Determinants of neonatal, postneonatal and maternal mortality on models of primary health

Background

The state of São Paulo recorded a significant reduction in infant mortality, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality and maternal mortality in the state of São Paulo, Brazil.

Methods

In this ecological study, data from national official open sources were used. Analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality and maternal mortality rates were calculated for every 1000 live births, 2013. The association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. We used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted “p” at 5%.

Results

The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates.

Conclusions

It was concluded that the Family Health Care Strategy model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model.

Key messages

Implementation of public policies with specific focus on attenuating these factors and making it possible to optimize resources, and not interrupting the FHS. Knowledge of the factors with impact on these indicators would be of help in formulating public policies.

Effect of Argon Plasma Surface Treatment on Bond Strength of Resin Composite Repair

Objectives:

This study evaluated the effect of argon plasma treatment (PLA) and its combination with sandblasting (SAN), silanization (SIL), and hydrophobic bonding resin (HBR) application on the micro-shear bond strength of water-aged restorative resin composite to a newly placed composite, simulating restoration repair.

Methods and Materials:

Forty-five light-cured composite plates (20-mm long × 20-mm wide × 4-mm thick) were fabricated using a hybrid composite and stored at 37°C in distilled water for six months. The aged composite surfaces were treated according to the following experimental groups, varying both treatment and order of application: 1) SAN + SIL + HBR (control), 2) SAN + PLA for 30 seconds + SIL + HBR, 3) SAN + SIL + PLA + HBR, 4) PLA + SIL + HBR, 5) PLA + SIL, 6) PLA + HBR, 7) SIL + PLA + HBR, 8) SIL + PLA, and 9) PLA. After the surface treatments, four fresh resin composite cylinders (1.5-mm high × 1.5-mm diameter) of the same composite were built on each aged composite surface using a silicone mold. After water storage for 24 hours or one year, the specimens were submitted to shear bond strength testing. Data were statistically analyzed by two-way analysis of variance and Tukey's test (5%).

Results:

Groups 1, 2, and 4 presented significantly higher bond strength means at 24 hours, although group 4 did not differ from group 7. Groups 5, 8, and 9 demonstrated significantly lower means than the other groups. Even though groups 1 and 2 had a significant bond strength reduction after 1 year, they still demonstrated higher bond strength at one year of storage.

Conclusions:

While PLA application combined with surface treatment methods demonstrated high bond strength results, this treatment alone was not as beneficial as other methods that included SAN, SIL and HBR.

Factors associated with Brazilian adolescents' satisfaction with oral health

OBJECTIVE

To identify the sociodemographic, clinical and self-reported indicators of oral health associated with Brazilian adolescents' satisfaction with oral health.

METHODS

Secondary data were used following the examination of 4,231 adolescents, aged 15 to 19 years, participating in a national oral health survey (SBBrasil 2010). The independent variables were grouped into demographics, predisposition/facilitation, oral health conditions and perceived dental treatment need. Satisfaction with oral health was considered the dependent variable. Ordinal logistic (multiple) regression models tested the variables in sequence (hierarchical), as per the conceptual model, assuming p≤0.05 as the criterion for remaining in the model (Wald test). Adjustment of the model was evaluated with the Akaike information criterion (AIC) and -2 Log L.

RESULTS

Participants with perceived treatment need (OR=2.36, 95% CI = 2.14-2.61), toothache (OR=1.18, 1.10-1.28), presence of oral impacts on daily performance (OIDP) (OR= 1.55, 1.44-1.68), severe and very severe dental aesthetic index (DAI) (OR=1.17, 1.08-1.27), were female (OR=1.16, 1.10-1.23), were of black/brown ethnicity (OR=1.10, 1.04-1.17), and had caries in anterior (OR=1.20, 1.08-1.32) and posterior teeth (OR=1.22, 1.13-1.32) presented lower satisfaction with oral health.

CONCLUSION

Satisfaction with oral health in Brazilian adolescents is linked to a multidimensional structure of factors that include demographic aspects, such as gender and ethnic group, self-perception aspects, such as perceived treatment need and oral health impact on daily activities, and clinical aspects, such as the presence of toothache, severe malocclusion and caries in anterior and posterior teeth.

