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Aim The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil. Materials and methods A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP14 ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP14 scores. Results In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL. Conclusions The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area.

Aim The aim of the present study was to evaluate whether periodontitis is independently associated with oral health-related quality of life (OHRQoL) in individuals with end-stage renal disease (ESRD). Materials and methods Calibrated examiners assessed 180 adults with ESRD. A full-mouth periodontal examination was performed at six sites on each tooth. Periodontitis was considered a categorical variable (absent, mild/moderate or severe). OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP14 ) questionnaire. Adjusted multivariate Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP14 scores for periodontitis according to the severity categories. Results In the adjusted model, mild/moderate and severe periodontitis were significantly associated with poorer OHRQoL compared to the absence of periodontitis [RR = 1.49 (95% confidence interval: 1.16-1.91) and RR 1.77 (95% CI: 1.36-2.30), respectively]. The adjusted domain-specific analysis revealed that mild/moderate periodontitis significantly impacted the psychological disability domain and severe periodontitis significantly impacted the physical pain, psychological discomfort, physical disability and psychological disability domains. Conclusions Periodontitis exerts an influence on OHRQoL in individuals with ESRD, with a more severe condition impacting different domains.

This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing.PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes.Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes.SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence.There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.

Sleep quality disturbances are a common occurrence in post-traumatic stress disorder (PTSD) and may remain after evidence-based treatment for PTSD has been implemented. If left untreated, sleep disturbance can perpetuate or aggravate the disorder. A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted comparing efficacy, acceptability, and tolerability among antidepressants for sleep quality improvement in PTSD, using Cochane's RoB2.0 and GRADE approach for NMA. The Cochrane Library, LILACS, PsycINFO, PTSDpubs, and PubMed Central databases were searched from inception to November 29, 2020, leading to the retrieval of 3733 reports. After the selection process, seven RCTs were included in the review (N = 600). We found low certainty of evidence (LCE) that sertraline may improve sleep quality (measured by PSQI) in adult patients with PTSD (MD -0.48, 95% CrI -0.63 to -0.32). Sertraline was as well accepted (RR 1.12, 95% CrI -0.83 to 1.52, very low certainty [VLCE]) and as well tolerated as placebo (RR 0.58, 95% CrI 0.28 to 1.14, LCE). Mirtazapine (MD -3.35, 95% CrI -9.06 to 2.39, LCE), paroxetine (MD -3.13, 95% CrI -7.47 to 1.26, VLCE), nefazodone (MD -0.25, 95% CrI -5.95 to 5.38, VLCE), and bupropion (MD -2.28, 95% CrI -4.75 to 0.21, VLCE) were similar to placebo for improving sleep quality. These antidepressants resulted in little or no benefit for sleep in PTSD. Although the NMA suggested that sertraline may improve sleep in PTSD compared to placebo, due to the low certainty, these estimates are not robust enough to guide clinical decisions.

Objective The aim of the present cross-sectional study was to determine whether alcohol use disorders (AUD) are independently associated with severe and extent cases of periodontitis in individuals living in a rural area of Brazil. Methods A representative probability sample (N = 585) was evaluated using six-site full-mouth periodontal examination. AUD was assessed using the alcohol use disorders identification test (AUDIT) and considered in its unidimensional and bidimensional factor structures. The first address hazardous alcohol consumption [HAC (overall scores ≥8)], and the second deals with two distinct constructs, harmful use [HU (items 1-3 scores ≥4 for men or ≥3 for women)], and alcohol-related consequences [ARC (items 4-10 scores ≥1)]. Periodontal outcomes were defined based on the criteria proposed by the CDC-AAP (2012) and an adaptation of the EFP-AAP (2018) definition of generalized stages III or IV periodontitis (GP). Adjusted multilevel multinomial and binary logistic regression analysis were used with a conceptual hierarchical approach to calculate the odds ratios (OR) of periodontal outcomes. Results In the adjusted model, HU (OR = 2.69; 95% CI: 1.29-5.58) and ARC (OR = 3.79; 95% CI: 1.51-9.51) were significantly associated with higher prevalence of severe periodontitis (SP). Higher occurrence of GP was detected in individuals presenting HAC (OR = 1.88; 95% CI: 1.05-3.37) and ARC (OR = 2.90; 95% CI: 1.61-5.24). Conclusion AUD was independently associated with higher prevalence of SP and GP in individuals living in a rural area.

