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Carnoy's solution has been widely undertaken as adjunctive therapy for benign odontogenic tumors. Although its outcomes were highly investigated, little information is available regarding its mechanism of action and the role of chloroform in composition. The aim of this study was to characterize Carnoy's solution (with and without chloroform) in order to survey its physicochemical and pharmacological properties. UV/Vis spectroscopy, Raman microspectroscopy, viscosity assessment, pH analysis, and ion (Fe3+) concentration were studied. All solutions were prepared by the same operator and assayed at each 7 days within a 4-week period. All solutions depicted acidic pH whereas the viscosity was increased by the addition of chloroform. Starting in the seventh day after preparation, solutions with chloroform showed iron precipitation when nonfiltered. Carnoy's solution without chloroform was stable during the survey period as evidenced by Raman spectroscopy. In conclusion, Carnoy's solution possesses an acidic characteristic, it is stable when stored at room temperature, and precipitates iron salts when in the presence of chloroform in a nonfiltered solution. The chloroform increases the viscosity of the solution and makes its pH slightly more acidic when compared to the Carnoy's solution without chloroform. Raman spectroscopy favored the evaluation of components' stability in solutions by using the spectra analysis and the established correlations between the peaks in different periods.

This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1 h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P < 0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P < 0.05). Pain scores peaked at 4 h postoperative in the experimental groups, but at 2 h postoperative in the placebo group (P < 0.05). A significant reduction in TNF-α concentration from time 0′ to time 30′ was seen for ibuprofen (P = 0.001) and etoricoxib (P = 0.016). The ibuprofen group showed a significant reduction in IL-1β levels from time 0′ to time 30′ (P = 0.038). In conclusion, TNF-α and IL-1β levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.

Essential oils of many plants have been previously tested in the treatment of oral diseases and otherinfections. This study was a randomized, double-blind, in parallel with an active control study, whichaimed to evaluate the efficacy of three formulations of the Lippia sidoides Cham. essential oil (LSO) in thereduction of salivary Streptococcus mutans in children with caries. 81 volunteers, aged 6–12 years, bothgenders, with caries, were recruited to participate in this study, and randomly assigned to either one offive different groups. Each group received topical treatment with either 1.4% LSO toothpaste, 1.4% LSOgel, 0.8% LSO mouthwash, 1% chlorhexidine gel, or 0.12% chlorhexidine mouthwash. A 5-ml volume ofeach gel was placed inside disposable trays, and applied for 1 min, every 24 h, for 5 consecutive days.The mouthwash groups used 5-ml volume of a mouthwash inside disposable syringes. In the toothpastegroup, children brushed their teeth for 1 min, once a day for 5 days. Saliva was collected before andafter treatment. MS colonies were counted, isolated and confirmed through biochemical tests. Differ-ences in MS levels measured in different days within the same treatment group was only verified withLSO toothpaste, chlorhexidine gel and chlorhexidine mouthwash. Comparison between groups of LSOmouthwash, toothpaste and gel showed that the toothpaste group expressed significantly lower MS lev-els than the mouthwash and gel groups at day-30. Chlorhexidine significantly reduced MS levels after5 days of treatment, but these levels returned to baseline in other periods of the study. LSO toothpastereduced MS levels after 5 days of treatment, and MS levels remained low and did not return to baselineduring subsequent analysis. Hence, LSO toothpaste demonstrated the most long-lasting MS reduction insaliva, whereas other LSO formulations did not effectively reduce MS levels in children with dental caries.

Thrombocytopenia is defined as a reduced platelet count within blood (

Osteogenesis imperfecta (OI) is a rare hereditary condition caused by changes in collagen metabolism. It is classified into four types according to clinical, genetic, and radiological criteria. Clinically, bone fragility, short stature, blue sclerae, and locomotion difficulties may be observed in this disease. OI is often associated to severe dental problems, such as dentinogenesis imperfecta (DI) and malocclusions. Radiographically, affected teeth may have crowns with bulbous appearance, accentuated constriction in the cementoenamel junction, narrowed roots, large root canals due to defective dentin formation, and taurodontism (enlarged pulp chambers). There is no definitive cure, but bisphosphonate therapy is reported to improve bone quality; however, there is a potential risk of bisphosphonate-related osteonecrosis of the jaw. In this study we report a case of OI in a male pediatric patient with no family history of OI who was receiving ongoing treatment with intravenous perfusion of bisphosphonate and who required dental surgery. In addition, we discussed the clinical and imaging findings and briefly reviewed the literature.

