The Relationship between Professional Variables and Burnout Syndrome in Brazilian Dentists during the COVID-19 Pandemic

Burnout syndrome (BS) is a highly prevalent occupational disease among dentists who, during the COVID-19 pandemic, have been at greater risk of contracting the disease, generating stress and distancing. The aim of this study was to assess the association of social conditions, professional factors and perceptions of COVID-19 with Burnout Syndrome. This was a cross-sectional study of 302 Brazilian dentists working in the clinical and private sectors. The professionals completed the Oldenburg Burnout Inventory online and answered sociodemographic and professional questions and questions related to their perception of the pandemic. Poisson regression with unadjusted and adjusted robust variance was used to estimate the association between burnout syndrome (dependent variable) and the independent variables. The presence of BS was strongly associated with age, training in a private institution, professionals who claimed to have sufficient protective knowledge and fear of being contaminated by SARS-CoV-2 during patient care (p < 0.05). The findings of this study show that there has been an impact of the COVID-19 pandemic on the occurrence of Burnout syndrome in dentists, especially, those who worked in the public sector and those who were afraid to work with other health professionals.

The changes on salivary flow rates, buffering capacity and chromogranin A levels in adults after bariatric surgery

OBJECTIVES

This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group.

MATERIALS AND METHODS

Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA).

RESULTS

After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates.

CONCLUSION

According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction.

CLINICAL RELEVANCE

The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS.

Comparison of the Metabolic Profile between Unstimulated and Stimulated Saliva Samples from Pregnant Women with/without Obesity and Periodontitis

This study aimed to compare the metabolic profile of unstimulated (US) and stimulated (SS) saliva samples from pregnant women with/without obesity and periodontitis. Ninety-six pregnant women were divided into: obesity + periodontitis (OP = 20); obesity/no periodontitis (OWP = 27); normal BMI + periodontitis (NP = 20); and normal BMI/no periodontitis (NWP = 29). US and SS samples were collected by expectoration and chewing of sterilized parafilm gum, respectively, and samples were individually analyzed by Proton Nuclear Magnetic Resonance (1H-NMR). Univariate (t test and correlations) and multivariate (Principal Component Analysis-PCA, and Partial Least Square-Discriminant Analysis-PLS-DA with Variance Importance Projection-VIP scores) and Metabolite Set Enrichment Analysis were done (p < 0.05). Metabolites commonly found in all groups in elevated concentration in US samples were 5-Aminopentoate, Acetic acid, Butyric acid, Propionic acid, Pyruvic acid, and Succinic acid. They were mainly related to the butyrate metabolism, citric acid cycle, amino sugar metabolism, fatty acids biosynthesis, pyruvate metabolism, glutamate metabolism, and Warburg effect. Metabolites commonly found in all groups that were in elevated concentration in SS samples were Citrulline, Fumaric acid, Histidine, N-acetyl glutamine, N-acetylneuraminic acid, para-hydroxyphenylacetic acid, Proline, Tyrosine. Although some differences were found between unstimulated and stimulated saliva samples from pregnant women with/without obesity and periodontitis, stimulated saliva collection seems adequate, demonstrating similar metabolic pathways to unstimulated saliva samples when groups are compared.

Is There a Difference in the Proteomic Profile of Stimulated and Unstimulated Saliva Samples from Pregnant Women with/without Obesity and Periodontitis?

This study aimed to compare the proteomic profile of stimulated and unstimulated saliva samples from pregnant women with/without obesity and periodontitis. Pregnant women were allocated into four groups: with obesity and periodontitis (OP); with obesity but without periodontitis (OWP); with normal BMI but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Stimulated saliva (SS) and unstimulated saliva (US) samples were collected, and salivary proteins were extracted and individually processed by proteomic analysis (nLC-ESI-MS/MS). Proteins involved with the immune response process, antioxidant activity, and retina homeostasis were decreased or absent in SS samples from all groups (i.e., Antileukoproteinase, Lysozyme C, Alpha-2-macroglobulin-like protein 1, Heat shock proteins-70 kDa 1-like, 1A, 1B, 6, Heat shock-related 70 kDa protein 2, Putative Heat shock 70 kDa protein 7, Heat shock cognate 71 kDa). Additionally, proteins related to the carbohydrate metabolic process and glycolytic and glucose metabolic process were absent in SS, mainly from OP and OWP (i.e., Frutose-bisphosphate aldose A, Glusoce-6-phosphate isomerase, Pyruvate kinase). Saliva stimulation decreased important proteins involved with immune response and inflammation process in all groups. Unstimulated salivary samples seem to be the best choice for the proteomic approach in pregnant women.

Salivary Adiponectin and Albumin Levels on the Gingival Conditions of Patients Undergoing Bariatric Surgery: A Cohort Study

This study analyzed the salivary proteomics, adiponectin and albumin, related to weight loss and periodontitis in patients undergoing bariatric surgery. This study included fourteen patients with morbid obesity (body mass index, BMI > 40 kg/m²) who underwent bariatric surgery Roux-en-Y gastric bypass (RYGB) in System Health Public in Brazil. Data on demographic and anthropometric measures were extracted from medical records preoperatively and 6 and 12 months post-surgery. The variables assessed were: probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and stimulated whole-mouth saliva. In this study, saliva samples were analyzed by electrophoresis and immunoblotting. The ELISA kit was used to measure the MMP8 levels to determine potential markers for obesity. Adiponectin and albumin levels were also evaluated. Weight loss was associated with significant changes in patients' periodontal clinical data. Although 7 out of 10 periodontal patients showed an increase in salivary adiponectin levels after root planning treatment, when analyzed by Western blotting, the increase was not statistically significant (21.1 ± 4.8 to 26.3 ± 9.4 arbitrary units, p > 0.99). There was no correlation between albumin levels and salivary adiponectin pre-surgery, nor 6 months or 12 months after surgery. Weight loss was not improved by low-grade inflammation in bariatric patients, since albumin levels were similar between periods. Periodontitis is an inflammatory disease that is modulated by several factors, among which adiponectin plays an important role for the treatment of periodontal disease.