Objectives To systematically evaluate the literature on whether plaque-disclosing (PD) methods, applied by dental professionals (FQ1) or at-home (FQ2), combined with verbal oral hygiene instructions and brushing demonstration (standard OHI) lead to improvements in self-performed dental plaque control in comparison to standard OHI alone. Materials and methods Seven databases were searched by two independent reviewers according to pre-specified eligibility criteria up to September 2020. No restrictions regarding language, date and type of report were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) were used for quality appraisal. Multiple comparisons referring to a single study were included if the articles evaluated different PD agents. Narrative synthesis using evidence tables were performed. Results Seven eligible studies were retrieved, including data of 430 individuals (159 wearers of orthodontic appliances). The studies exhibited considerable heterogeneity regarding outcome assessments and follow-up. 11 (eight corresponding to FQ1 and three to FQ2) out of 13 relevant comparisons found no significant difference between techniques for dental plaque outcomes and three (two corresponding to FQ1 and one to FQ2) out of five comparisons indicated a positive effect of standard OHI with aid of PD methods on gingival inflammation scores. With respect specifically to orthodontic patients, three out of four comparisons indicated significant improvements on gingival inflammation scores for individuals instructed with PD methods. Conclusion Clinicians should consider PD agents as adjunct to standard OHI in orthodontic patients. For those without appliances, PD methods can be used as an alternative.

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms “dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance).” Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.

OBJECTIVES To systematically review observational studies assessing the association between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in children, adolescents and adults. METHODS Electronic searches were performed in the PubMed, Embase, Web of Science, LILACS and Scopus databases for articles published up to September 2020. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the effect of SES on the OHRQoL in all age groups using validated methods. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for meta-analysis followed by a meta-regression analysis. A random-effects model was used to estimate the pooled calculate prevalence ratio (PR) and respective 95% confidence intervals (CI) for each study. RESULTS The search strategy retrieved 6114 publications. Some 139 articles met the eligibility criteria and were included in the systematic review. Of those, 75 were included in the general meta-analysis they represented a total sample of 109 269 individuals. People of lower SES had worse OHRQoL (PR 1.30; 95% CI 1.26-1.35). In the meta-analyses of different subgroups, an association was found between low SES and worse OHRQoL in countries of all economic classifications, in all age groups and irrespective of the socioeconomic indicator used. A socioeconomic gradient in OHRQoL was also observed, in which the lower the individuals' socioeconomic position, the poorer their OHRQoL. CONCLUSIONS Individuals of low SES had poorer OHRQoL, regardless of the country's economic classification, SES indicator and age group. Public policies aiming to reduce social inequalities are necessary for better OHRQoL throughout life.

Determine the association between breastfeeding and the development of mouth breathing in children. Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. The overall prevalence of mouth breathing was 44% (95% CI: 38–49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41–0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31–1.18). Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. Clinical relevance: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. PROSPERO registry: CRD42017062172

Background Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. Objectives To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. Methods A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. Results The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2 = 98.5%) and 3% (95% CI 2%-3%; I2 = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2 = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2 = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2 = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2 = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2 = 98.3%). Discussion The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. Conclusions Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Background The purpose of this study was to compare efficacy and acceptability among drug treatments for adults with post-traumatic stress disorder (PTSD) through a systematic review, random-effects pairwise and network meta-analyses. Methods Double-blind randomized controlled trials comparing pharmacological interventions for adults with PTSD were searched from database inception through Aug. 28, 2018, on Cochrane (Central), Embase, LILACS, PILOTS, PsycINFO, PubMed, and Web of Science. Clinical trial registries and the websites of pharmaceutical companies were also searched. The GRADE system was used to assess the quality of the evidence. Results The systematic review included 58 studies comprising 6766 patients randomized to 26 different interventions. Regarding efficacy, topiramate (SMD = -0.57; 95%CrI: -1.07,-0.10), risperidone (SMD = -0.53; 95%CrI: -0.93,-0.15), quetiapine (SMD = -0.59; 95%CrI: -1.06,-0.11), paroxetine (SMD = -0.35; 95%CrI: -0.48,-0.21), venlafaxine (SMD = -0.25; 95%CrI: -0.44,-0.05), fluoxetine (SMD = -0.28; 95%CrI: -0.46,-0.08), and sertraline (SMD = -0.21; 95%CrI: -0.33,-0.09) outperformed placebo. Moreover, phenelzine (RR = 3.39; 95%CrI: 1.43,11.09), lamotrigine (RR = 4.39; 95%CrI: 1.18,26.38), and fluoxetine (RR = 1.28%CrI: 1.01,1.59) outperformed placebo in terms of acceptability. Conclusions The NMA supports topiramate, risperidone, quetiapine, paroxetine, venlafaxine, fluoxetine and sertraline as effective pharmacological choices for the treatment of PTSD. Quetiapine and topiramate have the shortcoming of relying on a few small studies, but the clinically meaningful change in symptoms is noteworthy and merits further investigation. Among the pharmacological treatments with evidence of efficacy compared to placebo, fluoxetine achieved a relatively high rank regarding acceptability. To the best of our knowledge, this is the largest contemporary NMA on the subject and the addition of new medications is an important extension of previous meta-analyses, enabling a larger number of drug comparisons.