Noonan syndrome is a multiple malformation disorder with an autosomal dominant inheritance pattern. Congenital heart defects, short stature, thoracic deformities, short neck with webbing, hypertelorism, malocclusions, and feeding difficulties are some of the commonly observed clinical features. We report on a case of a patient with Noonan syndrome, severe open bite, associated feeding difficulties, and strong gag reflex, discussing conservative management with myofunctional therapy. Myofunctionai therapy has demonstrated a successfui outcome, reestablishing masticatory function and routine dental home care after an 18-month foliow-up.

Around 2015, Zika virus infection during the prenatal period was associated with poor outcomes such as microcephaly and other serious brain abnormalities. Infection by this virus has become a concern, gaining international attention, due to an apparent 20-fold increase in the incidence of microcephaly during an outbreak of this disease in Brazil. Later studies concluded that the phenotype presented not only involved microcephaly, but constituted a new pattern of birth defects, called congenital Zika syndrome (CZS). Previously, a cross-sectional study showed that individuals affected by CZS have a higher prevalence of posteriorly positioned or submucosal lingual frenulum. However, the present dissertation aimed to evaluate the oral frenulum of children with CZS and to evaluate possible associations between neurological alterations and the oral frenulum phenotypes observed in this population. The present work has a longitudinal design, as part of a broader multidisciplinary cohort project. The final study sample consisted of 63 children diagnosed with CZS, aged between 1 and 20 months of both sexes. Data collection was carried out at four different times, spread over a period of 30 months. Thirty-one healthy children, in the same age group, of both sexes made up the control group. The babies underwent thorough clinical and neurological evaluations by a multidisciplinary team. Then, data collection included intraoral anatomical assessments performed by a pediatric dentist. The lingual frenulum was evaluated observing the following aspects: visibility, thickness, and level of fixation. The labial frenulum was examined by moving the upper and lower lips apart, followed by bidigital pressure. The protocols of Coryllos et al. (2004) and Kotlow (2013) for the classification of lingual and labial frenulum respectively. The association between categorical variables such as dysphagia (presence/absence), congenital contractures (presence/absence), type of lingual frenulum, type of upper labial frenulum, type of lower labial frenulum were tested by chi-square and Fisher's exact tests. The significance level was set at p < 0.05. A significant number of children with CZS have the superior labial frenulum inserted into the papilla region extending to the palate region (p = 0.0008) and a significant association between this type of frenulum and the absence of congenital contracture (p = 0.0435). Children with CZS had lower labial frenulum frequently inserted in a V (p = 0.001), and a significant association was observed between this type of frenulum and the presence of dysphagia (p = 0.0278). The present study expanded the understanding of the most prevalent phenotypes of oral frenulum in children affected by CZS and demonstrates the existence of an association between the phenotypic pattern of oral frenulum and neurological alterations observed in that syndrome. These findings may help to predict the neurological manifestations of CZS and indicate the need to evaluate a greater number of affected patients to establish protocols and predict the risk of the emergence of such neurological alterations based on the oral frenulum. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Demanda Social - CAPES/DS Em meados de 2015, a infecção pelo vírus Zika durante o período pré-natal foi associada a desfechos desfavoráveis, como microcefalia e outras anomalias cerebrais graves. A infecção por esse vírus se tornou preocupante, ganhando atenção internacional, devido a um aparente aumento de 20 vezes na incidência de microcefalia durante o surto dessa doença no Brasil. Estudos posteriores concluíram que o fenótipo apresentado envolvia não apenas a microcefalia, mas constituía um novo padrão de defeitos congênitos chamado síndrome congênita do Zika (SCZ). Previamente, estudo transversal demonstrou que indivíduos afetados pela SCZ apresentam uma maior prevalência de frênulo lingual posicionado posteriormente ou submucoso. Entretanto, a presente dissertação objetivou avaliar frênulos orais de crianças portadoras de SCZ e possíveis associações existentes entre alterações neurológicas e os fenótipos de frênulos orais observados nessa população. O presente trabalho dispõe de um delineamento longitudinal, fazendo parte de um projeto de coorte multidisciplinar mais amplo. A amostra final do estudo foi composta por 63 crianças com diagnóstico de SCZ, na faixa etária de 1 a 20 meses, de ambos os sexos. A coleta de dados foi realizada em quatro momentos distintos, distribuídos em um período de 30 meses. Trinta e uma crianças saudáveis, na mesma faixa etária e de ambos os sexos, compuseram o grupo controle. Os bebês passaram por avaliações clínicas e neurológicas completas feitas por uma equipe multidisciplinar. Em seguida, a coleta de dados incluiu avaliações anatômicas intraorais, realizadas por um odontopediatra. O frênulo lingual foi avaliado observando-se os seguintes aspectos: visibilidade, espessura e nível de fixação. Os frênulos labiais foram examinados através do afastamento dos lábios superior e inferior, seguido de pressão bidigital. Foram utilizados os protocolos de Coryllos et al. (2004) e Kotlow (2013) para a classificação dos frênulos lingual e labiais respectivamente. As associações entre variáveis categóricas, como disfagia (presença/ausência), contraturas congênitas (presença/ausência), tipo de frênulo lingual, tipo de frênulo labial superior e tipo de frênulo labial inferior, foram testadas pelos testes do quiquadrado e exato de Fisher. O nível de significância foi estabelecido em p < 0,05. Uma quantidade significativa de crianças com SCZ possui o frênulo labial superior inserido na região da papila, estendendo-se até a região do palato (p = 0,0008), e há uma associação significativa entre este tipo de frênulo e a ausência de contraturas congênitas (p = 0,0435). Crianças com SCZ apresentaram frênulos labiais inferiores frequentemente inseridos em V (p = 0,001), tendo sido observada uma associação significativa entre este tipo de frênulo e a presença de disfagia (p = 0,0278). O presente estudo ampliou a compreensão acerca dos fenótipos mais prevalentes de frênulos orais em crianças afetadas pela SCZ e demonstra a existência de associação entre padrão fenotípico de frênulos orais e alterações neurológicas observadas na referida síndrome. Esses achados poderão auxiliar na previsão das manifestações neurológicas da SCZ e indicam a necessidade de avaliação de um maior número de pacientes afetados para que se possa estabelecer protocolos e previsão de risco do surgimento de tais alterações neurológicas com base nos frênulos orais.

The present thesis has objectives divided into two chapters. Chapter 1 aims, through a systematic review with meta-analysis, to investigate whether diabetes mellitus type 1 (DM1) promotes changes in salivary levels of immunoglobulins (Ig) A, G and M when compared to that in individuals without DM1. The search strategy was performed in eight databases and gray literature, with nine studies being selected. Diabetic patients had a significant reduction in salivary flow (p=0.0008; Cohen's d = -0.19, 95% CI= -0.33, -0.05), but not significant enough to modify the IgA concentration (p=0.120; Cohen's d) = 0.58, 95% CI = -0.15, 1.32). However, DM1 increased IgA concentration by reducing salivary flow (Cohen's d = 0.84; 95% CI = 0.36, 1.32), with a strong estimate of effect (p=0.0006). Regarding IgG, no