Bariatric Surgery and Vitamin D: Trends in Older Women and Association with Clinical Features and VDR Gene Polymorphisms

(1) Background: Obesity and its comorbidities can cause burdens and limitations. Bariatric surgery (BS) is indicated as a safe procedure to reduce body mass and improve present comorbidities. However, several complications were reported, such as vitamin D [25(OH)D] deficiency. We evaluated if 25(OH)D serum levels relate to clinical characteristics, symptoms, or habits in women after their BS, and whether the vitamin D receptor (VDR) gene's TaqI and FokI polymorphisms affected 25(OH)D levels and the total body bone mineral density (TBBMD). (2) Methods: This cohort cross-sectional comparative analytical prospective study consisted of 27 women, 61.6 ± 5.0 years, submitted to BS one year prior at a public reference hospital, DF-Brazil. All participants were asked to follow the physical and dietary activity recommendations and received vitamin D3 supplements. Their anthropometric, biochemical, and immunological measurements and blood samples were obtained. (3) Results: 73.3% of participants had low 25(OH)D levels, and their levels correlated positively with TBBMD and negatively with systolic pressure. VDR TaqI did not affect 25(OH)D levels, whereas VDR FokI's allele f presence correlated to a median rise in 25(OH)D levels. Neither polymorphism correlated to TBBMD. (4) Conclusions: 25(OH)D levels were positively correlated with TBBMD, negatively with systolic blood pressure, and were higher in those with the VDR FokI allele f.

Label-Free Quantitative Proteomic Analysis Reveals Inflammatory Pattern Associated with Obesity and Periodontitis in Pregnant Women

Obesity and pregnancy may have synergistic effects on periodontal condition, and proteomics could be an ideal approach to highlight the pathophysiological mechanisms associated with these outcomes. This study analyzed the salivary proteomics related to obesity and periodontitis in women during pregnancy (T1) and after delivery (T2). Initially, 126 women were recruited and forty were allocated into groups: with obesity and periodontitis (OP); with obesity, but without periodontitis (OWP); with normal BMI, but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Whole-mouth saliva was collected in T1 and T2, and proteins were extracted and individually processed by label-free proteomics (nLC-ESI-MS/MS). The up-regulations of Heat shock 70 kDa protein 1A, 1B, and 1-like were related to both obesity and periodontitis, separately. Albumin and Thioredoxin were up-regulated in periodontitis cases, while Cystatins (mainly S, SA, SN) and Lactotransferrin were down-regulated. The high abundances of Submaxillary gland androgen-regulated protein 3B, Protein S100-A8, Matrix metalloproteinase-9, Heat shock 70 kDa protein 2 and 6, Putative Heat shock 70 kDa protein 7, Heat shock 71 kDa protein, Haptoglobin and Plastin-1 were significant in the combination of obesity and periodontitis. Obesity and periodontitis remarkably altered the proteome of the saliva during pregnancy with substantial alterations after delivery.

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to generate pooled evidence for the association between excessive weight and pregnancy induced periodontitis. EMBASE, SCOPUS, PubMed/MEDLINE, Web of Science, BVS/LILACS, Cochrane Library and SCIELO databases were accessed. Eligibility criteria were: human clinical studies published between year 2000 and 2021. Newcastle-Ottawa scale was used to evaluate risk of bias of the studies. Meta-analysis was performed using MedCalc® Statistical Software. Eleven studies were included, evaluating 2152 pregnant women (743 with overweight/obesity and 1409 with normal body mass index - BMI), with a mean age of 29.62 years. Most studies had low risk of bias. A positive association between overweight/obesity and periodontitis was found, with an average of 61.04% of women with overweight/obesity and periodontitis, showing the overall random-effects relative risk and 95% CI of 2.21 (1.53–3.17) (p < 0.001). Arterial hypertension, gestational diabetes mellitus and excessive gestational weight gain were the most common adverse effects of maternal obesity that may have been linked to periodontitis induced pro-inflammatory state. In conclusion, a positive association was found between overweight/obesity and periodontitis during pregnancy. However, the high heterogeneity between the studies related to sample size, periodontal classification and the cutoff-points for BMI are the main limitation.

Metabolomic Profiles Associated with Obesity and Periodontitis during Pregnancy: Cross-Sectional Study with Proton Nuclear Magnetic Resonance (1H-NMR)-Based Analysis

This study aimed to elucidate the metabolomic signature associated with obesity and periodontitis during pregnancy in plasma and saliva biofluids. Ninety-eight pregnant women were divided into: with obesity and periodontitis (OP = 20), with obesity but without periodontitis (OWP = 27), with normal BMI but with periodontitis (NP = 21), with normal BMI and without periodontitis (NWP = 30). Saliva and plasma were analyzed by 1H-NMR for metabolites identification. Partial Least Squares-Discriminant Analysis (PLS-DA), Sparse PLS-DA (sPLS-DA), and Variable Importance of Projection (VIP) were performed. ANOVA and Pearson’s correlation were applied (p < 0.05). Plasmatic analysis indicated the levels of glucose (p = 0.041) and phenylalanine (p = 0.015) were positively correlated with periodontal parameters and BMI, respectively. In saliva, periodontitis was mainly associated with high levels of acetic acid (p = 0.024), isovaleric acid, butyric acid, leucine, valine, isoleucine, and propionic acid (p < 0.001). High salivary concentrations of glycine (p = 0.015), succinic acid (p = 0.015), and lactate (p = 0.026) were associated with obesity. Saliva demonstrated a more elucidative difference than plasma, indicating the glucose-alanine cycle, alanine metabolism, valine, leucine and isoleucine degradation, glutamate metabolism, and Warburg effect as the main metabolic pathways.

Obesity during pregnancy and its oral repercussions

Obesity during pregnancy and its oral repercussions: what is the current evidence?

IMPACT OF BARIATRIC SURGERY IN ANXIETY AND ORAL CONDITION OF OBESE INDIVIDUALS: A COHORT PROSPECTIVE STUDY

BACKGROUND

Obesity and bariatric surgery may be related with mental and oral disorders.

AIM

To evaluate the impact of bariatric surgery on anxiety, initial dental caries lesion and gingival bleeding in obese patients.

METHODS

Eighty-nine patients were divided in two groups: Control Group (CG) - obese patients and Experimental Group (EG) - patients submitted to bariatric surgery. EG was analyzed before and 12 months after bariatric surgery; for the CG, was respected an interval of 12 months between the evaluations. International Caries Detection and Assessment System, Gingival Bleeding Index and Trace-State Anxiety Inventory were used. Medical profile, anthropometrics data, sociodemographic and behavioral variables were considered.

