Orientador: Daniela Cardoso Umbelino Cavallini / Coorientador: Carla Raquel Fontana / Banca: Juliana Cabrini Carmello / Banca: Marlus Chorilli / Resumo: Os microrganismos probióticos associados a produtos alimentícios já são amplamente utilizados para a manutenção da saúde e redução do risco de certas doenças. Nesse contexto, diversos estudos mostram que cepas probióticas específicas têm grande potencial de manutenção e melhora da saúde oral, apresentando atividade anticariogênica, redução da halitose e prevenção de infecções oportunistas, como a candidose, frequentemente presente em indivíduos imunocomprometidos. Essas condições patogênicas apresentadas estão relacionadas à formação e estabelecimento de biofilmes na cavidade oral. As infecções provenientes de biofilmes são duradouras, altamente resistentes à farmacoterapia e de difícil eliminação. Dessa forma, o objetivo do presente estudo foi obter filmes orodispersíveis (ODF) contendo cepa probiótica Enterococcus faecium CRL 183, avaliando sua capacidade de inibir a formação e/ou maturação de biofilme de Candida albicans in vitro. Essa cepa foi selecionada devido as suas características de cultivo, informações disponíveis sobre efeito probiótico, segurança e caráter inovador, pois não há na literatura informações sobre a atividade antifúngica dessa cepa na cavidade oral. A segurança da cepa probiótica foi avaliada através do teste susceptibilidade a antimicrobianos. Para testar a capacidade de inibição de biofilmes de C. albicans in vitro foram formados biofilmes polimicrobianos (C. albicans + E. faecium), em diferentes proporções de fungo: probiótico (1:1; 1:10; 1:... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Probiotic microorganisms associated with food are already widely used to maintain health and reduce risk of certain diseases. In this context, several studies show that certain probiotic strains have great potential for maintenance and improvement of oral health, presenting anticariogenic activity, reduction of halitosis and prevention of opportunistic infections, such as candidiasis, often present in immunocompromised individuals. These pathogenic conditions are related to formation and establishment of biofilms in the oral cavity. Infections caused by biofilms are long-lasting, highly resistant to pharmacotherapy and difficult to eliminate. Thus, the objective of the present study is to obtain orodispersible films (ODF) containing Enterococcus faecium CRL 183, evaluating its capacity of inhibiting the formation and / or maturation of Candida albicans biofilms in vitro. This strain was selected due to its cultivation characteristics, available information on probiotic effect and safety and innovative character, as there is no information on the antifungal activity of this strain in the oral cavity. The safety of the probiotic strain was evaluated by antimicrobial susceptibility test. In order to test the ability to inhibit the formation of C. albicans biofilms in vitro, combined polymicrobial biofilms (C. albicans + E. faecium) with different proportions of opportunistic pathogens: probiotic were formed (1: 1, 1:10, 1: 100), during the formation (24 hours) and maturation (48... (Complete abstract click electronic access below) / Mestre

Faculty of Health Sciences School of Public Health 8900179x nmathabathe@eun.org.za / South Africa is ranked as the country with largest number of people living with the Human Immunodeficiency Virus (HIV) in the world. Oral health care workers have a role to play in the national response to the HIV epidemic through the provision of quality oral health services. The aim of this study was to determine the knowledge, attitudes and practices of oral hygienists and dental therapists on HIV/AIDS. A total of 1160 questionnaires were mailed to 831 oral hygienists and 329 dental therapists registered with the Health Professionals Council of South Africa in 2000. The questionnaire covered: demographic factors; general and oral health-specific HIV/AIDS knowledge; attitudes towards HIV/AIDS patients; infection control practices and ethical/legal issues. The response rate was 27.4% (n=318), 255 oral hygienists and 63 dental therapists. Overall, respondents in this study illustrated sound knowledge on oral manifestations of HIV/AIDS and modes of transmission of the virus although 10% reported that the virus could be transmitted through mosquito bites and 25% agreed that HIV could be transmitted via saliva. Respondents reported compliance with basic infection control practices although 35% did not agree that infection control measures that protect against the hepatitis B virus could provide adequate protection against HIV. In addition 73.8% of the respondents reported that additional infection control measures must be taken in the treatment of HIV/AIDS patients in the dental surgery. The results of this study indicate a need for continuous HIV professional education of oral hygienists and dental therapists in order to improve the quality of care provided to HIV infected patients.