Temporomandibular myofascial pain presents a major challenge in the diagnosis of temporomandibular disorders (TMD). Due to the characteristics of this condition, intramuscular injection procedures are often needed for adequate control of symptoms and treatment. Thus, the aim of this systematic review was to evaluate the effectiveness of dry needling and injection with different substances in temporomandibular myofascial pain. Electronic databases PubMed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus, Web of Science and CAPES Catalog of Dissertations and Theses were searched for randomized clinical trials until January 2018. Manual search was performed in relevant journals and in the references/citations of the included studies. The selection of studies was carried out by two independent reviewers according to eligibility criteria. From 7128 eligible studies, 137 were selected for full-text analysis and 18 were included. Due to the heterogeneity of the primary studies it was not possible to perform a meta-analysis. The narrative analysis of the results showed that most of the studies had methodological limitations and biases that compromised the quality of the findings. Dry needling and local anaesthesic injections seem promising, but there is a need to conduct further randomized clinical trials, with larger samples and longer follow-up times, to evaluate the real effectiveness of the technique and evaluated substances.

SUMMARY Biofilm (bacterial plaque) accumulation on the surface of restorative materials favors the occurrence of secondary caries and periodontal inflammation. Surface characteristics of restorations can be modified by finishing and/or polishing procedures and may affect bacterial adhesion. The aim of this systematic review was to characterize how finishing and polishing methods affect the surface properties of different restorative materials with regard to bacterial adhesion and biofilm formation. Searches were carried out in MEDLINE-PubMed, EMBASE, Cochrane-CENTRAL, and LILACS databases. From 2882 potential articles found in the initial searches, only 18 met the eligible criteria and were included in this review (12 with in vitro design, four with in situ design, and two clinical trials). However, they presented high heterogeneity regarding materials considered and methodology for evaluating the desired outcome. Risk bias analysis showed that only two studies presented low risk (whereas 11 showed high and five showed medium risk). Thus, only descriptive analyses considering study design, materials, intervention (finishing/polishing), surface characteristics (roughness and surface free energy), and protocol for biofilm formation (bacterial adhesion) could be performed. Some conclusions could be drawn: the impact of roughness on bacterial adhesion seems to be related not to a roughness threshold (as previously believed) but rather to a range, the range of surface roughness among different polishing methods is wide and material dependent, finishing invariably creates a rougher surface and should always be followed by a polishing method, each dental material requires its own treatment modality to obtain and maintain as smooth a surface as possible, and in vitro designs do not seem to be powerful tools to draw relevant conclusions, so in vivo and in situ designs become strongly recommended.

Microbial biofilms represent a challenge in the treatment of infections, due to the low efficacy of the antimicrobials. This study evaluated the antimicrobial effect of nanoparticles of Melaleuca alternifolia (TTO) in dental biofilm. Thirty-eight volunteers used an oral device in situ in situ including four bovine enamel specimens for 07 days. From the fifth day four solutions were applied randomly for each specimen: Physiological Saline Solution (0.85% NaCl) (C+), Chlorhexidine 0.12% (CHX), M. alternifolia oil 0.3% (TTO), and a nanoparticle solution of 0.3% M. alternifolia oil (NPTTO). The nanoparticles of TTO were characterized for pH, IPD, medium size, zeta potential and Transmission Electron Microscopy. Antimicrobial activity was evaluated by viable microorganisms count and the structure of the biofilm by atomic force microscopy. The NPTTO presented pH 6.4, particle diameter of 197.9 ± 1 nm, polydispersion index of 0.242 ± 0.005, zeta potential of −7.12 mV and ±0:27 spherical shape. The C+ resulted in 100% of bacterial vitality, while CHX, TTO and NPTTO showed 34.2%, 51.4% and 25.8%, respectively. The AFM images showed biofilms with an average roughness of 350 nm for C+, 275 nm for CHX, 500 nm for TTO and 100 nm for NPTTO. The NPTTO demonstrated excellent antimicrobial activity in the biofilm formed in situ and will possibly be used in future for the treatment/prevention of oral biofilms.