RESULTS

There were no statistically significant differences between groups in evaluation times regarding to initial dental caries lesion and anxiety. However, the number of teeth with initial dental caries lesion (p=0.0033) and gingival bleeding (p<0.0001) increased significantly after bariatric surgery in EG.

CONCLUSION

These results reinforce the need for multi-professional team follow-up, including dental care, for both obese and bariatric patients.

Tooth movement, orofacial pain, and leptin, interleukin-1β, and tumor necrosis factor-α levels in obese adolescents

OBJECTIVES

To evaluate tooth movement, orofacial pain, and leptin, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α cytokine levels in the gingival crevicular fluid (GCF) during orthodontic treatment in obese adolescents.

MATERIALS AND METHODS

Participants included adolescent patients aged 12-18 years: group 1, obese (n = 30), and group 2, nonobese controls (n = 30). They were evaluated before (T0) and after 1 hour (T1), 24 hours (T2), and 1 week (T3) of fixed appliance bonding. Periodontal examination (T0), collection of GCF (T1, T2, T3), and evaluation of Little's irregularity index (T0, T3) were performed, and a visual analog scale was used to measure pain (T1, T2, T3). Evaluation of IL-1β, TNF-α, and leptin cytokines was performed using a Luminex assay. Mann-Whitney and t-tests were used for intergroup comparisons, and a generalized estimating equation and cluster analyses were used for comparisons among observation times (P < .05).

RESULTS

The obese group had a higher prevalence of probing depth of ≥4 mm and bleeding on probing. Orthodontic tooth movement was similar in both groups. Peak of pain was at T2 in both groups and was higher in the obese patients. TNF-α showed a slight increase at T1, followed by a gradual decrease at T2 and T3 in both groups. The obese group had a higher concentration of IL-1β before and during orthodontic treatment. There was no difference in tooth movement between obese and control patients during the first week of orthodontic treatment.

CONCLUSIONS

Obese adolescents had a greater subjective report of orofacial pain after 24 hours of orthodontic treatment and higher concentrations of IL-1β proinflammatory cytokine before and during tooth movement as compared with nonobese control adolescents.

Salivary cytokines levels, maternal periodontitis and infants' weight at birth: A cohort study in pregnant women with obesity

INTRODUCTION

Obesity and pregnancy may have synergistic effects on maternal periodontal tissues. In contrast, maternal obesity and periodontitis are antagonistic factors for the babies' weight at birth. This study evaluated, during pregnancy (T1) and after delivery (T2), periodontal parameters and salivary levels of cytokines in women with obesity, and the association of these outcomes with the baby's weight at birth.

METHODS

After matching by age, socioeconomic status and systemic health, the sample was composed of pregnant women with obesity (GO = 25; BMI ≥30 kg/m²) and normal BMI (GN = 25; BMI between 18.5 and 24.99 kg/m²), who were evaluated regarding: periodontal parameters; salivary levels of TNF-α, IL-1β and leptin (Luminex® assay); and babies' weight at birth. Mann-Whitney, Friedman, ANOVA; chi-square and Cochran's Q tests were applied (p < 0.05).

RESULTS

GO showed higher prevalence of periodontitis in T1 and T2 (p <0.001), with higher salivary levels of TNF-α (p = 0.003) and IL-1β (p = 0.009) in T1. IL-1β significantly decreased after delivery in GO. No intergroup differences for leptin levels were found, but both groups had a significant reduction of leptin levels between periods (p <0.001). GO had children with lower birth weight (p = 0.022), being classified as low (<2,500 g) or insufficient (2,500-2,999 g) weight.

DISCUSSION

It is suggestive that the inflammatory pattern caused by obesity and periodontitis, mainly related to high levels of TNF-α, impair the babies' weight at birth, resulting in more frequency of low/insufficient weight at birth.

COVID-19 and its relation to pregnancy and neonates: a systematic review

Abstract Objectives: this study systematically reviewed the literature in order to better understand the association among COVID-19, pregnancy and neonates. Methods: MEDLINE, EMBASE, Web of Science, BVS and SCOPUS were assessed, considering the terms: (covid 19 OR covid-19 OR novel coronavirus OR 2019 novel coronavirus OR 2019-nCoV OR sarscov 2 OR sars-cov-2 OR sarscov2 OR sars cov-2) AND (pregnancy OR pregnant OR pregnant women OR gestation OR gestational) AND (infant OR fetal OR neonatal). Thirty full-text were included (408 pregnant women, 11 non-pregnant women and 279 neonates). Results: fever (45.83%) and cough (31.61%) were the main symptoms of COVID-19 during the pregnancy. Low levels of lymphocytes (32.10%), elevated levels of C-reactive protein (32.35%); leukocytosis (29.41%); neutrophil (5.88%); and radiographic alterations on chest CT, x-ray or ultrasound (45.84%) were the main laboratorial findings. Cesarean delivery and preterm were registered in 239 and 49 cases, respectively. Ten neonates tested positive for SARS-CoV-2. Conclusion: when COVID-19 pneumonia affects women during pregnancy, the symptoms are similar to those experienced by non-pregnant women. In addition, there is still no plausible evidence suggesting vertical transmission of SARS-CoV-2 virus from mother to child.

Systemic Condition, Periodontal Status, and Quality of Life in Obese Women During Pregnancy and After Delivery

Objective

To evaluate the systemic condition, periodontal status, and quality of life of obese women during pregnancy and after delivery.

Methods

This prospective cohort consisted of 60 women examined in the third trimester of pregnancy (32nd-36th gestational week [T1]) and after delivery (T2) and were divided into elevated body mass index (BMI; GO = 30) and normal BMI (GN = 30) according to the World Health Organization. The variables assessed were: (1) gestational weight gain, arterial hypertension (AH), and diabetes mellitus; (2) oral hygiene behaviour (frequency of dental floss using and toothbrushing); (3) probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and dental biofilm; and (4) quality of life (Oral Health Impact Project [OHIP]-14). Analysis of variance (ANOVA), Friedman, Cochran's Q and χ² tests, and logistic regression model were adopted (P < .05).

Results

GO showed a higher frequency of AH in T1 (P < .001). Both groups decreased the frequency of dental floss use (P = .013) and toothbrushing (P < .001) and increased the percentage of dental biofilm in T2 (P < .001). GO presented a greater PPD and CAL in T1 and T2 and higher BOP in T1 (P < .001), demonstrating a negative impact in the following dimensions of Oral Health Impact Project-14 during T1 functional limitation (P = .020), physical disability (P = .020), and handicap (P = .021).

