insulin (at fasting and after glucose load), various plasma haemostatic factors.

RESULTS

Sonographic IAD correlated positively with plasma fibrinogen (r = 0.33; P < 0.01), PAI-1 activity (r = 0.52; P < 0.0001) and antigen (r = 0.32; P < 0.05), and negatively with t-PA activity, at baseline and after stasis (r = -0.28 and r = 0.31; P < 0.05). Factor VII levels did not correlate significantly with sonographic IAD. Haemostatic variables were also closely associated with BMI, plasma triglyceride and insulin concentrations. Most correlations of haemostatic factors with IAD disappeared after adjustment for either BMI or insulin or triglycerides, except PAI-1 levels which maintained a significant association even after simultaneous adjustment for all potential confounders.

CONCLUSIONS

These results, obtained by sonography, confirm our previous findings of significant associations of haemostatic variables with visceral fat accumulation by using computed tomography, and highlight the role of the intra-abdominal fat as an independent predictor of PAI-1 activity.

Chronic obstructive pancreatitis in humans is a lithiasic disease

In humans chronic obstructive pancreatitis (COP) is thought to be a disease devoid of ductal stones. The aim of this study was to verify the presence and frequency of calcifications in patients with COP and compare them with those found in patients with chronic calcifying/calcific pancreatitis (CCP). We conducted a retrospective ERCP investigation in 115 patients with documented chronic pancreatitis. Only 75 could be safely classified as COP or CCP. Fifty-three patients (M:F ratio, 5.6:1; mean age, 36.1 +/- 12.2 years) had CCP, 46 of whom (86.8%) with calcifications. Twenty-two patients (M:F ratio, 3.4:1; mean age, 45.3 +/- 16.2 years; p < 0.05 vs. CCP) presented COP at endoscopic retrograde cholangiopancreatography, 8 (36.4%) with ductal calcifications (p < 0.0001 vs. CCP). COP was secondary to acute pancreatitis in nine cases, to odditis in 11 cases, and to malignant tumor and hypertrophy of Oddi's sphincter, respectively, in the other two cases. The two patient groups showed no significant differences in drinking and smoking habits, number of painful relapses, disease duration, and incidence of diabetes, gallstones, and need for surgery. In conclusion, formation of ductal stones is by no means rare in COP and should be classified as a form of lithiasic pancreatitis. Early restoration of pancreatic outflow by removing the obstruction, or by shunt-type operations and abstinence from drinking and smoking, should resolve this type of disease.