It is not clear how using partial-mouth periodontal examination (PMPE) protocols affects estimates of the association between gingival bleeding (GB) and oral health-related quality of life (OHRQoL). The aim of the present study is to assess impact of different PMPEs on the association between GB and OHRQoL in 12-year-old adolescents.A total of 1,134 adolescents were evaluated for clinical and subjective variables. GB was determined by full-mouth examination (FME) of six sites (disto-buccal [DB], mid-buccal [B], mesio-buccal [MB], disto-lingual [DL], mid-lingual, and mesio-lingual [ML]) and different PMPEs were calculated using a 15% cut-off point: 1) full-mouth (MB-B-DB/MB-B-DL); 2) two diagonal quadrants (six sites/MB-B-DB/MB-B-DL); 3) two randomly selected half-mouth quadrants (six sites/MB-B-DB/ MB-B-DL/MB-DB-ML-DL); and 4) the community periodontal index. OHRQoL was assessed using the Child Perceptions Questionnaire (CPQAdolescents with GB showed significantly poorer OHRQoL than their counterparts when FME was used. In contrast, more than half of PMPE protocols did not detect significant associations between GB and CPQUsing PMPE to assess GB in adolescents significantly affects associations with OHRQoL outcomes, depending on the protocol used. PMPEs that evaluated MB-B-DL sites of randomly selected half-mouth quadrants (1 or 2 and 3 or 4) achieved results closer to those obtained with FME.

Objective To compare counts of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis and Fusobacterium nucleatum between crack users and non-users. Materials and methods A cross-sectional study was conducted involving seventy-four crack cocaine users and eighty-one non-users matched for age, gender and tobacco use. Demographic and clinical variables were analysed. Subgingival bacterial samples were collected from four sites with the greatest probing depths and were analysed using real-time polymerase chain reaction. Results No significant difference was found in the prevalence of total counts for each bacterial species analysed between groups. However, crack users had a 1.85 (95% CI: 1.03–3.31), 2.19 (95% CI 1.24–3.88), 2.53 (95% CI 1.27–5.04) and 2.40 (95% CI 1.22–4.75) greater probability of having the higher counts (≥75th percentile) for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, respectively. Conclusion Although some crack users had higher (>75th percentile) bacterial counts for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, total counts did not differ between crack users and non-users, leading to the hypothesis that the higher occurrence of periodontitis on crack users may be related to other non-bacterial factors.

Crack cocaine can alter functions related to the immune system and exert a negative influence on progression and severity of periodontitis. The aim of this study is to compare periodontal status between crack cocaine users and crack cocaine non-users and investigate the association between crack cocaine and periodontitis after adjustments for confounding variables.This cross-sectional study evaluated 106 individuals exposed to crack cocaine and 106 never exposed, matched for age, sex, and tobacco use. An examiner determined visible plaque index (VPI), marginal bleeding index, supragingival dental calculus, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Logistic regression was used to model associations between crack cocaine and periodontitis (at least three sites with CAL4 mm and at least two sites with PD3 mm, not in the same site or tooth).Prevalence of periodontitis among crack non-users and crack users was 20.8% and 43.4%, respectively. Crack users had greater VPI, BOP, PD ≥3 mm, and CAL ≥4 mm than crack non-users. Periodontitis was associated with age24 years, schooling ≤8 years, smoking, moderate/heavy alcohol use, and plaque rate ≥41%. Crack users had an approximately three-fold greater chance (odds ratio: 3.44; 95% confidence interval: 1.51 to 7.86) of periodontitis than non-users.Occurrence of periodontitis, visible plaque, and gingival bleeding was significantly higher among crack users, and crack use was associated with occurrence of periodontitis.

OBJECTIVE: To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS: A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O’Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS: Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS: The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

To evaluate the effect of herbal mouthrinses as an adjuvant to oral hygiene on dental plaque and gingival inflammation in subjects with gingivitis. Searches were conducted in the PubMed/MEDLINE, Cochrane-CENTRAL, EMBASE, Web of Science, LILACS/BIREME, Clinical Trials Registry and grey literature for Randomised Clinical Trials (RCTs) published up to April 2018 without language restrictions. From 4,013 paper found, 20 studies met the eligibility criteria and were included. The herbal mouthrinses achieved significant reductions in dental plaque and gingival inflammation compared to placebo rinses. Five herbal products (Camelia sinensis, Azadirachta indica, Anacardium occidentale Linn, Schinus terebinthifolius and Curcuma longa) showed better results than chlorhexidine in dental plaque and gingival inflammation reductions. However, the unclear risk of bias of most included RCTs precludes definitive conclusions. Therefore, it is necessary to improve the design of future RCT in other reduced potential bias that may affect the degree of precision of treatment outcomes in order to evaluate the effect size and clinical relevance of herbal mouthrinses.