Conclusion

Obese women presented higher prevalence of AH during pregnancy and higher prevalence of periodontitis in both periods. They showed a poor quality of life in T1 regarding functional limitation, physical disability, and handicap.

Association Between Arterial Hypertension and Periodontal Status in Morbidly Obese Patients Who Are Candidates for Bariatric Surgery

Objective

This study aimed to compare the systemic and periodontal conditions between morbidly obese patients with and without hypertension who were candidates for bariatric surgery.

Methods

The study cohort had 111 morbidly obese patients stratified into two groups: patients with (G1 = 54) and without (G2 = 57) arterial hypertension. The following characteristics were compared between the two groups: (i) education level; (ii) anthropometric parameters [weight, height, body mass index (BMI), waist and hip circumferences and waist-to-hip ratio (WHR)]; (iii) risk of developing cardiovascular diseases (based on patients’ sex, age and WHR); (iv) behaviours regarding oral hygiene; and (v) periodontal status. The t-test, Mann–Whitney U-test, chi-square test and logistic regression were applied, with a significance level of 5%.

Results

Patients in G1 had a lower level of education (P = 0.002). There were no intergroup differences for weight (P = 0.211), height (P = 0.126), BMI (P = 0.551), waist circumference (P = 0.859) and WHR (P = 0.067); however, patients in G2 had a smaller hip circumference (P = 0.029), and 78% of patients in G1 had a high/very high risk of developing cardiovascular diseases. The prevalence of periodontitis was 72.2% (n = 39) in G1 and 38.6% (n = 22) in G2. On logistic regression analysis, age [adjusted odds ratio (OR) = 1.07; 95% CI = 1.01–1.13; P = 0.008) and the presence of arterial hypertension (OR = 2.77; 95% CI = 1.17–6.56; P = 0.019) were identified as the independent variables associated with periodontitis.

Conclusion

Morbid obesity and arterial hypertension are associated with a higher prevalence of cardiovascular diseases. Moreover, morbidly obese patients with hypertension have a higher prevalence of periodontitis and greater severity of periodontal disease than those without hypertension.

ASSESSMENT OF ALVEOLAR BONE PATTERN IN OBESE AND NON-OBESE WOMEN, BEFORE AND AFTER BARIATRIC SURGERY: A PROSPECTIVE COHORT STUDY

BACKGROUND

Right and left periapical radiographs in A eutrophic example of normal bone level; in B of morbidly obese before bariatric surgery, presenting bone loss; and in morbidly obese C after six months of the operation presenting great bone loss. Bariatric surgery may have a negative impact on oral bone structure.

AIM

To verify the alveolar bone pattern through radiomorphometric indices of panoramic radiography and linear measurements performed in periapical radiographs in eutrophic and morbidly obese patients before and after bariatric surgery.

METHODS

The sample consisted of 31 women aged 20-35 years old, divided into two groups: obese group (GO-obese grade III) and control group (GC-eutrophic). Twenty eutrophic and 11 obese morbidities were evaluated in the pre and postoperative bariatric surgery (six months). Radiomorphometric and plaque indices were evaluated at T0 (baseline) and T1 (six months) times, in both groups. In the radiographic analysis the trabecular pattern through the Lindh visual ladder and the bone loss were evaluated by calculating the distance from the cement-enamel junction to the bone crest in periapical radiographs. Panoramic radiographs were used to measure the mandibular cortical index (ICM), mentonian index (IM) and panoramic mandibular index (MPI), in addition to the Turesky plate index.

RESULTS

There was a significant loss of bone in T1 in patients submitted to bariatric surgery, when compared to eutrophic patients (p<0.05). The trabecular pattern became sparser after surgery with a visual difference. The plate index showed a slight improvement after surgery and the eutrophic maintained similar values over time.

CONCLUSION

The standard alveolar bone presents greater bone loss in obese patients and worsens this standard after bariatric surgery when compared to eutrophic patients. The same happens with the trabecular pattern that becomes sparser after bariatric surgery.

Periodontal status of women with excessive gestational weight gain and the association with their newborns' health

OBJECTIVE

The aim of this study was to assess the association between high gestational weight gain and systemic and periodontal status of women between the 32nd and 36th gestational weeks of pregnancy (T1) and after delivery (T2), and the association of these factors with newborns' health.

METHODS

The sample was divided into excessive gestational weight gain (GE = 25) and normal gestational weight gain (GN = 25) and was evaluated regarding: (i) socio-economic status; (ii) systemic and periodontal status; and (iii) newborns' health. The results were analysed using the Mann-Whitney U-test, the t-test, the Friedman test, analysis of variance (ANOVA) and Cochran's Q test (P < 0.05).

RESULTS

Women with GE had lower household income (P = 0.010) and higher body mass index (BMI) at both T1 and T2. The prevalence of hypertension at T1 was higher in women with GE, but the condition resolved post-delivery (P = 0.001). Worsening in oral hygiene was observed at T2 in both groups (P < 0.001). Sixty-eight percent of women with GE and 16% of women with GN had periodontitis at T1, and 52% and 12%, respectively, had periodontitis at T2. In women with GE, the BMI of newborns was higher (P = 0.031).

CONCLUSIONS

Women with high gestational weight gain also showed a high prevalence of hypertension and periodontitis during pregnancy, and persistent periodontitis after delivery. High gestational weight gain was related to high BMI of newborns.

Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth

INTRODUCTION

Excessive weight is associated with periodontitis because of inflammatory mediators secreted by the adipose tissue. Periodontal impairments can occur during pregnancy due to association between high hormonal levels and inadequate oral hygiene. Moreover, periodontitis and excessive weight during pregnancy can negatively affect an infant's weight at birth.

OBJECTIVE

This observational, cross-sectional study aimed to evaluate the association between pre-pregnancy overweight/obesity, periodontitis during the third trimester of pregnancy, and the infants' birth weight.

METHODOLOGY

The sample set was divided into 2 groups according to the preconception body mass index: obesity/overweight (G1=50) and normal weight (G2=50). Educational level, monthly household income, and systemic impairments during pregnancy were assessed. Pocket probing depth (PPD) and clinical attachment level (CAL) were obtained to analyze periodontitis. The children's birth weight was classified as low (<2.5 kg), insufficient (2.5-2.999 kg), normal (3-3.999 kg), or excessive (≥4 kg). Bivariate analysis (Mann-Whitney U test, t-test, chi-squared test) and logistic regression (stepwise backward likelihood ratio) were performed (p<0.05).