Efeito da Aplicação de Plasma na Adesão de Cimentos Resinosos à Blocos de Resinas CAD/CAM

Este estudo investigou o efeito da aplicação de plasma de argônio na resistência de união por cisalhamento (RUC) de dois cimentos resinosos a 3 resinas híbridas para CAD/CAM (Enamic, Cerasmart e Lava Ultimate) e uma resina composta indireta (Epricord – controle). Os materiais restauradores indiretos foram tratados (1) de acordo com instruções do fabricante (2) plasma de argônio (30s) e (3) plasma de argônio + adesivo ou silano. Em seguida, moldes de silicone foram posicionados na superfície tratada dos materiais e os cimentos resinosos (Panavia V5/PV5 ou RelyX Ultimate/RXU) foram inseridos no orifício do molde, obtendo-se cilindros dos cimen-tos (1,5 mm diâmetro e 1,0 mm altura) após fotoativação (n10). As amostras foram armazenadas em água destilada por 24 h e testadas em máquina de ensaio. Dados de RUC foram analisados por ANOVA 3-fatores e teste de Tukey (5%). A RUC do PV5 e RXU ao Lava Ultimate tratado com plasma e plasma + adesivo não mostrou diferença significativa quando comparado ao controle. Para os demais materiais, o tratamento como sugere o fabricante produziu maiores RCUs com o PV5. O RXU aplicado no Enamic com o uso do plasma não mostrou diferença estatística em re-lação ao controle. Para o Cerasmart e Epricord, a aplicação do plasma + adesivo também não diferiu do controle. Em geral, o RXU resultou em maior RUC que o PV5. A RUC dos cimentos resinosos aos materiais restauradores indiretos seguindo as instruções do fabricante produziu os melhores resultados, entretanto o uso do plasma pode ser uma alternativa, dependendo do material e do cimento resinoso.Palavras-chave: Resinas Compostas. Resistência ao Cisalhamento. Plasma.

Effect of Restorative System and Thermal Cycling on the Tooth-Restoration Interface – OCT Evaluation

The present study evaluated the tooth/noncarious cervical lesion restoration interface when using different adhesive systems and resin composites, submitted to thermal cycling (TC), using optical coherence tomography (OCT). Noncarious cervical lesion (NCCL) preparations (0.7 mm depth × 2 mm diameter) were performed on 60 human third molars and randomly divided into six groups, according to the adhesive system and resin composite used: group 1 = Adper Single Bond 2 (SB2) + Aelite LS Posterior (AP); group 2 = SB2 + Venus Diamond (VD); group = SB2 + Filtek Z250XT (Z250); group 4 = Clearfil SE Bond (CSE) + AP; group 5 = CSE + VD; group 6 = CSE + Z250. Selective enamel etching was performed for 30 seconds on groups 4, 5, and 6, while groups 1, 2, and 3 were etched for 30 seconds in enamel and 15 seconds in dentin. All groups were evaluated using OCT before and after TC (n=10). Images were analyzed using Image J software; enamel and dentin margins were separately evaluated. Data from OCT were submitted to PROC MIXED for repeated measurements and Tukey Kramer test (α = 0.05). No marginal gaps were observed in etched enamel, either before or after TC, for all adhesive and resin composite systems. A significant interaction was found between adhesive system and TC for the dentin groups; after TC, restorations with CSE showed smaller gaps at the dentin/restoration interface compared with SB2 for all resin composites. Increased gap percentages were noticed after TC compared with the gaps before TC for all groups. In conclusion, TC affected marginal integrity only in dentin margins, whereas etched enamel margins remained stable even after TC. Dentin margins restored with CSE adhesive system showed better marginal adaptation than those restored with SB2. Resin composites did not influence marginal integrity of NCCL restorations.

Effect of Toothpaste Application Prior to Dental Bleaching on Whitening Effectiveness and Enamel Properties

OBJECTIVE

The purpose of this study was to investigate the effects on the enamel properties and effectiveness of bleaching using 35% hydrogen peroxide (HP) when applying toothpastes with different active agents prior to dental bleaching.

METHODS

Seventy enamel blocks (4 × 4 × 2 mm) were submitted to in vitro treatment protocols in a tooth-brushing machine (n=10): with distilled water and exposure to placebo gel (negative control [NC]) or HP bleaching (positive control [PC]); and brushing with differing toothpastes prior to HP bleaching, including potassium nitrate toothpaste (PN) containing NaF, conventional sodium monofluorophosphate toothpaste (FT), arginine-based toothpastes (PA and SAN), or a toothpaste containing bioactive glass (NM). Color changes were determined using the CIE L*a*b* system (ΔE, ΔL, Δa, and Δb), and a roughness (Ra) analysis was performed before and after treatments. Surface microhardness (SMH) and cross-sectional microhardness (CSMH) were analyzed after treatment. Data were analyzed with repeated measures ANOVA for Ra, one-way ANOVA (SMH, ΔE, ΔL, Δa, and Δb), split-plot ANOVA (CSMH), and Tukey post hoc test (α<0.05). The relationship between the physical surface properties and color properties was evaluated using a multivariate Canonical correlation analysis.

RESULTS

Color changes were statistically similar in the bleached groups. After treatments, SMH and CSMH decreased in PC. SMH increased significantly in the toothpaste groups vs the negative and positive control (NM > PA = SAN > all other groups) or decreased HP effects (CSMH). Ra increased in all bleached groups, with the exception of NM, which did not differ from the NC. The variation in the color variables (ΔL, Δa, and Δb) explained 21% of the variation in the physical surface variables (Ra and SMH).