No Brasil existem dificuldades para o controle da dosagem correta do flúor na água de abastecimento, ainda que sua incorporação represente um método seguro, econômico, eficaz e eficiente para reduzir os níveis de cárie dentária na população. O flúor presente constantemente na água ingerida participa dos ciclos de desmineralização e remineralização do esmalte dentário, atuando de forma terapêutica e preventiva, tendo sido atribuída à fluoretação das águas uma redução de 30 a 60% na incidência da cárie dentária. Para alcançar os efeitos preventivos, os teores adequados precisam ser mantidos permanentemente, pois a interrupção temporária ou definitiva e teores de flúor abaixo do recomendado acarretam a perda do benefício pela população. Para teores acima do recomendado, corremos o risco de desenvolver a fluorose dentária nas crianças cujos dentes estejam em formação. Este estudo propõe, através de uma metodologia qualitativa, usando como estratégia investigativa a entrevista semi-estruturada e a análise documental, conhecer como o município de Ribeirão Preto realiza o monitoramento da fluoretação das águas de abastecimento público, contextualizando-o com as políticas públicas de saúde, sendo no campo da saúde bucal, seu principal avanço foi a redução do índice CPO-D, de 6,14 em 1992, para 1,95 em 2004. Contudo, o município ainda apresenta dificuldades para universalização da assistência odontológica e para as referências de especialidades. A rede de abastecimento público de água do município apresenta uma singularidade ao ser constituída por 99 poços artesianos, que constituem 76 pontos para aplicação do cloro e flúor, sendo que este último começou a ser adicionado a partir de 1987, somente atingindo 100% dos poços em 1996.Inúmeras dificuldades de ordem técnica, de recursos materiais, humanos, administrativos e financeiros precisam ser superados para que a fluoretação efetivamente aconteça e somente a partir de 1997 o heterocontrole passou a ser realizado. A partir de 2000 a Vigilância Sanitária passou a realizar o acompanhamento da fluoretação e dentre as amostras analisadas, menos de 50% estão com teor adequado para o flúor, geralmente abaixo de 0,6 ppm, com prejuízos dos benefícios previstos por essa ação. As ações e projetos para melhorias na fluoretação ainda não foram capazes de melhorar esses resultados. A participação e o controle social da fluoretação representam ainda um processo incipiente na construção das políticas públicas vigentes no Município. / In Brazil there are several problems to control de correct level of fluoride in the public water system, although its incorporation is a safe, economic, efficacious and efficient method to reduce tooth cavities in the population. The fluoride ingested regularly in the water influences the demineralization and remineralization cycles and is a therapeutic and preventive strategy. Some studies found that water fluoride contributes to a 30 to 60% reduction of dental cavities incidence. In order to achieve preventive effects, the adequate levels of fluoride must be continuously maintained as its temporary or definitive interruption and low fluoride doses (below the recommendation) can result in the loss of its benefits. On the other hand, high fluoride doses cause the risk of dental fluorosis especially in children whose teeth are still developing. Based on a qualitative methodology and using semi-structured interviews and analysis of documents, the author aimed at learning how the municipality of Ribeirão Preto monitors the public water fluoride levels, in the context of public health policies. The main improvement in oral health was the reduction of CPO-D index, from 6.14 in 1992 to 1.95 in 2004, although it still presents difficulties regarding care universalization and speciality references. The public water system has 99 artesian wells with 76 places for chloride and fluoride application. Fluoride application began in 1987, achieving 100% in 1996. Several technical problems or regarding material, human, administrative and financial resources are observed and must be solved in order to have effective water fluoridation. Only in 1997, the municipality initiated the fluoride control. In 2000, the Sanitary Surveillance Department began to supervise water fluoridation and among the analyzed samples, less than 50% present the adequate level of fluoride, generally below 0.6 ppm, impairing possible benefits. The actions and projects directed to improve the fluoride levels did not achieve good results. Social participation and control of fluoridation still represent an incipient process in the construction of public policies in the municipality.

Indicadores são essenciais para os serviços de saúde tanto no diagnóstico, como na avaliação e controle de suas ações. Com a evolução do SUS, os municípios ainda estão se adequando às novas funções decorrentes do processo de municipalização. Para tanto, é imprescindível um sistema de informação em saúde consistente, fator preponderante no planejamento. O objetivo deste trabalho foi analisar os sistemas de informações e os indicadores de saúde bucal utilizados pelos municípios da região de Osasco, bem como aperfeiçoá-los e propor o uso de outros indicadores. O estudo foi desenvolvido nos municípios pertencentes à extinta Direção Regional de Saúde (DIR) V Osasco, através do Comitê de Saúde Bucal da região. Inicialmente, os coordenadores de saúde bucal responderam questionários referentes aos sistemas de informações e indicadores utilizados. Em seguida, foram realizadas oficinas com estes coordenadores para aprimoramento destas ferramentas. Observou-se que os municípios enfrentam problemas para o efetivo uso dos indicadores no controle, avaliação e planejamento de ações de saúde bucal. Esperase que a região, através das coordenações locais de saúde bucal, desenvolvam mecanismos para utilizar cada vez mais e com maior qualidade as informações geradas pelos seus sistemas de informações e possam traduzi-las em indicadores confiáveis e úteis para o fortalecimento de suas gestões. / Indicators are essential for health care both in diagnosis, as in the evaluation and control of their actions. With SUS development, municipalities are still adjusting to the new tasks arising from municipalization process. So, a consistent health information system is very important, predominant factor in planning. The purpose of this study was to analize information systems and oral health indicators used by municipalities in the region of Osasco, besides improve them and propose the use of other indicators. The study was conducted in the municipalities belonging to the defunct Regional Direction of Health (DIR) V - Osasco, through the Committee for Oral Health in the region. Initially, the coordinators of oral health filled out questionnaires concerning information systems and indicators used. Then workshops were held with these coordinators to improve these tools. It was observed that municipalities face problems for the effective use of the indicators in control, evaluation and planning of actions of oral health. It is expected that the region, through the coordination of local oral health, develop mechanisms to use ever more and with higher quality the information generated by its information systems, translating them into useful and reliable indicators for the strengthening of their management .