RESULTS

G1 showed lower socioeconomic levels and higher prevalence of arterial hypertension and gestational diabetes mellitus during pregnancy than G2 (p=0.002). G1 showed higher means of PPD and CAL (p=0.041 and p=0.039, respectively) and therefore a higher prevalence of periodontitis than G2 (p=0.0003). G1 showed lower infants' birth weight than G2 (p=0.0004). Excessive maternal weight and educational levels were independent variables associated with periodontitis during the third trimester of pregnancy (X2[2]=23.21; p<0.0001). Maternal overweight/obesity was also associated with low/insufficient birth weight (X2[1]=7.01; p=0.008).

CONCLUSION

The present findings suggest an association between excessive pre-pregnancy weight, maternal periodontitis, and low/insufficient birth weight.

Systemic conditions and oral health-related quality of life of pregnant women of normal weight and who are overweight

OBJECTIVE

This study evaluated systemic and periodontal conditions and their association with quality of life in women in the third trimester of pregnancy, assisted by the Brazilian public health-care system, with excessive and normal weight.

METHODS

Fifty pregnant women were allocated into two groups according to their pre-pregnancy body mass index (BMI): excessive (GE; n = 25; BMI ≥ 25.00 kg/m² ); and normal (GN; n = 25; 18.00 ≤ BMI ≤ 24.99 kg/m² ). Thereafter, variables such as socio-economic level, anthropometric parameters (body mass index and gestational weight gain), systemic conditions, periodontal status, and oral health-related quality of life using the short version of the Oral Health Impact Profile (OHIP-14), were evaluated.

RESULTS

There was no significant difference between groups in schooling level, monthly household income and gestational weight gain (P > 0.05). The GE group showed a higher frequency of arterial hypertension (P = 0.018), sought dental services less frequently (P = 0.035), had a higher prevalence of periodontitis (P = 0.011), and had a higher OHIP-14 overall score (P = 0.004) characterised by physical and psychological impact. In the final binary logistic regression models, high maternal BMI was associated with arterial hypertension and periodontitis during pregnancy, while periodontitis was strongly associated with moderate and high impact on quality of life.

CONCLUSION

Pregnant women in the third trimester with excessive weight, assisted by the Brazilian public health-care system, presented with a higher prevalence of arterial hypertension, worse periodontal conditions and consequent high impact on quality of life.

BARIATRIC SURGERY IMPACT ON GASTROESOPHAGEAL REFLUX AND DENTAL WEAR: A SYSTEMATIC REVIEW

Introduction:

Several oral problems may be perceived in individuals who were submitted to bariatric surgery, due to metabolic and behavioral changes relative to diet and oral hygiene. Tooth wear appears to suffer impact after bariatric surgery, because there may be an increase in gastroesophageal reflux.

Objective:

To systematically review the literature regarding the impact of bariatric surgery on gastroesophageal reflux and tooth wear.

Method:

The following databases were accessed by two independent, calibrated examiners: PubMed, Medline, Lilacs, Scielo and Cochrane using the following descriptors: “bariatric surgery” AND “dental erosion” OR “bariatric surgery” AND “dental erosion” AND “gastroesophageal reflux disease”. After excluding duplicate studies, 12 studies were initially evaluated by the title and abstract. The excluded studies were those without relevance to the present research, literature review studies and case reports. Thus, four articles were included in this study. All the articles evaluated indicated high association between gastroesophageal reflux and tooth wear in patients submitted to bariatric surgery. Association of these outcomes was more evident six months after the surgical procedure.

Conclusion:

Patients submitted to bariatric surgery showed higher prevalence of gastroesophageal reflux and tooth wear.

DENTAL WEAR AND TOOTH LOSS IN MORBID OBESE PATIENTS AFTER BARIATRIC SURGERY

BACKGROUND

Obesity and its surgical treatment have been related with oral diseases. Aim: To evaluate and compare dental wear and dental loss in eutrophic and morbidly obese patients submitted to Roux-en-Y gastric bypass.

METHOD

Observational and analytical study with gender and age matching. The sample consisted of 240 patients, divided into four groups: eutrophic (GC=60), morbidly obese (GO=60), operated with up to 24 months (G24=60) and operated on for more than 36 months (G36=60). The following variables were analyzed: race, schooling, economic class, hypertension, diabetes, triglycerides, cholesterol, BMI, weight loss, waist-hip ratio, smoking, alcoholism, tooth loss and tooth wear.

RESULTS

GO presented lower economic class (p=0.012), hypertension (p<0.001), diabetes (p<0.001), cholesterol (p=0.001), BMI (p<0.001), waist-hip ratio (p<0.001) and percentage of weight loss percent (p<0.001) than groups G24 and G36. Dental wear was higher among the II and V sextants.

CONCLUSION

Individuals submitted to Roux-en-Y gastric bypass, regardless of the surgery period, presented more dental wear on the incisal/occlusal surfaces, and the anterior teeth were the most affected. Dental wear was associated with age and number of missing teeth.

Systemic and oral conditions of pregnant women with excessive weight assisted in a private health system

OBJECTIVE

This observational cross-sectional study aimed to evaluate systemic and oral conditions in pregnant women with excessive pre-pregnancy weight (PEW) and normal pre-pregnancy weight (PNW) who underwent follow-up in the private healthcare system during the third trimester of pregnancy.

METHODS

Fifty pregnant women were evaluated from August 2017 to February 2018 and divided into two groups: women with PEW (n = 25); and those with PNW (n = 25). Their weight and body mass index (BMI), periodontal disease status, stimulated salivary flow, and systemic condition were evaluated. Statistical analyses were conducted using t-test, Mann-Whitney test, chi-square test and binary logistic regression (P < 0.05).

RESULTS

The groups did not differ in age, educational level or monthly household income (P > 0.05). The PEW group had a higher frequency of arterial hypertension (P = 0.019) and excessive weight gain during gestation (P = 0.010), sought dental services less frequently, and had increased severity of periodontitis (P < 0.0001). Both groups presented low salivary flow, with no intergroup difference. In the final binary logistic regression models, high maternal pre-pregnancy BMI was a significant predictor of arterial hypertension and periodontitis during the third trimester of gestation; maternal excessive weight gain was also a significant predictor of periodontitis during pregnancy.