CONCLUSION

The application of toothpaste prior to dental bleaching did not interfere with the effectiveness of treatment. The bioactive glass based toothpaste protected the enamel against the deleterious effects of dental bleaching.

Influence of the artefact reduction algorithm of Picasso Trio CBCT system on the diagnosis of vertical root fractures in teeth with metal posts

OBJECTIVES

To assess the influence of the artefact reduction algorithm (AR) available on the Picasso Trio 3D(®) imaging system (Vatech, Hwaseong, Republic of Korea) on image quality [greyscale values, contrast-to-noise ratio (CNR) and artefact formation] and diagnosis of vertical root fractures (VRFs) in the teeth with intracanal metal posts.

METHODS

30 uniradicular teeth had their crowns removed and their roots endodontically treated to receive intracanal metal posts. In 20 teeth, both complete (n = 10) and incomplete (n = 10) VRFs were created. Each tooth was scanned twice, with and without AR activation. The mean and variation of greyscale values, as well as CNR, were calculated for all images. Subsequently, an evaluator compared the amount of artefact (cupping, white streaks and dark bands) in all images. Five evaluators rated for VRF presence using a five-point scale.

RESULTS

Mean greyscale values and CNR were significantly decreased in images acquired with the AR. The usage of the algorithm promoted an overall reduction of image artefacts. Regarding the diagnosis of complete and incomplete VRFs, the use of the AR had an overall negative impact on specificity and accuracy.

CONCLUSIONS

While indeed reducing artefact formation, the use of the AR, instead of improving the impact on the diagnosis of VRFs in teeth with intracanal metal posts, had a negative impact on the diagnosis.

In Situ Surface Biodegradation of Restorative Materials

This study aimed to evaluate the surface characteristics of restorative materials (roughness, hardness, chemical changes by energy-dispersive spectroscopy [EDX], and scanning electron microscopy [SEM]) submitted to in situ biodegradation. Fifteen discs of each material (IPS e.max [EM], Filtek Supreme [FS], Vitremer [VI], Ketac Molar Easymix [KM], and Amalgam GS-80 [AM]) were fabricated in a metallic mold (4.0 mm × 1.5 mm). Roughness, hardness, SEM, and EDX were then evaluated. Fifteen healthy volunteers used a palatal device containing one disc of each restorative material for seven days. After the biodegradation, the roughness, hardness, SEM, and EDX were once again evaluated. Data obtained from the roughness and hardness evaluations were submitted to Kolmogorov-Smirnov and Tukey-Kramer tests (p&lt;0.05). All esthetic restorative materials showed a significant increase in the roughness after biodegradation. Before biodegradation, significant differences in the hardness among the materials were seen: EM&gt;AM&gt;FS&gt;KM&gt;VI. After biodegradation, the hardness was significantly altered among the materials studied: EM&gt;AM&gt;FS=KM&gt;VI, along with a significant increase in the hardness for AM, KM, and VI. SEM images indicated degradation on the surface of all materials, showing porosities, cracks, and roughness. Furthermore, after biodegradation, FS showed the presence of Cl, K, and Ca on the surface, while F was not present on the VI and KM surfaces. EM and AM did not have alterations in their chemical composition after biodegradation. It was concluded that the dental biofilm accumulation in situ on different restorative materials is a material-dependent parameter. Overall, all materials changed after biodegradation: esthetic restorative materials showed increased roughness, confirmed by SEM, and the ionomer materials and silver amalgam showed a significantly higher hardness. Finally, the initial chemical composition of the composite resin and ionomer materials evaluated was significantly altered by the action of the biofilm in situ.

Light-curing Time and Aging Effects on the Nanomechanical Properties of Methacrylate- and Silorane-based Restorations

The aim of this study was to assess the influence of light-curing time on the nanohardness (H) and reduced elastic modulus (Er) of components (underlying dentin, hybrid layer, adhesive, and composite) of methacrylate- and silorane-based restorations after 24 hours and six months of storage. Class II slot preparations were carried out in human molars (n=3) and restored with methacrylate (Clearfil SE Bond [Kuraray] + Filtek Z250 [3M ESPE]) or silorane (LS restorative system [3M ESPE]) restorative systems and light-cured using light-emitting diode at 1390 mW/cm2 for the recommended manufacturers' time or double time. Restorations were sectioned, and bonded dentin-resin interfaces were embedded in epoxy resin and polished for evaluation with a Berkovich fluid cell tip (TI 700 Ubi-1 nanoindenter, Hysitron). Data were statistically analyzed by analysis of variance and Tukey's test (alpha=0.05). Overall, the H and Er values were higher for methacrylate-based restorations than for silorane materials (p≤0.05), an increase in curing time did not improve the H and Er of the bonded interface components of either material (p&gt;0.05), and aging significantly decreased the mechanical properties of interface components of both resin-based restorative systems (p≤0.05). In general, nanomechanical properties decreased after six months of storage, the methacrylate restorative system exhibited higher H and Er than silorane, and light-curing time did not influence the properties tested.