A Saúde Bucal está relacionada à exposição ao flúor, hábitos dietéticos e higiênicos menos cariogênicos, além de fatores sócio-econômico-culturais favoráveis. A melhor intervenção farmacêutica constitui-se em formular um agente fluoretado capaz de prevenir e/ou retardar o processo carioso. Procedeu-se a coleta de dentes terceiros molares inclusos que foram fragmentados e adaptados em suportes adequados para serem submetidos aos testes. Determinou-se o protocolo experimental baseado, seqüencialmente, em: avaliação da microdureza das amostras dentárias hígidas; desmineralização das mesmas; avaliação da microdureza das amostras desmineralizadas; remineralização das amostras com diferentes fontes de flúor, em duas concentrações distintas, com três valores de pH e duas posologias diversas; nova avaliação da microdureza no 5 º, 10 º , 15º e 20º dias, seguida de análise por Microscopia Eletrônica de Varredura, com comparação dos resultados quanto à eficácia remineralizante e estabilidade dos enxagüatórios à base de flúor propostos neste experimento. / Oral Health is directly related to the increase of exposure to fluorine, as well as hygienic and dietetic habits that are less cariogenic, and favorable social and economical factors. Consequently, the best pharmaceutical intervention consists in formulating a fluorine agent that is able to prevent and/or retard the carious process. A protocol was executed for the collection of teeth at odontological clinics. After being extracted, those third molar included teeth were, taken to the laboratory so that all the necessary removals of blood deposits, as well as residual tissues, which are unnecessary to the experiment, could be done. The teeth were fragmented and adapted to supports that were adequate to the preparation of the samples that would be tested. The experimental protocol was based on: the evaluation of the hardness of samples of included teeth; demineralization of the samples; the evaluation of the hardness of the samples; the remineralization of the samples with different sources of fluoride, in two different oncentrations, with three pH values and two diverse posologies ; new hardness evaluation on the 5th, 10th, and 15th and 20 th days, followed by an analysis by Electronic Microscopy of Screening with a comparative analysis of the results regarding the efficacy and stability of the mouth rinse propouse in this experiment.

O texto dedica-se, inicialmente, ao estudo das condições de desenvolvimento brasileiro nas áreas econômica e social, retratando a forte crise que caracterizou os anos oitenta. Após examinar o sistema geral de atenção à saúde, analisa o aparelho prestador de serviços odontológicos e os gastos em saúde geral e em saúde bucal para o ano de 1989. A questão epidemiológica é vista sob a ótica de cinco indicadores principais: ataque pela cárie dental, doenças periodontais, necessidade e uso de próteses totais, edentulismo e procura de atendimento, estimando-se médias, percentuais e valores totais idade por idade para a população de 5 a 79 anos. O estudo dos programas e políticas setoriais engloba as iniciativas de nível central e regional, as açôes preventivas e dois temas relacionados à saúde oral: o consumo e produção de açúcar e o modelo de ensino elementar. Apresentam-se sugestôes para estruturação geral do sistema de atendimento odontológico com ênfase em sub-sistemas de prevenção, educação em saúde, atenção a crianças e adolescentes, cuidados a outros grupos e problemas, vigilância sanitária e epidemiológica, além de propor medidas relacionadas à preparação de recursos humanos, ao financiamento setorial e às linhas de estudos e pesquisas. / First of all the text looks at the Brazilian economic and social development showing the strong general crisis of the last decade. After reviewing the global health systern, it examines the dental care system and the financial aspects and expenditures of the health and dental sectors for 1989. The epidemiological question is focused on the basis of five main indicators: dental caries attack, periodontal diseases, needs and use of dentures, edentulism and demand for dental care, including statistical estirnations related to averages, percentages and total needs for urban people 5 to 79 year-old. The analysis of the oral health programs and policies includes central and regional actions, preventive measures, sugar consumption and production, and the elementary education model. Suggestions are presented for the following topics: structure of the dental care system for the Brazilian population with emphasis on sub-systems of prevention; health education; dental care for children, youths and other age brackets; sanitary and epidemiological monitoring programs; dental personnel training; financing and, finally, research recommendations.