CONCLUSION

Women with PEW who underwent follow-up in a private healthcare system had a higher prevalence of arterial hypertension and worse periodontal status during the third trimester of pregnancy as compared to women with normal weight.

Systemic and periodontal conditions of overweight/obese patients during pregnancy and after delivery: a prospective cohort

OBJECTIVE

To evaluate the systemic and periodontal conditions, as well as the determinants of health in pregnant women with and without obesity/overweight during the second and third trimesters of pregnancy and after delivery.

MATERIALS AND METHODS

In the second trimester (T1), 93 pregnant women were divided into two groups with either excessive weight (G1, n = 53) or normal weight (G2, n = 40) and subsequently examined them in the third trimester of pregnancy (T2) and at least 2 months after delivery (T3). The following variables were analyzed: (a) systemic impairments during pregnancy-arterial hypertension (AH) and gestational diabetes mellitus (GDM); (b) oral hygiene behavior; (c) periodontal conditions; (d) anthropometric data and systemic health condition after pregnancy. The Mann-Whitney test, chi-squared test, ANOVA, and binary logistic regression were adopted (p < 0.05).

RESULTS

G1 showed higher frequency of GDM and AH in T1 and T2, respectively (p = 0.047; p = 0.004). Both groups had worse oral hygiene behaviors after delivery. A higher frequency of periodontitis was found in all periods for G1 (p < 0.05). G2 showed improvement of all periodontal parameters after delivery, whereas G1 showed no difference regarding these parameters between time periods.

CONCLUSION

Pregnant women with excessive weight presented worse systemic and periodontal conditions during pregnancy and after delivery.

CLINICAL RELEVANCE

Low socioeconomic level and overweight/obesity were significant predictors of periodontitis during pregnancy and after delivery.

Association of metabolic syndrome with oral and systemic conditions in morbidly obese patients

Aim: This study aimed to evaluate oral and systemic conditions in morbidly obese patients with and without metabolic syndrome (MS) prior to bariatric surgery. Methods: One hundred patients were included and equally divided into two groups: G1 - with MS (n = 50) and G2 - without MS (n = 50). MS was diagnosed in patients presenting at least three of five signs: abdominal obesity, high triglyceride level, low high-density lipoprotein cholesterol (HDL-C) level, hypertension, and altered fasting glycemia. Variables analyzed included the patients’ age, sex, body mass index (BMI), waist-to-hip ratio (WHR), and number of missing teeth. Both BMI and WHR were used to evaluate the risk of developing cardiovascular disease (RCVD). Mann-Whitney, Chi-squared, t test, hierarchical multiple linear regression and binary logistic regression models were used in statistical analyses (p<0.05). Results: There were no group-wise differences in sex (p=0.631) and BMI (p=0.200); however, the WHR (p=0.009), age (p=0.0001), and number of missing teeth (p=0.0003) were higher in G1. Obese patients with MS who were candidates for bariatric surgery presented higher RCVD than obese patients without MS (p=0.019). Binary logistic regression revealed patient age [adjusted OR=1.05, 95% CI=1.00-1.11, p=0.042] and number of missing teeth [adjusted OR=1.17, 95% CI=1.04-1.31, p=0.013] to be significant predictors of MS. Conclusion: Morbidly obese patients with MS had worse oral and systemic conditions than those without MS, regarding WHR, RCDV and number of missing teeth.

ALVEOLAR BONE PATTERN AND SALIVARY LEPTIN LEVELS AMONG PREMENOPAUSAL OBESE WOMEN

Background:

Systemic bone loss may lead to more severe periodontal destruction, decreasing local bone mineral density.

Aim:

A cross-sectional designed was performed to study associations among alveolar bone pattern, salivary leptin concentrations, and clinical periodontal status in premenopausal obese and eutrophic women.

Methods:

Thirty morbid obese (G1) and 30 normal-weight (G2) women were included. Anthropometric and periodontal measurements (probing depth - PD, clinical attachment levels - CAL, presence of calculus, bleeding on probing -BOP, and plaque accumulation) were assessed. OHIP-14 was used for assessment of oral health impact on quality of life. Panoramic radiography was used to obtain the panoramic mandibular index (PMI), mandibular cortical index (MCI), and mental index (MI). Intraoral periapical (PA) radiography was taken to measure the total trabecular bone volume. Leptin was measured in saliva of fasted overnight women.

Results:

Groups 1 and 2 differed in all anthropometric aspects, but height. Pocket depth, calculus, BOP, and plaque index were worse in G1. No differences between groups were found considering OHIP. Normal-weight subjects showed higher proportion of dense bone trabeculae than obese subjects for pre-molars, but not for molars. Mental and panoramic mandibular indexes did not differ and were in normal level. Leptin concentration was dependent only on BMI.

Conclusion:

Obesity affected the periodontal conditions, the alveolar bone pattern, and the salivary leptin concentration.

Weight loss after bariatric surgery and periodontal changes: a 12-month prospective study

BACKGROUND

Several longitudinal studies have explored the association of obesity and weight gain with periodontal disease. However, the effect of weight loss on periodontal tissues remains unclear.

OBJECTIVE

To explore whether weight loss after bariatric surgery was associated with changes in periodontal measures over 12 months.

SETTING

Two public hospitals in São Paulo, Brazil.

METHODS

We used data from 110 morbidly obese patients (body mass index [BMI]>40 kg/m² or≥35 kg/m² with co-morbid conditions) who underwent bariatric surgery between April 2011 and March 2013. Data on demographic factors, BMI, smoking habits, and glucose levels were extracted from medical records preoperatively and after 6 and 12 months postsurgery. A full-mouth periodontal examination was conducted by trained examiners to assess probing pocket depth, clinical attachment loss, and bleeding on probing (BOP) at baseline and 6 and 12 months after surgery. Data were analyzed using linear mixed-effects models.

RESULTS

BMI was not significantly related to the proportion of sites with BOP at baseline, but it was negatively associated with the rate of change in the proportion of sites with BOP. The greater the BMI loss, the higher the proportion of sites with BOP, particularly 6 months after surgery. However, BMI was not associated with baseline probing pocket depth and clinical attachment loss or rates of changes in these periodontal outcomes.

