Embora o diamino fluoreto de prata (DFP) venha mostrando bons resultados para paralisação de lesões de cárie, seu uso no Brasil é diminuto, podendo sua indicação estar sendo subestimada nos dias de hoje. Especula-se que isso seja devido à coloração enegrecida que o DFP pode causar. Além disso, o tratamento com o DFP é um procedimento simples, não invasivo, rápido e que não requer equipamento caro ou infraestrutura de apoio para sua aplicação. Para isso, foi conduzido um estudo controlado e randomizado, de grupos paralelos, no qual foi feita a comparação do uso do DFP a 30% com uma técnica de escovação direcionada em primeiros molares permanentes em erupção, bastante indicada na clínica odontopediátrica, mas que exige a mudança no posicionamento da escova para ser realizada. Devido aos comparadores ativos (tratamento com DFP e orientações quanto à técnica de escovação transversal), serem procedimentos muito diferentes, podendo o paciente ser influenciado e negligenciar as orientações recebidas quanto ao uso da escovação transversal, foi optado pela aplicação de placebo, simulando a aplicação do DFP no grupo da escovação transversal, fornecendo assim, tratamentos semelhantes aos participantes no sentido de se sentirem tratados igualmente ao grupo do DFP pelo dentista. Assim, o primeiro capítulo desta dissertação, tem como objetivo descrever esta nova metodologia com o uso de placebo, realizando análises em termos de custo, aceitabilidade referida pelo participante e adesão aos diferentes tratamentos propostos. A validade do uso desse placebo criado para simular a aplicação do DFP é importante para cumprir o papel que se espera desse tipo de medida, além de ser bem aceita pelos participantes e mostrar viabilidade para sua inclusão em um estudo de eficácia. Já o segundo capítulo, tem como objetivo principal, verificar a relação de custo-eficácia do uso do DFP para a paralisação de lesões de cárie ativa em esmalte na superfície oclusal de primeiros molares permanentes em erupção. Outros desfechos centrados nos pacientes, como a aceitabilidade e percepção dos responsáveis quanto a estética e a saúde dos dentes de seus filhos, foram também avaliados. Aspectos relacionados ao impacto do desfecho escolhido no que tange à avaliação da eficácia foram também discutidos. Apesar de efeitos semelhantes, as técnicas propostas diferem quanto à adesão e custo para sua implementação, fatores que devem ser considerados na tomada de decisão de tratamento. Além disso, a despeito da possível coloração que cause nos dentes, o tratamento com DFP não causa impacto sob a visão dos responsáveis. Assim, esta dissertação pôde contribuir tanto no aspecto metodológico, discutindo aspectos importantes no delineamento e interpretação de resultados desse tipo de estudo clínico de eficácia, bem como para apontar a possibilidade de boa aceitação do DFP pelos responsáveis, questionada por alguns especialistas, embora para sua implementação em larga escala, para essa finalidade, acompanhamento mais longo e busca por desfechos mais robustos sejam fundamentais. / Although Silver Diamine Fluoride (SDF) has been showed good results in controlling caries lesions, many dentists in Brazil can avoid its use possibly underestimating its indications nowadays due to the staining caused by its usage. On the other hand, treatment with SDF is a simple, non-invasive and quick procedure and it does not require expensive equipment or infrastructure support for its implementation. A randomized clinical trial with two-arm parallel groups was conducted, comparing the treatment of enamel caries lesions with 30% SDF versus cross-toothbrushing technique (usually indicated in pediatric dental clinic and that requires a modification of the toothbrush position to be performed), on occlusal surfaces of erupting first permanent molars. Since both active groups (treatment with SDF and cross tooth-brushing technique instructions) use different procedures and patients can be influenced and neglect the brushing instructions, it was decided to include a placebo application in the cross-toothbrushing technique group, simulating the SDF treatment. Therefore, it was provided a similar treatment for participants in both groups so they could feel equally treated by the operator. Thus, the aim for the first chapter of this dissertation was to describe this new methodology, using the placebo treatment and making cost, acceptability and adherence to the proposed treatment analyses. The validity of using this placebo, created to simulate SDF applications, is important to fulfill the role expected for this type of measure, as well as being well accepted by the participants and show its feasibility to be included in an efficacy study. The second chapter aims to demonstrate the cost-efficacy and the real possibility of promoting the use of SDF in clinical practice for the control of active enamel caries lesions on occlusal surfaces of first erupting permanent molars. Other patient-centered outcomes, as the caregivers\' acceptability and perception about the received treatment (related to their children´s oral health and aesthetics), were also evaluated. Aspects related to the impact of possible chosen outcomes were also discussed. Although similar effects were found between groups, both proposed techniques differed in treatment adherence and cost for implementation. These factors should be considered when making treatment decisions. Furthermore, regarding the possible tooth staining caused by SDF, no impact was found on caregivers\' perspective. Finally, this study may contribute, in terms of study design methodology, by discussing important aspects in the conception and interpretation of results in studies of clinical efficacy. Besides, it could also help to underlie the possibility of a good acceptance of SDF by parents, commonly questioned by some experts. However, longer follow-up and more robust outcomes analysis are critical for SDF large-scale implementation.

Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p < .01); at the subsequent assessment, gender differences were found in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.

Dental restorative materials interact with their surrounding oral environment. Interaction factors can be release of toxic components and/or effects on biofilm formation and gingiva. In the end of the nineties, a calcium aluminate cement (CAC) was manufactured as a “bioceramic” alternative to resin composite. Dental ceramics are considered to be chemically stable and not to favour dental biofilm formation. Since the influence of aged, resin-bonded ceramic coverages is not fully investigated and the effect of CAC restorations on the dental biofilm formation and gingival response is unknown, those issues were evaluated in this thesis. With or without oral hygiene, in clinical trials including cervical surfaces of CAC, and approximal surfaces of a leucite-reinforced bonded ceramic; biofilm growth, presence of caries-associated bacteria, clinical expressions of gingivitis, the amounts of gingival crevicular fluid (GCF) and its levels of IL-1α, IL-1β and IL-1 ra were investigated in comparison with resin composite and enamel. In addition, the unknown cytotoxic effect of specimens of CAC on fibroblasts was assessed in vitro. With current oral hygiene a similar biofilm formation and gingival response, as evaluated, were observed at sites of CAC, resin composite and enamel. After ceased oral hygiene, more biofilm was assembled on CAC and on resin composite than on enamel. Neither with, nor without oral hygiene, biofilm formation, presence of caries-associated bacteria, clinical gingivitis and the levels of IL-1α, IL-1β and IL-1 ra differed between sites of ceramic, resin composite and enamel. Higher volumes of GCF were collected at ceramic sites compared to enamel. Fresh specimens of CAC showed the lowest cytotoxic effects on fibroblasts compared with three resin composites, zinc phosphate and glass ionomer cements. In conclusion, the low cytotoxic effect of CAC and the limited increase in dental biofilm formation on that material compared with enamel suggest CAC to be a biocompatible dental material with respect to dental biofilm formation, presence of caries-associated microflora and gingival response. This finding, together with the observation that the influence of bonded ceramic on dental biofilm formation, caries-associated microflora and clinical gingivitis was not different from that of enamel, implicates for both CAC restorations and bonded ceramic that the need of oral hygiene and professional oral health care is not reduced.

Thesis (Ph. D.)--University of Michigan, 1979. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 298-309).

No description available.