Free form surface measurement and its subsequent analysis is becoming a subject of considerable interest, not only within the engineering field, but also in bioengineering, medical and dental research. In particular, within the field of dental research, the oral structures comprise a variety of complex free form surfaces, which are often recorded by elastomeric impression materials. In this study, an optical triangulation-based, noncontact probe fitted onto a Co-ordinate Measuring Machine was used to acquire three-dimensional co-ordinate data from such complex free form surfaces. When using an optical probe to digitise a complex free form surface represented by impressions, an optimal digitisation strategy is critical to limit the uncertainty of the data acquisition procedure, because the raw data are the basis for later surface measurement and analysis. This study attempted to optimise a method for three dimensional free form surface data acquisition, measurement and analysis. A theoretical and systematic analysis of error distribution was carried out using standard objects and optimal digitisation strategies were proposed in relation to specified models. Two simulation models of two typical human tooth surfaces were extensively analysed and evaluated. Three reference systems were developed for comparative measurements of those surfaces that have fewer geometrical features. An integrated automatic data acquisition procedure was also developed to scan a large number of impressions. Several successful research applications have been carried out using the methodology developed in this study.

The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.

Magister Scientiae Dentium - MSc(Dent) / The Gauteng province is divided into 5 districts each of which have a public based oral health programme. Each district provides oral health treatments such as dental extractions with treatment of pain and sepsis, preventive dentistry, simple restorations, removable prosthodontics (complete and partial dentures) and minor oral surgery in selected facilities. The main treatment modality in most government based dental clinics is dental extractions (Department of Health, 2003). This indicates the poor status of the population’s teeth. Dental caries is a condition that can be prevented if adequate efforts are made to practice preventive dentistry. Preventive dentistry has been a treatment modality that has been practiced poorly or almost completely ignored in several oral health facilities for many years. This neglect could be due to several factors such as in adequate knowledge regarding preventive dentistry procedures, poor attitude towards preventive dentistry, lack of motivation, or lack of resources (Clark, 2011). The purpose of this study is to determine why preventive dentistry has been neglected for so many years.

Magister Scientiae Dentium - MSc(Dent) / A good oral health self-perception can contribute to improved knowledge of oral health self-care and practice as well as increase the proper use of dental care services. This study evaluated how adolescents from urban and peri-urban Maputo City assess their oral health status, behaviour and oral health risk factors. This is an analytic cross-sectional study, conducted in the urban and peri-urban schools of Maputo City involving adolescents in the age groups of 12 and 15-19 years old. The study was carried out in five schools, three Complete Primary schools and two Secondary schools from urban and peri-urban areas in Maputo City selected by convenience due to their geographic location. The size of the sample was 500 comprising 236 twelve year olds and 264 15-19 year olds. Data was collected using a self-completion questionnaire designed by the World Health Organization (WHO) and translated into Portuguese. The questionnaire included variables such as socio-demographic data (age, gender, location and parent or guardian level of education), self-assessment of oral health status and quality of life; self reported oral health behaviour and lifestyles, oral health risk factor knowledge (alcohol, tobacco and dietary), dental visits and daily impact of oral health. Chi-square for associations and a Spearman correlation tests were used to determine relationships between categorical data. All tests were assumed statistically significant at p≤0.05. The results showed that most of the adolescents classified their teeth (49.7%) and gum (38.2%) health as normal. There was no statistical difference between adolescents from urban and peri-urban schools (Spearman rs (399) = 0,114, p =0,02). The majority (n=322; 65.2%) of the adolescents clean their teeth twice a day. There was no difference between school level (primary and secondary school) and frequency of teeth cleaning. Most of the adolescents use a toothbrush (97.8%) and toothpaste (93.5%) to clean their teeth and only 11.9% also use dental floss but 52.1% didn´t know if their toothpaste was fluoridated or not. Smoking was reported by less than 1% of the adolescents. The main reason for dental service utilization, (reported by 67.5%) was pain or problems with teeth, gums or mouth. There was an association between oral health status and problems experienced in daily life because of their teeth and mouth. There was no significant difference for oral health assessment, risk factors and behaviours, between adolescents from urban and peri-urban schools. Although some satisfactory results were found, the need to strengthen oral health promotion in schools is high, especially considering the causes for dental service utilization were mostly pain and trouble with teeth in this group.