Objective The aim of this study was to assess the associations of gingival bleeding with individual and community social variables among schoolchildren. Methods This cross-sectional study evaluated a representative, multistage, random sample of 1,134 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. The participants were examined clinically, and full-mouth gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding). The children's parents or guardians answered questions regarding their socioeconomic status and social capital, and an assessment of the associations was performed using multilevel Poisson regression models. Results The prevalence of gingival bleeding was 96.21 percent. The multilevel adjusted assessment revealed that socioeconomic, clinical, and social capital variables at the individual level were associated with higher levels of gingival bleeding. Children whose fathers had a low educational level, children who had dental plaque and dental crowding, and children who never/almost never attended religious meetings exhibited significantly higher levels of gingival bleeding than their counterparts. This social gradient remained significant even after adjusting for contextual-level covariates. Conclusion The results indicate that the socioeconomic status and features of social capital are associated with the levels of gingival bleeding among schoolchildren.

Background Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects. Aim The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects. Material and Methods The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model. Results The WMD in PD reduction [−0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) −0.24, −0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (−0.14 mm, n = 9, p = 0.11, 95% CI −0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI −0.04, 8.07; and −1.91%, n = 7, p = 0.39, 95% CI −6.32, 2.51 respectively) did not favour adjunctive antibiotic use. Conclusion Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects.

The aim of this study was to assess with histological and inflammatory analysis the use of flossing as a diagnostic method for detecting proximal gingivitis. This is a diagnostic accuracy paper composed of two different studies. In the first study, three groups were identified based on papilla status: bleeding (+) with both methods (N = 26); bleeding (+) with dental floss, but no bleeding (−) with probing (N = 26); and no bleeding (−) with either method (N = 26). One papilla from all 78 participants was biopsied and analyzed for the determination of inflammatory infiltrate and percentage of collagen fibers. Sensibility, specificity, positive and negative predictive, and accuracy values were analyzed. In the second study, the volume of gingival crevicular fluid (GCF) was analyzed in 49 participants with flossing+/probing− and flossing−/probing− at contralateral proximal sites. The GCF volume was compared between these sites (n = 172). Significantly greater frequencies of moderate/intense inflammation were found in the flossing+/probing+ (100%) and flossing+/probing− (92.3%) groups compared to those in the flossing−/probing− (0%) group. Significantly different percentages of collagen fibers were found among the three groups (flossing+/probing+ (40.90 ± 3.68); flossing+/probing− (45.78 ± 4.55); flossing−/probing− (60.01 ± 36.66)) (P

SUMMARY The aim of this study was to evaluate the effect of grinding with diamond burs and low-temperature aging on the material surface characteristics and bacteria adhesion on a yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) surface. Y-TZP specimens were made from presintered blocks, sintered as recommended by the manufacturer, and assigned into six groups according to two factors—grinding (three levels: as sintered, grinding with extra-fine diamond bur [25-μm grit], and grinding with coarse diamond bur [181-μm grit]) and hydrothermal aging—to promote low-temperature degradation (two levels: presence/absence). Phase transformation (X-ray diffractometer), surface roughness, micromorphological patterns (atomic force microscopy), and contact angle (goniometer) were analyzed. Bacterial adhesion (colony-forming units [CFU]/biofilm) was quantified using an in vitro polymicrobial biofilm model. Both the surface treatment and hydrothermal aging promoted an increase in m-phase content. Roughness values increased as a function of increasing bur grit sizes. Grinding with a coarse diamond bur resulted in significantly lower values of contact angle (p0.05). Grinding with diamond burs and hydrothermal aging modified the Y-TZP surface properties; however, these properties had no effect on the amount of bacteria adhesion on the material surface.

This is a systematic review of clinical and laboratory studies evaluating the effect of Melaleuca alternifolia on periodontopathogens, dental plaque, gingivitis, periodontitis, and inflammatory responses. The PubMed, Cochrane, Web of science, Bireme, Lilacs, Prospero, Open Grey, and Clinical Trials databases were searched to identify potentially eligible studies through October 2016. Of 1,654 potentially eligible studies, 25 were included in the systematic review. Their methodology was evaluated through the Cochrane Handbook for clinical studies and the GRADE system for in vivo/in vitro studies. Although clinical studies must be interpreted with caution due to methodological limitations, laboratory studies have found promising results. In vitro evidences showed that M. alternifolia has bactericidal and bacteriostatic effects against the most prevalent periodontopathogens. Clinical studies found comparable effects to chlorhexidine 0.12% in reducing gingival inflammation, although the antiplaque effect was lower. M. alternifolia also showed antioxidant properties, which are beneficial to the host, allied to the reduction on immune-inflammatory responses to pathogens. This systematic review suggests that the M. alternifolia has potential anti-inflammatory and antimicrobial properties, which can be easily applied to the periodontal tissues. However, further clinical trials are needed to elucidate the clinical relevance of its application.