Influence of exposure factors on the variability of CBCT voxel values: a phantom study

OBJECTIVES

To assess the influence of milliamperage and kilovolt peak (kVp) on the variability of cone beam CT (CBCT) voxel values.

METHODS

CBCT scans were obtained from radiographic phantoms in varying concentrations of dipotassium hydrogen phosphate solutions (200-1200 mg ml(-1)) under different protocols of milliamperage and kVp. In addition, scans were performed with and without a dental implant and exo-mass. The variability of CBCT voxel values was measured on each scan, and factorial analysis of variance and the post hoc Tukey test were performed (α = 0.05). Linear regression was performed to assess the relationship between voxel value variability and dipotassium hydrogen phosphate concentration.

RESULTS

milliamperage and the presence of a dental implant did not produce significant interference (p = 0.28 and 0.87, respectively) in voxel value variability. Scans at the highest kVp value presented a significant reduction (p ≤ 0.0001) in voxel value variability when only exo-mass was not present. Voxel value variability was not influenced by exo-mass in scans at the highest levels of milliamperage and kVp. The presence of exo-mass produced a significant reduction (p ≤ 0.0001) in voxel value variability in most of the scans. Higher concentrations yielded greater variations in voxel values in all scans, except for those operating at the highest levels of mAs and kVp.

CONCLUSIONS

mAs did not influence the variability of CBCT voxel values; higher kVp reduced such variability when only the object was smaller than the field of view.

Influence of chemical degradation on the surface properties of nano restorative materials

OBJECTIVES

The aim of this in vitro study was to investigate the effect of chemical degradation on the surface roughness (Ra) and hardness (Knoop hardness number [KHN]) of nano restorative materials.

METHODS

Disc-shaped specimens (5-mm diameter; 2-mm thick) of Filtek Z350 and TPH Spectrum composites and the Vitremer and Ketac Nano light-curing glass ionomer cements were prepared according to the manufacturers' instructions. After 24 hours, polishing procedures were performed and initial measurements of Ra and KHN were taken. The specimens were divided into 12 groups (n=10) according to material and storage media: artificial saliva, orange juice, and Coca-Cola. After 30 days of storage, the specimens were reevaluated for Ra and KHN. The pH values of the storage media were measured weekly. Data were tested for significant differences by repeated-measures three-way analysis of variance and Tukey tests (p<0.05).

RESULTS

Composites were found to present lower roughness values and higher hardness values than the ionomeric materials under all storage conditions. After degradation, the KHN of all experimental samples decreased significantly, while the Ra of the ionomeric materials increased, depending on the media, with a markedly negative impact of Coca-Cola and orange juice. There was no difference among the storage media for Filtek Z350 with regard to the KHN values. Nanofillers did not show any influence on the roughness and hardness of resin-modified glass ionomer cements and resin composites concerning their degradation resistance.

Association between oral health-related quality of life and atraumatic restorative treatment in school children: an exploratory study

BACKGROUND

The present study's objectives were to compare the perceptions of oral health-related quality of life (OHRQoL) among school children presents dental caries with that of caries-free school children, and to evaluate the subjective impact of atraumatic restorative treatment (ART) on the OHRQoL of school children.

DESIGN

Exploratory study.

SETTING

Public school in Piracicaba, Brazil.

MATERIALS AND METHODS

The sample was composed of 30 children in the age-group of 8-10 years. The children were divided into two groups: one with caries and other without caries. The information related to OHRQoL was obtained through the administration of the Child Perceptions Questionnaires (CPQ 8-10 ). To evaluate the impact of ART on the school children's OHRQoL, the CPQ 8-10 was re-administered 4 weeks after the initial treatment. For statistical analysis we used the nonparametric Wilcoxon test for two dependent variables (test and re-test groups) and the nonparametric Mann-Whitney test for independent variables (test and control groups).

RESULTS

It was observed that children with dental caries reported larger impact of oral health conditions on the quality of life when compared with the caries-free group, especially in the emotional and social well-being domains ( P ≤.05). After the school children who presented with dental caries received ART, there was improvement in the median scores of CPQ 8-10 in all of the domains, but particularly in the functional limitation domain ( P ≤.05).

CONCLUSION

Dental caries exerts a strong influence on the OHRQoL of children. ART was shown to be a simple and painless caries management approach that could improve the OHRQoL of school children.