significant change was observed with DM1 in the patients' saliva (p=0.420). There was no significant variation in salivary IgM levels (p=0.300). Chapter 2 aimed to evaluate the association between salivary parameters: glucose (GS), flow, pH and proteins concentration; fasting and postprandial blood glucose; glycated hemoglobin; caries (CI), plaque (PI) and gingival bleeding (BI) indexes; and diet in children with (CDM1) and without (SDM1) DM1. The CDM1 and SDM1 groups were composed of 36 and 49 patients, respectively, matched for sex and age. For the evaluation of CI, PI and BI, a clinical examination was performed. The dietary pattern was obtained through the diet diary for the 24 hours prior to the appointment. Unstimulated total saliva was collected. Salivary protein concentration was analyzed by the bicinchoninic acid method. The Kolmogorov-Smirnov, Mann-Whitney and Spearman tests were used, considering p

The pharmaceutical formulation of a drug is an essential tool that has the purpose of facilitating its administration and obtaining the greatest desired therapeutic effect. Thus, the availability of the drug from the pharmaceutical form assumes a critical role in the clinical effectiveness of a drug. Surgery to remove third molars is a procedure often performed in dentistry, being associated with varying degrees of postoperative pain. Therefore, immediate control and an understanding of the pathophysiological mechanisms of postoperative pain and control strategies are essential in clinical practice. Knowledge of the different formulations and appropriate doses of medications are essential for immediate pain control, since most patients experience moderate to severe pain in these procedures. Ibuprofen (IBU) is a non-steroidal anti-inflammatory drug (NSAID), widely used for the treatment of postoperative pain, administered orally, in doses of 400 to 600mg, every 6-8 hours, preferably after meals. Improvements in the pharmacokinetics of ibuprofen have led to the development of new formulations and new ibuprofen salts with a faster dissolution rate. Thus, the aim of the present study was to evaluate the onset of action and effectiveness of different formulations of ibuprofen in controlling postoperative pain in patients undergoing third molar surgery. A randomized, double-blind, divided mouth, clinical trial was conducted with volunteers who needed the removal of the third mandibular molars with similar patterns of bone inclusion and surgical difficulty between the right and left sides, and required osteotomy. Eligible patients were randomly assigned to 2 groups to receive a single dose (400 mg) of ibuprofen gel capsules (Alivium), Ibuprofen drops 100mg / ml (Alivium), 4ml single dose dissolved in 100 ml of water or placebo. The parameters of onset of action and analgesic efficacy of ibuprofen were evaluated in different presentations with the visual analog scale, which was applied immediately, 15 minutes, 30 minutes, 1h, 2h, 4h and 6 hours after the surgery, where the patient reported the intensity of pain, as well as day and time. As a result, we can see in terms of the analgesic efficacy of IBU formulations, there was no statistically significant difference between the gel capsule - drops solution (p> 0.05), over time when assessing peak pain after 15 min of surgery (0, 20 ± 2.00; -0.12 ± 2.53,), 30 min (0.96 ± 2.38; 0.92 ± 2.81), 1 h (-0.4 ± 1.42; - 0.60 ± 2.64), 2 h (0.52 ± 1.68; -0.16 ± 3.23), 4 h (-1.0 ± 2.63; -0.40 ± 3.09) and 6 h (-1.28 ± 2.18; -1.04 ± 2.54). The placebo effect had an influence on the results, in the second surgical moment, regardless of being in the placebo group and active treatment. A significant difference was observed in relation to pain scores for patients on active treatment (p = 0.013), who reported less pain, 30 minutes after surgery (0.94 ± 2.58) when compared to the placebo group. However, in the sixth hour (-1.16 ± 2.35) it was observed that individuals who took a placebo reported less pain perception (p = 0.0010) when compared to the group treated with the active principle. As a conclusion of the study, the pharmaceutical forms studied, through the application of the visual analog scale, showed a significant reduction in clinical pain parameters 30 minutes after administration, and were effective in controlling postoperative pain in surgery to remove lower third molars. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) - Demanda Social A formulação farmacêutica de um medicamento é uma ferramenta essencial, que possui a finalidade de facilitar sua administração e obter o maior efeito terapêutico desejado. Dessa maneira, a disponibilidade do fármaco, a partir da forma farmacêutica, assume um papel crítico na eficácia clínica de um medicamento. A cirurgia para remoção de terceiros molares constitui um procedimento frequentemente realizado em Odontologia, estando associado a variados graus de dor pós-operatória. Desse modo, é essencial, na prática clínica, o controle imediato e o entendimento dos mecanismos fisiopatológicos da dor pós-operatória e das estratégias de controle. O conhecimento das diferentes formulações e de doses adequadas dos medicamentos são fundamentais para o controle imediato da dor, visto que a maioria dos pacientes experimentam dor moderada a severa nesses procedimentos. O ibuprofeno (IBU) é um anti-inflamatório não esteroidal (AINE), largamente empregado para o tratamento da dor pós-operatória, administrado por via oral, em doses de 400 a 600mg, a cada 6-8 horas, preferencialmente, após as refeições. Melhorias na farmacocinética do ibuprofeno levaram ao desenvolvimento de novas formulações e novos sais de ibuprofeno com uma taxa de dissolução mais rápida. Portanto, o objetivo do presente estudo foi avaliar o início de ação e a eficácia de diferentes formulações do ibuprofeno no controle da dor pós-operatória, em pacientes submetidos à cirurgia de terceiros molares. Foi realizado um ensaio clínico, randomizado, boca dividida, duplo cego, com voluntários que necessitavam da remoção dos terceiros molares mandibulares com padrões similares de inclusão óssea e dificuldade cirúrgica entre os lados direito e esquerdo e precisavam de osteotomia. Os pacientes elegíveis foram randomicamente alocados em 2 grupos para receber uma dose única (400 mg) de ibuprofeno cápsulas-gel (Alivium®), ibuprofeno gotas 100mg/ml (Alivium®), 4ml dose única dissolvidos em 100 ml de água ou placebo. Foram avaliados os parâmetros de início de ação e de eficácia analgésica do ibuprofeno em diferentes apresentações com a escala visual analógica, que foi aplicada, imediatamente, em 15 minutos, 30 minutos, 1h, 2h, 4h e 6h após o término da cirurgia, cujo paciente informou a intensidade da dor, bem como o dia e o horário. Como resultados, evidenciamos que, quanto à eficácia analgésica das formulações do IBU, não houve diferença estatisticamente significativa entre cápsula gel – solução gotas (p>0,05) ao longo do tempo, quando feita a avaliação do pico da dor após 15 min de cirurgia (0,20±2,00; -0,12±2,53,), 30 min (0,96±2,38; 0,92±2,81), 1 h (-0,4±1,42; -0.60±2,64), 2 h (0,52±1,68; -0,16±3,23), 4h (-1,0±2,63; -0,40±3,09) e 6 h ( -1,28±2,18; -1,04±2,54). O efeito placebo teve influência nos resultados, no segundo momento cirúrgico, independentemente de ser do grupo placebo e do tratamento ativo. Foi observada uma diferença significativa em relação aos escores de dor para os pacientes do tratamento ativo (p=0,013), os quais reportaram menos dor 30 minutos após a cirurgia (0,94±2,58) quando comparados ao grupo placebo. Entretanto, na sexta hora (-1,16±2,35), foi observado que indivíduos que tomaram placebo relataram menor percepção da dor (p=0,0010) quando comparados ao grupo tratado com o princípio ativo. Como conclusão do estudo, as formas farmacêuticas estudadas, por meio da aplicação da escala visual analógica, apresentaram redução significativa dos parâmetros clínicos de dor 30 minutos após administração e foram eficazes no controle da dor pós-operatória em cirurgia de remoção de terceiros molares inferiores.