Objective The aim of this study was to investigate the impact of the use of crack and other illicit drugs on oral health-related quality of life (OHRQoL) in young adults. Methods This cross-sectional study evaluated 106 crack users at a public treatment center for drug addiction and 106 controls matched for gender, age, and use of tobacco. Clinical examinations were performed for dental caries and periodontal disease. The outcome was OHRQoL, which was determined using the Oral Health Impact Profile (OHIP-14). The association between OHRQoL and illicit drugs was modeled using conditional Poisson regression. Results Users of crack and other illicit drugs had a poorer OHRQoL than the controls (p

Objective To compare the performance of partial-mouth periodontal examination (PMPE) protocols with different cut-off points to the full-mouth examination (FME) in the assessment of the prevalence and extent of gingival bleeding in adolescents. Methods A cross-sectional study was conducted involving 12-year-old adolescents. Following a systematic two-stage cluster sampling process, 1134 individuals were evaluated. Different PMPE protocols were compared to the FME with six sites per tooth. Sensitivity, specificity, area under the ROC curve (AUC), intraclass correlation coefficient (ICC), relative and absolute biases and the inflation factor were assessed for each PMPE protocol with different cut-off points for the severity of gingival bleeding. Results The highest AUC values were found for the six-site two-diagonal quadrant (2-4) (0.97), six-site random half-mouth (0.95) and Community Periodontal Index (0.95) protocols. The assessment of three sites [mesiobuccal (MB), buccal (B) and distolingual (DL)] in two diagonal quadrants and the random half-mouth protocol had higher sensitivity and lower specificity than the same protocols with distobuccal (DB) sites. However, the use of DB sites led to better specificity and improved the balance between sensitivity and specificity, except for the two-diagonal quadrant (1-3) protocol. The ≥1 cut-off point led to the most discrepant results from the FME. Conclusion Six-site two-diagonal quadrant (2-4) and random half-mouth assessments perform better in the evaluation of gingival bleeding in adolescents. However, when a faster protocol is needed, a two-diagonal quadrant assessment using only MB, B and DL sites can be used with no important loss of information.

Child oral health-related quality of life (COHRQoL) has been increasingly assessed. However, the full relationship between gingivitis and COHRQoL has been assessed by only a small number of studies. This study aims to assess the association between gingival bleeding and how a child perceives its OHRQoL.This cross-sectional study used multistage random sampling to enroll 1,134 12-year-old schoolchildren from Santa Maria, a southern city in Brazil. Participants were examined for gingival bleeding according to the community periodontal index criteria, a full-mouth clinical examination of six sites per tooth. COHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-Year-Old Children (CPQ11-14), and data on socioeconomic status were collected. Multilevel Poisson regression models fitted the association of gingivitis with overall and domain-specific CPQ11-14 scores.In general, children with bleeding in ≥15% of sites had higher total CPQ11-14 scores and domain-specific scores than their counterparts. This association persisted after adjustment for other potential confounders. The presence and extent of gingival bleeding was associated mainly with emotional limitation domains of the CPQ11-14; those with extended levels of gingivitis had a 1.20 times higher mean score than those with low-level/no gingival bleeding (rate ratio = 1.20; 95% confidence interval = 1.10 to 1.31).The present results indicate that the presence of extensive levels of gingivitis might be negatively associated with how children perceive their oral health and their daily life.

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo.