Influence of an intermediary base on the microleakage of simulated class II composite resin restorations

The aim of this in vitro study was to qualitatively and quantitatively evaluate the microleakage of Class II cavities restored with a methacrylate-based composite (Filtek Z250, 3M ESPE) or silorane-based composite (Filtek LS, 3M ESPE), varying the application of an intermediary base, using a low-viscosity composite resin (Filtek Z350 Flow, 3M ESPE) or resin-modified glass ionomer cement (RMGIC) (Vitrebond, 3M ESPE) and no intermediary base (control groups). Sixty cavities were prepared on the proximal surfaces of bovine teeth and were randomly divided according to the experimental groups (n=10). Following the restorative procedures and thermocycling, the samples were immersed in methylene blue for two hours. The qualitative evaluation was made using a stereomicroscope, whereby two observers analyzed the infiltration level of the dye within the tooth/filling. Microleakage scores among the groups were compared using the Kruskal-Wallis test followed by the Mann-Whitney test (p≤0.05). The samples were then ground and the powder was prepared for quantitative analysis in an absorbance spectrophotometer. The results were statistically analyzed by analysis of variance and the Tukey test (p≤0.05). Results from the quantitative analysis showed that LS presented higher values of microleakage than did Z250. There was a significant difference between both composites concerning the intermediary materials, with the lowest values obtained using RMGIC as an intermediary base. Results from the qualitative analysis showed that there were no statistically significant differences between composites; however, there were significant differences for both composites concerning the intermediary materials, with the lowest values obtained using RMGIC as an intermediary. It is possible to conclude that using RMGIC as an intermediary base provided lower microleakage, indicating better sealing of the tooth-restoration interface.

Variations in caries diagnoses and treatment recommendations and their impacts on the costs of oral health care

OBJECTIVE

To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil made a combined visual-radiographic caries examination of 40 occlusal surfaces of extracted permanent teeth mounted on two dental mannequins and proposed treatment plans for each tooth. Histological validation then evaluated the diagnoses validity and the suitability of the treatment plans.

OUTCOME MEASURES

Inter-examiner agreement was calculated by Cohen's Kappa statistics. The sensitivity and specificity of caries detection and treatment decision were calculated. The costs of dental treatment plans for public health system were calculated from a Brazilian public health service fee scale.

RESULTS

Inter-examiner agreement for caries detection was moderate (kappa = 0.42) while for treatment decisions it was fair (kappa = 0.29). The sensitivity and specificity were 0.69 and 0.65 for caries detection and 0.56 and 0.65 for treatment decision respectively. Dentists overestimated the presence and depth of carious lesions and there was a tendency to treat enamel lesions using invasive therapeutic procedures. Mean treatment cost across the two cases was 32US$ (range 9-65) while the histologically validated cost was 23US$.

CONCLUSION

The variability in caries detection and treatment decision negatively affected the cost of the dental treatment.

In-depth polymerization of a self-adhesive dual-cured resin cement

The aim of this study was to assess Knoop hardness at different depths of a dual-cured self-adhesive resin cement through different thicknesses of Empress Esthetic® ceramic.Flattened bovine dentin was embedded in resin. The cement was inserted into a rubber mold (0.8 x 5 mm) that was placed between two polyvinyl chloride plastic films and placed over the flat dentin and light cured by Elipar Trilight-QTH (800 mW/cm2) or Ultra-Lumelight-emitting diode (LED 5; 1585 mW/cm2) over ceramic disks 1.4 or 2 mm thick. The specimens(n=6) were stored for 24 hours before Knoop hardness (KHN) was measured. The data were submitted to analysis of variance in a factorial split-plot design and Tukey's test (a=0.05).There was significant interaction among the study factors. In the groups cured by the QTHunit, an increase in ceramic thickness resulted in reduced cement hardness values at all depths, with the highest values always being found in the center (1.4 mm, 58.1; 2 mm, 50.1)and the lowest values at the bottom (1.4 mm,23.8; 2 mm, 20.2). When using the LED unit, the hardness values diminished with increased ceramic thickness only on the top (1.4 mm,51.5; 2 mm, 42.3). In the group with the 1.4-mm-thick disk, the LED curing unit resulted in similar values on the top (51.5) and center(51.9) and lower values on the bottom (24.2).However, when the cement was light cured through the 2-mm disk, the highest hardness value was obtained in the center (51.8), followed by the top (42.3) and bottom (19.9),results similar to those obtained with the QTH curing unit (center > top > bottom). The hardness values of the studied cement at different depths were dependent on the ceramic thickness but not on the light curing units used.