CONCLUSION

The findings suggest that weight loss was associated with increased gingival bleeding, showing a peak at 6 months after bariatric surgery. Periodontal pocketing and attachment loss remained unchanged during the study period.

Erosion and abrasion-inhibiting in situ effect of the Euclea natalensis plant of African regions

This study evaluated the effect of Euclea natalensis gel on the reduction of erosive wear with or without abrasion, in enamel and dentin. During two five-day experimental crossover phases, volunteers (n = 10) wore palatal devices containing human enamel and dentin blocks (E = 8 and D = 8). The gel was applied in a thin layer in the experimental group, and was not applied in the control group. In the intraoral phase, volunteers used the palatal appliance for 12 h before the gel treatment, and were instructed to start the erosive challenges 6 h after the gel application. Erosion was performed with Coca-Cola® (for 5 min) 4 times/day. The appliance was then put back into the mouth and was brushed after 30 minutes. After intraoral exposure, the appliances were removed and the specimens were analyzed using profilometry (mean ± SD, μm). The Euclea natalensis gel caused less wear in enamel in the experimental group (EROS = 12.86 ± 1.75 µm; EROS + ABRAS = 12.13 ± 2.12 µm) than in the control group (EROS = 14.12 ± 7.66 µm; EROS + ABRAS = 16.29 ± 10.72 µm); however, the groups did not differ from each other significantly. A statistically significant value was found for erosion and eros + abrasion in dentin (p = 0.001). Euclea natalensis may play a role in the prevention of dentin loss under mild erosive and abrasive conditions. A clinical trial is required to confirm these promising results in a clinical situation.

Lifestyle of patients with diabetes mellitus type 1: a systematic review

The aim of this review was to verify data concerning the relationship between the existent lifestyle and glycemic control in patients with Diabetes Mellitus Type 1 (DM1). The methods applied included the literature search strategy, selection of studies by means of inclusion and exclusion strategies, according to the characteristics of the studies. The search was conducted in the Lilacs, Medline, PubMed, Cochrame, SciELO and IBECS databases between in the period between 2005 and 2014. The articles selected were studies in humans, investing lifestyle, physical activities and glycemic levels. Of the 1798 studies initially identified, 11 met the eligibility criteria. Among the studies analyzed, 1 cohort; 1 longitudinal prospective, 1 case control and 8 transversal studies that approached the proposed theme were related. Regular physical activity was the variable that presented greatest relationship with the improvement in glycemic levels. Healthy active life, balanced diet, physical activities and education in diabetes improved the glycemic control of the DM1 patient. The results allowed the authors to conclude that a lifestyle based on physical activities interfered directly in the health of patients with DM1, in addition to contributing the glycemic control.

MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM DISTINCT SOCIOECONOMIC CLASSES

Background

Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both have led to serious public health problem. Oral health can be worsened by both, obesity and metabolic syndrome. Tooth loss harms masticatory function, essential status to whom will be submitted to bariatric surgery.

Aim

Assess masticatory function of obese candidates to bariatric surgery, who belong to distinct socioeconomic class range, in order to recognize hazard factors and the bias of socioeconomic factor in this context.

Methods

Observational cross-section study, with samples comprised by two groups of patients, with distinct socioeconomic class range, one of them belonging to public health system (SUSG) and the other to private clinic (CPG), candidates to bariatric surgery. Were assessed anthropometric data, comorbidities and medicines usage, blood tests, habits and the number of dental functional units.

Results

The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and age range (p=0,170). The number of dental functional units was higher in the private group (p<0.001). The impaired masticatory function was rather present among public group (p<0.001) and female gender (p<0,001). Regarded as blood tests, fasting glucose was higher in female in SUSG (p<0,001). The following hazard factors have corroborated to have patients rated as impaired masticatory function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186, p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545, p=0.045) and smokers (OR: 2.951, p=0.043).

Conclusion

The general health and masticatory function of female SUSG were worse, highlighting the socioeconomic condition as hazard factor.

IMPACT OF VITAMIN D AND CALCIUM DEFICIENCY IN THE BONES OF PATIENTS UNDERGOING BARIATRIC SURGERY: A SYSTEMATIC REVIEW

Introduction:

Bariatric surgery is considered the most effective tool in the control and treatment of severe obesity, but patients undergoing this procedure are at increased risk of developing nutritional deficiencies by limiting the intake and absorption of many nutrients.

Objective:

To assess the impact of vitamin D deficiency and calcium in bone in patients after gastric bypass in Roux-en-Y, pointing directly at the type of administration, doses and effects after surgery.

Method:

Was conducted a systematic review with articles related to the topic of the last 10 years searched in PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo and Cochrane using the headings "bariatric surgery", "bone", "obesity", "vitamin D '', "calcium" AND "absorption". Exclusion criteria to research on animals, smokers, pregnant women and patient treated with bisphosphonates.

Results:

Five articles were included in this review. All refer that bariatric surgery can lead to nutritional deficiencies and poor absorption of fats and fat-soluble vitamins and other micronutrients such as calcium.

Conclusion:

Patients submitted to RYGB should make use of multivitamins and minerals especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment and control of risk factors are essential to prevent complications after this operation.

Obesity and periodontitis: systematic review and meta-analysis

The scope of this study was to conduct a systematic review of the studies on the association between obesity and periodontitis. The methods applied included a literature search strategy and selection of studies using inclusion and exclusion in accordance with the criteria for characteristics of the studies and meta-analysis. The research was conducted in the PubMed, Embase and Lilacs databases through 2010. Selected papers were on studies on humans investigating whether or not obesity is a risk factor for periodontitis. Of the 822 studies identified, 31 studies met the inclusion criteria and were included in this meta-analysis. The risk of periodontitis was associated with obesity (or had a tendency for this) in 25 studies, though it was not associated in 6 studies. The meta-analysis showed a significant association with obesity and periodontitis (OR = 1.30 [95% Confidence Interval (CI), 1.25 - 1.35]) and with mean Body Mass Index (BMI) and periodontal disease (mean difference = 2.75). Obesity was associated with periodontitis, however the risk factors that aggravate these diseases should be better clarified to elucidate the direction of this association. Working with paired samples and avoiding confusion factors may contribute to homogeneity between the studies.