Objetivou-se identificar os indicadores de risco associados ao consumo de drogas ilícitas em escolares provenientes de escolas públicas de uma comunidade do sul do Brasil. Trata-se de uma pesquisa transversal não experimental, realizada com 535 estudantes do ensino fundamental e médio, representativos de seis escolas públicas. Os dados foram coletados por meio de um questionário, entre outubro/2011 e março/2012. Os resultados foram apresentados por distribuição de frequência simples e relativa e razões de chance (OR) e os intervalos de confiança 95% foram calculados para verificar associação entre as variáveis dependentes e independentes. Ainda, uma análise multivariada foi conduzida para o desfecho "você já usou drogas ilícitas?" A análise univariada demonstrou associação entre as variáveis: renda familiar, cor, turno em que estuda, reprovação escolar, utilização de métodos de prevenção, hábito de fumar e se conhece alguém que utiliza drogas, as quais se mostraram associadas ao desfecho já ter experimentado drogas ilícitas. Após a análise multivariadao hábito de fumar foi o único indicador significativamente associado sobre já ter utilizado drogas ilícitas. Os resultados permitem afirmar que o hábito de fumar é um importante indicador de risco preditivo para o uso de drogas ilícitas. This study sought to identify the risk indicators associated with the consumption of illicit drugs by schoolchildren in public schools in a community in the south of Brazil. This is a non-experimental cross-sectional study conducted with 535 students of primary schoolchildren from six public schools. Data were collected using a questionnaire between October 2011 and March 2012. The results were presented by simple and relative distribution of frequency and odds ratio (OR) and the 95% reliability intervals were calculated to verify the association between the dependent and independent variables. Multivariate analysis was also performed using the question "have you ever used illicit drugs?" Univariate analysis revealed an association between family income, color, period in which the child studied, failure to pass annual tests, use of methods of prevention, smoking habit and knowing someone who uses drugs with the fact of having experimented with the use of illicit drugs. After multivariate analysis, the smoking habit was the only indicator significantly associated with the question of having made use of illicit drugs. The results indicate that the smoking habit is an important indicator of the predictive risk for the use of illicit drugs.

Objective To compare the antimicrobial efficacy of a 0.12% chlorhexidine (CHX) and herbal green tea (Camellia sinensis) solution on established biofilms formed at different oxygen tensions in an in situ model. Method Twenty-five dental students were eligible for the study. In situ devices with standardized enamel specimens (ES) facing the palatal and buccal sides were inserted in the mouths of volunteers for a 7 day period. No agent was applied during the first four days. From the fifth day onward, both agents were applied to the test ES group and no agent was applied to the control ES group. After 7 days the ES fragments were removed from the devices, sonicated, plated on agar, and incubated for 24 h at 37 °C to determine and quantify the colony forming units (CFUs). Result CHX had significantly higher efficacy compared to green tea on the buccal (1330 vs. 2170 CFU/µL) and palatal (2250 vs. 2520 CFU/µL) ES. In addition, intragroup comparisons showed significantly higher efficacy in buccal ES over palatal ES (1330 vs. 2250 CFU/µL for CHX and 2170 vs, 2520 CFU/µL for CV) for both solutions. Analysis of the ES controls showed significantly higher biofilm formation in palatal ES compared to buccal ES. Conclusion CHX has higher efficacy than green tea on 4-day biofilms. The efficacy of both agents was reduced for biofilms grown in a low oxygen tension environment. Therefore, the oxygen tension environment seems to influence the efficacy of the tested agents.

This study evaluated the clinical diagnosis of proximal gingivitis by comparing two methods: dental flossing and the gingival bleeding index (GBI). One hundred subjects (aged at least 18 years, with 15% of positive proximal sites for GBI, without proximal attachment loss) were randomized into five evaluation protocols. Each protocol consisted of two assessments with a 10-minute interval between them: first GBI/second floss, first floss/second GBI, first GBI/second GBI, first tooth floss/second floss, and first gum floss-second floss. The dental floss was slid against the tooth surface (TF) and the gingival tissue (GF). The evaluated proximal sites should present teeth with established point of contact and probing depth ≤ 3mm. One trained and calibrated examiner performed all the assessments. The mean percentages of agreement and disagreement were calculated for the sites with gingival bleeding in both evaluation methods (GBI and flossing). The primary outcome was the percentage of disagreement between the assessments in the different protocols. The data were analyzed by one-way ANOVA, McNemar, chi-square and Tukey’s post hoc tests, with a 5% significance level. When gingivitis was absent in the first assessment (negative GBI), bleeding was detected in the second assessment by TF and GF in 41.7% (p < 0.001) and 50.7% (p < 0.001) of the sites, respectively. In the absence of gingivitis in the second assessment (negative GBI), TF and GF detected bleeding in the first assessment in 38.9% (p = 0.004) and 58.3% (p < 0.001) of the sites, respectively. TF and GF appears to be a better diagnostic indicator of proximal gingivitis than GBI.