Darbo tikslas. Įvertinti burnos higienos paslaugų poreikį 35- 65 metų amžiaus pacientams, besiruošiantiems protezuoti dantis, Kauno miesto dantų protezavimo klinikose. Tyrimo metodika (Methods). Tai momentinis tyrimas, kurio metu buvo įvertintas, pas burnos higienistą apsilankiusių asmenų, burnos higienos paslaugų poreikis.Tyrimas vyko 4 privačiose, atsitiktiniu būdu pasirinktose, Kauno miesto dantų protezavimo klinikose. Tyrimo metu buvo naudojama anoniminė anketa ir atliekamas objektyvus burnos higienos tyrimas. Iš viso apklausta 195 respondentai. Atsako dažnis 97,5 proc.. Duomenų statistinis patikimumas įvertintas χ² testu. Rezultatai (Results). Nemaža dalis (41,5 proc.) pacientų, nuo 35-65 metų amžiaus, nežino kaip dažnai reikia valyti dantis. Didelė dalis pacientų nežino, kokius dantų šepetėlius ir pastas reikia naudoti norint išvengti dantų ir dantenų ligų. Net 59,0 proc. pacientų, jaunesnių nei 45 metų amžiaus, jau nešioja dantų protezus, kurių nemoka prižiūrėti. Beveik pusė (46,2 proc.) visų tirtų pacientų niekada nesilankė pas burnos higienistą. Pagrindinė priežastis buvo žinių stoka. Daugiau nei pusei pacientų (53,8 proc.) vizitas pas burnos higienistą nebuvo pirmas. Didelei daliai jų jau buvo diagnozuotas gingivitas ar periodontitas. Net 71,3 proc. pacientų apie profesionalią burnos higieną išgirdo pirmą kartą tik iš gydytojo odontologo. Didelė dalis (84,6 proc.) pacientų nepriklausomai nuo lyties ir amžiaus, mano, kad tokia procedūra reikalinga norint... [toliau žr. visą tekstą] / Aim of the study. To evaluate the need for oral hygiene services for 35- 65-year-old patients, who are going to make teeth prosthetics at the Clinics of Tooth Prosthetics of Kaunas City. Methods. The need for oral hygiene services of persons having visited oral hygienist was evaluated. Research was carried out in 4 private randomly chosen clinics of tooth prosthetics of Kaunas city. Anonymous questionnaires were used and objective oral hygiene examination was performed. 195 respondents in total were surveyed. A response rate is 97,5 %. Statistical data reliability was evaluated by χ² test. Results. 35-65 years old patients 41,5 % do not know how often the teeth should be cleaned. Many patients do not know what toothbrushes and toothpastes should be used to avoid tooth and gums diseases. Even 59,0 % of patients younger than 45 years old, already have tooth prostheses, which they are not able to handle. Nearly a half (46,2 %) of all examined patients have never visited oral hygienist. The main reason being lack of knowledge. For more than a half of patients (53,8 %) this visit to oral hygienist was not first. Significant proportion of them already has diagnosis of gingivitis or periodontitis. Even 71,3 % of patients heard about a professional oral hygiene for the first time only from odontologist. Many patients (84,6 %) irrespective their sex and age think that such a procedure is necessary to avoid lesions of teeth and gums. It was proved, that visit to oral hygienist has... [to full text]