The present work aimed to assess the antibacterial efficacy, effect on salivary parameters and side effects of dentifrices containing different concentrations of essential oils in association with sodium fluoride for future testing in a prospective study in pediatric patients. Sixty healthy adults, both sexes, aged 18-45 years, without active caries lesions joined the study. Subjects were randomly assigned to brush their teeth during one minute with one of 5 dentifrices: 1%Lippia sidoides Cham (LSO), 2%LSO, 1% Carvacrol + Timol (Car+Thy), 0,5%Car+Thy or 1000 ppm de fluoreto de sódio (Control). All dentifrices contained 1000ppm of fluoride. Saliva was collected before (I) and after (F) toothbrushing to measure flow rate, pH, buffer capacity and mutans streptoccocci (MS) levels in saliva. A questionnaire (SQ) was applied to evaluate patient satisfaction and side effects. A significant difference was observed between I and F flow-rates: 1%LSO (p=0.002), 2%LSO (p=0.045); pH: Control (p=0.013), 1%LSO (p=0.006), 2%LSO (p=0.004), 0,5%Car+Thy (p=0.013); and buffer capacity - 1%LSO (p=0.015); 1%Car+Thy (p=0.019). MS reduction after toothbrushing was only observed with 2%LSO (p= 0.013) e 1%Car+Thy (p=0.021). SQ demonstrated burning sensation as the most evident side-effect noted by patients, followed by odor perception and sense of cleanliness. Burning sensation showed significant differences between 1%LSO and 1%Car+Thy (p=0.008); 2%LSO and 1%Car+Thy (p=0.003). Our results suggest that dentifrices containing LSO, Car and/or Thy in association with fluoride promote an increase in salivary flow rate, pH and buffer capacity, generating a reduction in MS at higher concentrations. In spite of a greater burning sensation, 2%LSO and 1%Car+Thy showed the best outcome for future testing. O presente estudo objetivou avaliar a eficácia antibacteriana, o efeito sobre os parâmetros salivares e a aceitabilidade pelos usuários de dentifrícios à base de diferentes concentrações de óleos essenciais associados ao flúor. Foram selecionados um total de 60 adultos saudáveis de ambos os gêneros, com idades entre 18 e 45 anos, sem cárie ativa, acompanhantes de pacientes atendidos da Universidade Federal do Ceará, Fortaleza (CE). Eles foram randomizados e igualmente divididos em 5 grupos para escovar os dentes por 1 minuto, usando uma das seguintes formulações: 1% Lippia Sidoides Cham (LSO), 2%LSO, 1% Carvacrol + Timol (Car+Thy), 0,5%Car+Thy e 1.000 ppm de fluoreto de sódio (CONTROLE). Todos os dentifrícios continham 1000 ppm de flúor. A coleta de saliva foi realizada antes e após a escovação com aplicação dos tratamentos, a fim de medir os níveis de fluxo salivar, pH, capacidade tampão e Streptoccoccus mutans (S. Mutans). Foi aplicado um questionário de satisfação (QS) após o término da escovação com o intuito de avaliar a grau de aceitabilidade dos pacientes aos diferentes dentifrícios frente aos vários efeitos colaterais que os mesmos pudessem provocar. Os dados foram tabulados para análise estatística e analisados no programa Statistical Package for the Social Sciences (SPSS), versão 20.0, com nível de significância de 5% e intervalo de confiança de 95%. Comparações entre valores iniciais e finais dos parâmetros salivares das diferentes formulações demonstraram diferenças estatisticamente significativas para os seguintes parâmetros: Fluxo - 1%LSO (p=0.002), 2% LSO (p=0.045); pH - Controle (p=0.013), 1%LSO (p=0.006), 2%LSO (p=0.004), 0,5%Car+Thy (p=0.013); Capacidade tampão - 1% LSO (p=0.015); ; 1% Car+Thy (p=0.019). A redução de S. mutans após escovação com os dentifrícios foi observada apenas nos grupos 2%LSO (p= 0.013) e 1%Car+Thy (p=0.021). O QS demonstrou que houve uma associação estatisticamente significante entre o tipo de dentifrício e a sensação de queimação (p=0.02). A sensação de queimação diferiu significativamente entre 1%LSO e 1%Car+Thy (p=0,008); 2%LSO e 1%Car+Thy (p=0,003). A percepção olfativa diferiu entre 1%LSO e 2%LSO (p=0.048). Os resultados sugerem que o uso de dentifrícios contendo Lippia sidoides Cham, carvacrol e timol em associação ao flúor promovem uma melhoria dos parâmetros salivares que protegem contra a cárie, através de um aumento do fluxo, pH e capacidade tampão. Esses dentifrícios apresentam sensação de queimação em diferentes níveis, mas demonstrou boa aceitabilidade por parte dos usuários. Finalmente, a ação antibacteriana foi observada somente com dentifrícios contendo 2% Lippia Sidoides Cham e 1% Carvacrol + Timol.