Introduction Evidence comparing periodontal conditions in orthodontic patients who regularly use or do not use dental floss is scarce. Methods The subjects were 330 patients who had been under fixed orthodontic treatment for at least 6 months. They were examined by 1 calibrated examiner for plaque and gingival indexes, probing pocket depths, clinical attachment losses, and excessive resin around brackets. Socioeconomic background, time with orthodontic appliances, and use of dental floss were assessed in interviews. Unadjusted and multiple logistic regression analyses were used to assess the associations. Results The results demonstrated statistically significant higher means of plaque index, gingival index, pocket probing depth, and clinical attachment loss for nonusers of dental floss. Intragroup analyses showed higher means of these parameters in proximal sites and posterior teeth, compared with their counterparts’ buccal and lingual sites and anterior teeth, respectively. After multivariate analysis, male subjects (P = 0.044) with a household income less than 5 national minimum wages (P = 0.044), and nonusers of dental floss (P = 0.000) showed higher probabilities of gingival bleeding (>30%) than did their counterparts. Conclusions Orthodontic patients who use dental floss regularly have somewhat better gingival conditions than those who do not use floss.

There is little material in the literature that compares biological width measurements in periapical and bite-wings radiographs with clinical measurements. The purpose of this study was to compare measurements of biological width taken by three different methods which are frequently used for planning periodontal surgery - periapical radiograph, bite-wing radiograph and transperiodontal probing - with the trans-surgical measurements. Thirty-four sites from twenty-one subjects were analyzed. The intra-class correlation coefficients between measurements obtained trans-surgically (gold standard) and those obtained by transperiodontal probing, periapical radiography and bite-wing radiography were determined. Average measurements were compared using the Wilcoxon test at a significance level of 0.05. Also, the frequency distribution of differences between test measurements and the gold standard was calculated. The results showed that transperiodontal probing (mean 2.05 mm) was the most accurate measurement, as compared to the gold standard (mean 1.97 mm), with no statistically significant difference observed. On the other hand, periapical and bite-wing radiographic mean values (1.56 mm and 1.72 mm, respectively) were smaller than the gold standard, with statistically significant differences (p < 0.05). It was concluded that transperiodontal probing was the most accurate measurement, as compared to the gold standard, followed by that obtained with the bite-wing radiograph. The clinical relevance of these results could be that planning for crown lengthening surgery should, preferably, include transperiodontal probing.

OBJECTIVES: Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12% chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group). METHODS: This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12% CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period. RESULTS: Intergroup comparisons showed statistically higher (p

Sjögren's syndrome (SjS) is a systemic autoimmune disease that might lead to hyposalivation and negatively affect the oral environment. The evidence with regard to the periodontal conditions in this group of subjects is still controversial. This study aimed to evaluate the periodontal clinical conditions and inflammatory markers in gingival crevicular fluid (GCF) from patients with primary Sjögren's syndrome (SjS [P]) or secondary Sjögren's syndrome (SjS [S]) compared to a control group.Nineteen individuals with SjS (11 SjS [P] and eight SjS [S]) and 19 controls, matched for gender, age, and tobacco exposure, were selected from two private clinics and a hospital. The groups were compared for stimulated whole saliva (SWS) flow rate, plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), and total amount of interleukin (IL)-1beta and total elastase activity in the GCF. Generalized estimating equations were used for data analysis.Individuals with SjS had a significantly lower SWS flow rate and higher mean PI, GI, PD, CAL, and BOP than controls. After adjustment for plaque, GI remained significantly higher in patients with SjS. Patients with SjS (S) had significantly higher mean CAL and PD than patients with SjS (P), and CAL and BOP remained significantly higher in this subgroup after adjustment. No differences were observed with regard to the GCF inflammatory markers. After adjusting for PD, subjects with SjS (P) showed lower levels of IL-1beta compared to controls.SjS seemed to negatively affect the periodontal condition because gingival inflammation was more evident in the individuals with SjS, particularly those with SjS (S).

To evaluate the effectiveness of a desensitizing gel for topical and home use for the treatment of dentin hypersensitivity (DH) by means of a 3-arm parallel, randomized, double blind clinical trial.107 participants were allocated to three groups: placebo gel (PG), test gel (TG) (5% sodium fluoride, 5% potassium oxalate, 10% strontium chloride) and 2% sodium fluoride gel (FG). DH measurement was performed by a single blind examiner by means of the visual analog scale (VAS) after tactile (blunt tipped probe), thermal (air blast) and osmotic (water blast) stimulus at time intervals of baseline, 7, 15 and 30 days.The greatest reductions in DH were observed for the TG, with significant differences for FG in the thermal (Δ = -56 vs -30) and osmotic stimuli (Δ = -44 vs -18). Considering the percentage of participants with moderate/severe pain at 30 days, the TG demonstrated the lowest percentages, with significant differences in comparison with the other groups in thermal and osmotic stimuli. We can conclude that the test gel showed a greater reduction in DH than fluoride 2% and placebo gel, and maybe a treatment option for individuals with DH.