Darbo tikslas. Įvertinti ėduonies paplitimą ir intensyvumą tarp Kauno miesto 12 metų moksleivių bei jų mitybos ir burnos higienos įpročius. Uždaviniai: Ištirti moksleivių dantų būklę ir burnos higieną; įvertinti burnos higienos ryšį su ėduonies intensyvumu; nustatyti moksleivių mitybos įpročius ir jų ryšius su tėvų socioekonomine padėtimi; įvertinti mitybos ir burnos higienos įpročių ryšį. Tyrimo metodika. 2007 m. buvo ištirti 167 atsitiktinai atrinkti Kauno miesto mokyklų 12 metų moksleiviai. Taikytas grupinės atrankos metodas (atrankos vienetas – mokykla). Atlikus klinikinę burnos ertmės apžiūrą, nustatytas dantų ėduonies intensyvumas bei paplitimas bei burnos higienos indeksas. Atlikus anketinę apklausą, įvertinti moksleivių mitybos ir burnos higienos įpročiai. Mitybos įpročių vertinimui taikytas dažnuminis mitybos tyrimo metodas. Statistinė duomenų analizė atlikta naudojant SPSS programos 12 versiją. Kokybinių požymių palyginimui tarp tiriamųjų grupių naudotas Chi-kvadrato testas. Skirtumai tarp kiekybinių požymių skirstinių vertinti, taikant Kruskal-Wallis testą. Tikrinant statistines hipotezes pasirinktas 0,05 reikšmingumo lygmuo. Rezultatai. Tarp Kauno miesto dvylikamečių dantų ėduonies paplitimas buvo 58,7 proc., KPI indekso reikšmė - 2,5. Gera burnos higiena nustatyta 40,7 proc., patenkinama - 36,5 proc., bloga - 22,8 proc. tyrime dalyvavusių moksleivių. Nustatytas ryšys tarp dantų ėduonies intensyvumo ir burnos higienos būklės. Didelės dalies moksleivių mitybos... [toliau žr. visą tekstą] / Aim of the study. To assess dental caries prevalence and severity and to evaluate nutrition and oral hygiene habits among 12- year- old schoolchildren in Kaunas city. Objectives: To evaluate dental caries experience and oral hygiene; to assess oral hygiene relation with dental caries; to ascertain schoolchildren nutrition habits and their relations with parents’ socio-economic status; to assess habits relation of nutrition and oral hygiene. Material and Methods: In year 2007, were examined 167 randomly selected aged 12 years schoolchildren of Kaunas city schools. A group sampling method was applied (a sampling unit – the school). Dental caries prevalence, DMFT and OHI-S were determined. Questionnaire inquiry was performed to assess schoolchildrens’ nutrition and oral hygiene habits. Statistical data analysis is performed by using SPSS program version 12. For qualitative indications’ comparison between exploratory groups Chi – square test was used. Differences between quantitative indications were assessed by applying Kruskal-Wallis test. Statistical significance was assumed when p<0.05. Results: Prevalence of dental caries was 58.7 percent, with mean DMFT 2.5. Good oral hygiene was determined in 40.7 percent, satisfactory – 36.5 percent, bad – 22.8 percent of the schoolchildren. Relation between DMFT and oral hygiene was ascertained. Among most of the participants nutrition habits were unhealthy. Even a half of them showed daily sweet consumption . 24.7 percent of boys... [to full text]

Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.

Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.

Munhälsan är en viktig del av allmänhälsan som kan påverka livskvaliteten. Plack har betydelse för munhälsan och kan vara en bidragande faktor till utveckling av parodontala sjukdomar och karies. Syftet med litteraturstudien var att jämföra den plackavlägsnande effekten med användning av manuell och elektrisk tandborste. Studien utfördes som en allmän litteraturstudie och materialet samlades in genom sökning av vetenskapliga artiklar i databasen Pub Med. Sökorden var ”dental plaque”, ”plaque”, ”dental biofilm”, ”electric toothbrush”, ”power toothbrush” och ”manual toothbrush”. Resultatet baserades på en sammanställning av 15 vetenskapliga artiklar. Elektrisk och manuell tandborstes plackavlägsnande effekt jämfördes mellan olika grupper som patienter med fast ortodontisk apparatur, patienter med parodontit och gingivit, tandläkarstudenter, barn, unga och vuxna individer. Resultaten visade att elektrisk tandborste hade bättre plackavlägsnande effekt än manuell tandborste inom alla grupper. Slutsatsen är att elektrisk tandborste har bättre plackavlägsnande effekt än manuell tandborste, vilket även stödjer studiens hypotes. / Oral health is an important part of overall health and may affect the quality of life. Plaque has an effect on oral health and may be a contributing factor to the development of periodontal diseases and caries. The purpose of this study was to compare the plaque removal efficacy with the use of manual and electric toothbrush. The study was conducted as a review and the material was collected by search of scientific articles in the database Pub Med. Keywords was "dental plaque", "plaque", "dental biofilm", "electric toothbrush", "power toothbrush" and "manual toothbrush". The result was based on 15 scientific articles. Plaque removal efficacy of electric and manual toothbrush was compared in different groups such as patients with fixed orthodontic appliances, patients with periodontitis and gingivitis, dental students, children, youth and adults. The results showed that the electric toothbrush had better plaque removal efficacy than manual toothbrush in all groups. The conclusion is that the electric toothbrush has better plaque removal efficiency than a manual toothbrush, which also supports the study's hypothesis.