Biodegradation and abrasive wear of nano restorative materials

The purpose of this study was to evaluate the biomechanical degradation of two nanofilled restorative materials (a resin-modified glass ionomer, Ketac N100 and a composite, Filtek Z350), compared with conventional materials (Vitremer and TPH Spectrum). Twenty specimens obtained from each material were divided into two storage groups (n=10): relative humidity (control) and Streptococcus mutans biofilm (biodegradation). After 7 days of storage, roughness values (Ra) and micrographs by scanning electron microscopy (SEM) were obtained. In a second experimental phase, the specimens previously subjected to biodegradation were fixed to the tooth-brushing device and abraded via toothbrushes, using dentifrice slurry (mechanical degradation). Next, these specimens were washed, dried, and reassessed by roughness and SEM. The data were submitted to repeated measures three-way analysis of variance (ANOVA) and Tukey tests (p<0.05). There was statistically significant interaction among factors: material, storage (humidity/biofilm), and abrasion (before/after). After biodegradation (S mutans biofilm storage), Ketac N100 presented the highest Ra values. Concerning bio plus mechanical challenge, TPH Spectrum, Ketac N100, and Vitremer presented the undesirable roughening of their surfaces, while the nano composite Filtek Z350 exhibited the best resistance to cumulative challenges proposed. The degraded aspect after biodegradation and the exposure of fillers after mechanical degradation were visualized in micrographs. This study demonstrated that the nanotechnology incorporated in restorative materials, as in composite resin and resin-modified glass ionomer, was important for the superior resistance to biomechanical degradation.

Student self-confidence in coping with uncooperative behaviours in paediatric dentistry

During paediatric dental treatment, non-collaboration and fearful reactions are frequently observed in the child client. The dentistry student must be prepared to cope with these reactions, particularly considering the importance of the relationship between dentists and patients in the promotion of oral health. The present study aimed to assess undergraduate dentistry students' perceptions of their ability to cope with non-collaboration situations in paediatric dentistry. A Likert-style questionnaire was used to analyse students' self-confidence levels, and proposed solutions to 10 problem situations the students would be likely to encounter were recorded. The questionnaire was administered to two undergraduate dentistry student groups from two different Brazilian Public Faculties, comprising 122 respondents. The self-confidence analysis indicated that it varied according to the extent of the child's reaction and the invasiveness of the procedure. Responses to the open-ended questions were categorised by solution proposed, and the analysis indicated that the most frequent responses were categorised as follows: tranquilising, explanation and restriction. Significant differences were found in tranquilising (with higher values for Faculty 2 than 1, and higher values for female students than male students at Faculty 2) and restriction (with higher values for female students compared with male student at both Faculties). The results and discussion focused on the aspects of training dentistry students' social and behavioural management skills.

Influence of the curing mode on fluoride ion release of self-adhesive resin luting cements in water or during pH-cycling regimen

This study evaluated the effects of curing modes and storage conditions on fluoride release of resin cements. In phase 1, the cumulative fluoride release rate from samples of the resin cements (Panavia F 2.0, RelyX Unicem, MaxCem, and BisCem) was quantified after 15 days storage in water (n=4). In phase 2, the fluoride release profiles from the same materials were analyzed during pH cycling (n=4). In this second phase, fluoride was measured at specific times (one, two, three, five, eight, and 15 days). Disk-shaped specimens were prepared (10 mm × 0.5 mm), and the materials were either light activated or allowed to autopolymerize. For both phases, the fluoride release was measured using a fluoride ion-specific electrode. The fluoride release in water was not affected by the curing mode of RelyX Unicem and Maxcem resin cements. Panavia F. 2.0 and BisCem resin cements, either light cured or autopolymerized modes, released higher amounts of fluoride in water than the other self-adhesive cements. In phase 2, the concentration of fluoride released decreased from the first day of pH cycling until the 15th day for all resin cements, for both curing modes, regardless of the storage solution used (demineralizing/remineralizing). The fluoride release rate during pH cycling by Panavia F 2.0 and MaxCem was not affected by the curing mode. The effect of the curing mode on fluoride ion release in water or during pH cycling was product dependent.

Effect of preheating resin composite and light-curing units on the microleakage of Class II restorations submitted to thermocycling

This in vitro study evaluated microleakage in Class II cavities restored with dental composite and varying light-curing units and the temperature of the composite when subjected to a thermocycling test. Ninety cavities were prepared on the proximal surfaces of bovine teeth and randomly divided according to the light-curing mode (QTH-420 mW/cm2, LED 2nd generation-1100 mW/cm2, or LED 3rd generation-700 mW/cm2) and temperature of the resin composite (23°C, 54°C and 60°C). Following the restorative procedures and thermocycling, the samples were immersed in methylene blue for 12 hours. The samples were ground and the powder prepared for analysis in an absorbance spectrophotometer. All the results were statistically analyzed using the nonparametric tests of Kruskal-Wallis and Dunn (p ≤ 0.05). The results showed that there was no statistical difference between the light-curing modes at a temperature of 23°C. For 54°C, QTH showed a microleakage mean that was significantly lower than those of the LED groups, and for 60°C, QTH had a microleakage mean significantly lower than that of the LED 2nd generation group. There was no statistical difference between the temperatures of the resin composite when LEDs were used. For QTH, 54°C showed statistically lower microleakage than 23°C. The group preheated to 60°C showed no difference when compared to the group heated to 23°C. Preheating the resin composite (54°C and 60°C) did not improve the microleakage means when high-irradiance LED was used; however, it decreased the microleakage means when a QTH with low irradiance was used.