Systemic consequences of bariatric surgery and its repercussions on oral health

INTRODUCTION

Morbid obesity control can be done by bariatric surgery that restricts or reduces the amount of food absorption. The objective of this review was to identify the consequences of bariatric surgery and its repercussions on oral health.

METHOD

It was used the Virtual Library of Health, which included articles that had any direct or indirect connection between bariatric surgery and oral health, and published in the last ten years.

RESULTS

Some complications of the surgery are chronicle reflux and nutritional deficiency, which may bring repercussions on the oral cavity, such as tooth erosion, bone loss and dental caries. On the other hand, there are also positive impacts, such as the decrease of diabetes, apnea and improvement on self-esteem, that makes the patients less vulnerable to complications regarding oral health, for example xerostomy and periodontal disease.

CONCLUSION

Maintaining proper oral health in patients undergoing bariatric surgery contributes to success after surgery protecting benefits and minimizing side effects.

Effect of propolis gel on the in vitro reduction of dentin permeability

Objective

The aim of this study was to evaluate the capacity of potassium oxalate, fluoride gel and two kinds of propolis gel to reduce the hydraulic conductance of dentin, in vitro.

Material and Methods

The methodology used for the measurement of hydraulic conductance of dentin in the present study was based on a model proposed in literature. Thirty-six 1-mm-thick dentin discs, obtained from extracted human third molars were divided into 4 groups (n=9). The groups corresponded to the following experimental materials: GI-10% propolis gel, pH 4.1; GII-30% propolis gel; GIII-3% potassium oxalate gel, pH 4,1; and GIV-1.23% fluoride gel, pH 4.1, applied to the dentin under the following surface conditions: after 37% phosphoric acid and before 6% citric acid application. The occluding capacity of the dentin tubules was evaluated using scanning electron microscopy (SEM) at ×500, ×1,000 and ×2,000 magnifications. Data were analyzed statistically by two-way ANOVA and Tukey's test at 5% significance level.

Results

Groups I, II, III, IV did not differ significantly from the others in any conditions by reducing in hydraulic conductance. The active agents reduced dentin permeability; however they produced the smallest reduction in hydraulic conductance when compared to the presence of smear layer (P<0.05). The effectiveness in reducing dentin permeability did not differ significantly from 10% or 30% propolis gels. SEM micrographs revealed that dentin tubules were partially occluded after treatment with propolis.

Conclusions

Under the conditions of this study, the application of 10% and 30% propolis gels did not seem to reduce the hydraulic conductance of dentin in vitro, but it showed capacity of partially obliterating the dentin tubules. Propolis is used in the treatment of different oral problems without causing significant great collateral effects, and can be a good option in the treatment of patients with dentin sensitivity.

Dental caries in adolescents from public schools in Maputo, Mozambique

AIM

To assess dental caries prevalence in adolescents at urban and sub-urban areas of Maputo-City, Mozambique and to identify its relationship with dental fluorosis, dental plaque, nutritional status, frequency of sugar consumption and the concentration of fluoride in public water supply.

METHODS

Subjects (n=601) were randomly selected from five urban schools and five sub-urban schools. Clinical examinations were performed under standardised conditions by a trained examiner using DMFT index, SiC index, fluorosis index, PHP, BMI, a sugar consumption questionnaire and water supply analysis. The bivariate analysis and Pearson correlation was used (p < 0.05).

RESULTS

The mean (DMFT) was 0.9 (+/- 1.65 SD). Children in urban schools showed less dental caries (0.8 +/- 1.49 SD) than children in sub-urban schools (1.1 +/- 1.80 SD, p = 0.03). Only 8.15% had very mild to moderate fluorosis but most presented poor oral hygiene. Cases of malnutrition were found in more sub-urban schools (n=109; 36.22%) than in urban schools (n=66; 22.00%) (p = 0.03). The frequency of sugar consumption was higher among urban children compared to suburban schools (p < 0.00). The level of fluoride in water consumption in urban schools was 0.4 ppmF, above the level of fluoride in sub-urban schools, 0.2 ppmF.

CONCLUSION

Dental caries should not be considered a major oral health problem in Maputo at the moment. However the data suggest the implementation of a population strategy to reduce dental caries rates, in children of both urban and sub-urban areas, in Maputo.

Manipulação do genoma humano: ética e direito

A biologia molecular tem fornecido as ferramentas básicas para os geneticistas se aprofundarem nos mecanismos moleculares que influem na variação das doenças. Deve-se destacar a responsabilidade científica e moral dos pesquisadores, uma vez que os cientistas devem imaginar as consequências morais da aplicação comercial de testes genéticos, já que esse fato envolve não só o indivíduo e suas famílias, mas toda a população. Além de ser preciso, também, fazer uma reflexão sobre como essas informações do genoma humano serão utilizadas, para o bem ou mal. O objetivo desta revisão foi trazer à luz do conhecimento dados sobre características éticas da aplicação da biologia molecular, relacionando-a com os direitos do ser humano. Após análise bibliográfica, pôde-se observar que o Projeto Genoma Humano gerou várias possibilidades, como identificação de genes associados a doenças com propriedades sinergísticas, mas modificando às vezes comportamentos ao intervir geneticamente no ser humano, trazendo benefícios ou malefícios sociais. O grande desafio é decidir o que a humanidade pretende em relação a este gigantesco salto.

[A new protocol for use and storage of tooth-brushing material for school children]

The aim of this study was to evaluate the storage and distribution of toothbrushing material for school children. Twenty individuals responsible for the collective oral hygiene of school children from Bauru - SP and São José dos Campos - SP participated in the first stage of the study, answering 2 questionnaires about five different kits for use by school children. The statistical analysis was performed using Wilcoxon (p<0,05). In the second stage, the amount of toothpaste or liquid cleanser applied to the toothbrush by 178 school children aged 4 to 8 years from 2 cities from the state of São Paulo (Bauru e Bariri) was weighed using a portable balance. The statistical analysis was obtained by using Pearson's correlation coefficient and analysis of covariance (p <0,05). Kit 5 obtained levels of satisfaction and high satisfaction when compared with the others kits (1 - 4). The school children from Bauru (0.41g) used smaller amounts of toothpaste than the school children from Bariri (0.48g). The average of the amount of liquid cleanser applied by the sample was 0.15g. The "drop technique" (liquid cleanser) was considered practical for dispensing a small, standardized quantity of the product. Kit 5 was considered a good alternative for establishing a collective oral health protocol in the Brazilian health system.