Effect of curing mode on bond strength of self-adhesive resin luting cements to dentin

In this study, the in vitro bond strength of dual-curing resin cements to indirect composite restorations when the cement was either light polymerized or allowed to only autopolymerize was evaluated. Occlusal dentin surfaces of 56 extracted human third molars were flattened to expose coronal dentin. Teeth were assigned to eight groups (n = 7) according to resin cement products and polymerization modes: conventional cement (Panavia F 2.0; Kuraray Medical) and self-adhesive cements [RelyX Unicem (3M ESPE), BisCem (Bisco), and G-Cem (GC Corp.)]. Cements were applied to prepolymerized resin discs (2-mm-thick Sinfony; 3M ESPE), which were subsequently bonded to the prepared dentin surfaces. The restored teeth were either light-polymerized through the overlying composite according to manufacturers' instructions or were allowed to only self-cure. After 24 h, the teeth and restorations were sectioned to obtain multiple bonded beams (1.0 mm(2)) and tested in tension at a crosshead speed of 0.5 mm/min until failure. Data (MPa) were analyzed by two-way ANOVA and Tukey test (alpha = 0.05). Light activation of some cement systems (G-Cem and Panavia F 2.0) increased the bond strength, while the curing mode did not affect the bond strength for some (RelyX Unicem and BisCem). The bond strength in the autopolymerized mode varied among products. In general, the use of self-adhesive resin cements did not provide significantly higher bond strengths than that of a conventional material, and two self-adhesive cements yielded significantly lower bond values (regardless of cure mode) than the other products.

Risk indicators of dental caries in 5-year-old Brazilian children

OBJECTIVE

To report the prevalence and severity of dental caries and to identify caries risk indicators among gender, clinical and socioeconomic variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005.

METHOD

The random sample consisted of 728 subjects attending public and private preschools that were examined by a calibrated dentist. Dental caries was measured using WHO criteria. The socioeconomic variables (type of school, monthly family income, number of people living in the household, parents' educational level and home ownership) were collected by means of a parental semi structured questionnaire.

RESULTS

The mean dmft was 1.30 (SD=2.47); 62.2% were caries-free. The multiple logistic regression analyses showed that the risk indicators of caries were father's incomplete college education and presence of initial lesion.

CONCLUSIONS

The prevalence of dental caries in 5-year-old preschool attenders in Piracicaba was moderate, and father's educational status below undergraduate level, as well as presence of initial lesions, were risk indicators of the disease.

Evaluation of root resorption associated with orthodontic movement in stressed rats

AIM

The aim of this study was to investigate the effects of acute and chronic systemic stress response on orthodontically induced root resorption.

METHODS

Male Wistar rats were restrained during 1 hour a day by stress models of short (3 days) and long duration (40 days), while control group was not submitted to restraint (N.=10/group). The upper left first molars of all rats were moved mesially by a fixed orthodontic appliance exerting 50 g force upon insertion during the last 14 days of the experiment. Then, animals were killed for blood collection and mensuration of plasmatic corticosterone by radioimmunoassay; the tissues around mesial root of the first molar were processed for histological and histochemical techniques with tartrate-resistant acid phosphatase. The degree of root resorption and the number of odontoclasts were evaluated, being the contralateral side of each animal serving as its control (split-mouth design).

RESULTS

The results revealed that the plasmatic levels of corticosterone were significantly higher in both the stressed groups than in the control one. There were no significant differences in the degree of root resorption and in the number of odontoclasts on the root between the 3 groups studied.

CONCLUSIONS

These results indicate that systemic stress alone can not be considered a risk factor for root resorption induced by orthodontic tooth movement.

Effect of incisal tooth wear and restoration on interocclusal distance during Brazilian Portuguese language speech

AIM

The aim of this study was to investigate changes in interocclusal distance (IOD) during pronunciation of /m/ and /s/ sounds in Brazilian Portuguese, in patients presenting dental wear due to bruxism, before and after placement of a stabilization appliance and restorative treatment.

METHODS

Subjects were divided into a control group of 19 patients with no dental wear and an experimental group of 18 patients presenting dental wear on anterior teeth due to bruxism. A stabilization appliance was placed in each patient in the experimental group and anterior teeth were restored. A magnetic jaw-tracking device measured the interocclusal distance during pronunciation of /m/ and /s/ phonemes. Interocclusal distance for the experimental group was evaluated one week before and again immediately before the appliance was inserted and 24 hours, 7 days, 1 month and 2 months after appliance insertion. The same evaluation was performed 7 days and 1 month after restorative treatment. In the control group, the measurements were carried out at the same intervals.

RESULTS

Comparison between groups revealed a significant difference (P<0.05) in interocclusal distance for the /m/ sound at all evaluation intervals. No differences were found before and after appliance insertion and restorative treatment with either phoneme.

CONCLUSION

Stabilization appliance therapy and restorative treatment of subjects with dental wear did not change the interocclusal distance during speech of /m/ and /s/ sounds in the Brazilian Portuguese language, however, when compared with normal subjects, the IOD values were higher for the dental wear group during pronunciation of the /m/ sound.

Identification of sex using cranial base measurements

It is well known that the skull provides elements for sex identification. Twenty-two bones form the cephalic cranium and they are divided into neurocranium and splancnocranium. This research aimed to study different characteristics between skulls from both sexes by evaluating the following measurements: mastoid notch to incisive foramen (right and left side); mastoid notch to mastoid notch; and incisive foramen to basion. In order to do so, two hundred skulls were selected (100 males and 100 females), with information about the age of the subjects (20-55 years old), sex and ethnic group known according to records at the Imaculada Conceicao Cemetery, located in the city of Campinas, Sao Paulo State, Brazil. Measurements were taken using a digital calliper. The results were subjected to a statistical analysis (logistic regression and discriminate function) and showed dimorphic characteristics within the measurements. A formula with 79.9% accuracy was established for sex identification (logito = 25.2772 - 0.1601 x incisive foramen to basion - 0.0934 x mastoid notch - mastoid notch). The authors have concluded that the method is efficient and suitable for anthropology and forensic purposes. The research also showed that the analysis may be carried out using a practical computer program.

What happens if you delay scanning Digora phosphor storage plates (PSPs) for up to 4 hours?

OBJECTIVES

To assess, both objectively and subjectively, the effects of different combinations of storage conditions and delaying scanning for up to 4 h on digital images captured using Digora phosphor storage plates (PSPs).

METHOD

Standardized images were obtained of an aluminium step wedge and dry mandible in acrylic using GE 1000 and phosphor storage plates (PSPs) from the Digora (Soredex) digital system. 12 plates were exposed and immediately scanned to produce the baseline gold standard. The plates were re-exposed and stored using three different storage combinations--(A) ambient temperature, (R) refrigeration and (S) low humidity, and then scanned after 10 min, 30 min, 1 h, 2 h, 3 h or 4 h. The objective analysis was carried out by pixel density measurements and the data analysed statistically using analysis of variance. Subjective analysis was carried out by three oral radiologists and the results analysed using the Mann Whitney U-test.

RESULTS

Objective analysis showed loss of pixel density after 4 h using all storage combinations. Subjectively, this loss of density was not evident.

CONCLUSION

There is a loss of image density at 4 h when using Digora PSPs which can not be detected clinically, but could compromise multisite research.

High-concentrated carbamide peroxide bleaching agents effects on enamel surface

Concern has been expressed regarding the adverse effects of peroxide-containing tooth bleaching agents on enamel surface. This study examined enamel average surface roughness before (baseline) and after an in-office bleaching protocol and investigated the influence of high concentrations of carbamide peroxide gels on its surface staining and morphology. Flat enamel surfaces were submitted to 35 and 37% carbamide peroxide or to no bleaching treatment (n = 10) and evaluated with a profilometer. Eight specimens from each group were randomly selected and immersed in a 2% methylene blue solution. Afterwards, specimens were ground into powder and prepared for the spectrophotometric analysis. Two remained specimens of each group were examined using a scanning electron microscope. Data were subjected to analysis of variance and Tukey test (P > 0.05). Baseline roughness average was statistically similar for all groups, however, 35% carbamide peroxide produced the roughest enamel surfaces. Different concentrations of carbamide peroxide produced similar staining means and enamel surface morphological alterations.

Effect of collagen removal on microleakage of resin composite restorations

This study evaluated the effects of collagen removal on the microleakage of two single-bottle adhesive systems. Forty human third molars were selected and each received two root preparations. The roots were randomly assigned for restoration using Prime & Bond 2.1 (Dentsply Ltda, Petrópolis, RJ 90915, Brazil) or Single Bond (3M Dental Products, St Paul, MN 55144, USA). One root in each tooth was treated with 36% H3PO4 for 15 seconds and the other received an additional treatment with 10% NaOCl for 60 seconds to remove the collagen layer before adhesive was applied. All preparations were restored with Z100 restorative resin (3M Dental Products). The specimens were submitted to 5,000 thermal cycles (5-55 degrees C) and stored in 37 degrees C distilled water for one year. The specimens were then coated with a varnish except for 1 mm of tooth structure surrounding the restoration and immersed in 2% buffered methylene blue for four hours. After rinsing, the restorations were sectioned and two independent observers scored the microleakage at the interface between the restorative material and the tooth using an optical microscope at x45 magnification. The scores were submitted to Fisher's Exact Test and the results showed that collagen removal significantly reduced microleakage for Prime & Bond 2.1 and had no effect on microleakage for Single Bond.