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BACKGROUND: Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries. SUMMARY: Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in vivo, in situ, or in vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n = 10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 h (n = 4) or individualized recommendations based on the patient's problem (n = 2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data were in situ (n = 13), and the overall study quality was judged as sufficient/low risk of bias. KEY MESSAGES: Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

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Abstract This study evaluated the effect of different firing protocols on the surface roughness and flexural strength of CAD/CAM lithium disilicate glass-ceramic (LD) after aging methods. Forty-two LD bars of 16 x 4 x 2 mm (IPS e-max CAD, Ivoclar) were randomly separated into two groups according to firing protocols: Single firing-Staining, glazing, and crystallization in a single step; Multiple firings-Crystallization+First staining+Firing+Second staining+Firing+Glazing+Firing. After protocols, initial surface roughness readings were taken (Surfcorder SE1700, Kosakalab). Samples were then randomly separated into three groups (n=7) according to the aging methods they were submitted: Thermomechanical cycling (TMC, ER System, Erios, 1,200,000 cycles, 0.3 MPa, 2 Hz and 5°C/37°C/55°C, 30 s swell time); Simulated toothbrushing (STB, Pepsodent, MAVTEC, 73,000 cycles), and Control (no aging). Final surface roughness readings were done, and samples were submitted to a three-point bending test (OM100, Odeme Dental Research) and fractographic analysis by scanning electron microscopy (EVO-MA10, ZEISS). Data were analyzed (2-way ANOVA, (α=.05). There was no difference (p>.05) in the flexural strength between the firing protocols, regardless of the aging method. STB decreased the flexural strength of samples submitted to multiple firings, different from control (p<.05). Without aging (Control), before TMC, and after STB, LD had lower surface roughness when submitted to multiple firings than to single firing (p<.05). The firing protocols did not affect the flexural strength or the surface roughness of the lithium disilicate glass-ceramic, even after aging. However, toothbrushing negatively affected the flexural strength and smoothed the surface of the ceramic submitted to multiple firings.

Resumo Este estudo avaliou o efeito de diferentes protocolos de queima na rugosidade de superfície e resistência à flexão de uma cerâmica vítrea de dissilicato de lítio (DL) para CAD/CAM, após métodos de envelhecimento. Quarenta e dois barras de DL (IPS e-max CAD, Ivoclar) de 16 x 4 x 2 mm foram separadas aleatoriamente em dois grupos de acordo com os protocolos de queima: Single firing-Pigmentação, glazeamento e cristalização em única etapa. Multiple firings-Cristalização+Primeira camada do pigmento+Queima+Segunda camada do pigmento+Queima+Glazeamento+Queima. Após os protocolos, foram realizadas leituras iniciais de rugosidade de superfície (Surfcorder SE1700, Kosakalab). As amostras foram então separadas aleatoriamente em três grupos (n=7) segundo o método de envelhecimento a que foram submetidas: Ciclagem termomecânica (CTM, Sistema ER, Erios, 1.200.000 ciclos, 0.3 MPa, 2 Hz e 5°C/37°C/55°C, 30 s de imersão), Escovação simulada (ES, Pepsodent, MAVTEC, 73.000 ciclos) e Controle (sem envelhecimento). Leituras finais de rugosidade foram realizadas, e as amostras foram submetidas ao ensaio de resistência à flexão em três pontos (OM100, Odeme Dental Research) e à análise fractográfica por microscopia eletrônica de varredura (EVO-MA10, ZEISS). Os dados foram analisados (ANOVA de dois fatores, (α=.05). Não houve diferença (p>.05) na resistência à flexão entre os protocolos de queima, independente do envelhecimento. ES diminuiu a resistência à flexão das amostras submetidas a multiple firings, diferente do controle (p<.05). Sem envelhecimento (Controle), antes da CTM e após ES, LD apresentou menor rugosidade de superfície quando submetido a multiple firings do que a single firing (p<.05). Os protocolos de queima não afetaram a resistência à flexão nem a rugosidade de superfície da cerâmica vítrea de dissilicato de lítio, mesmo após envelhecimento. No entanto, a escovação afetou negativamente a resistência à flexão e poliu a superfície da cerâmica submetida a multiple firings.

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OBJECTIVE: The effects of brushing on shaping with three different instruments were assessed in oval canals. DESIGN: Mandibular incisors were assigned to 6 groups (n = 12/group) according to the system, each one with or without brushing: Reciproc Blue, VDW.Rotate, and Race EVO. Micro-computed tomography was performed before and after preparation. RESULTS: Brushing strokes caused no increase in canal volume, surface area, and structure model index independently of the system (p > 0.05), except for RaCe EVO in the full canal surface area (p < 0.05). Brushing did not increase the prepared areas (p > 0.05), except for Reciproc in the apical canal (p < 0.05). Reciproc with no brushing exhibited less pericervical dentin than with brushing (p < 0.05), while RaCe EVO with brushing resulted in less remaining dentin (p < 0.05). CONCLUSIONS: The brushing motion had no effects on the overall shaping performance of the 3 instruments tested. An exception was the increase in prepared surface area in the apical canal segment when the Reciproc instrument was used with brushing strokes.

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Introducción: La enfermedad pulmonar obstructiva crónica cursa con un patrón inflamatorio en la vía aérea que incluye neutrófilos, macrófagos, linfocitos, los cuales se pueden obtener mediante un cepillado bronquial citológico. Objetivos: Identificar patrón inflamatorio según células inflamatorias presentes en la vía aérea, mediante el cepillado bronquial citológico e índice tabáquico de paquetes/año en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Se realizó un estudio descriptivo transversal en pacientes con enfermedad pulmonar obstructiva crónica, que concurrieron al Hospital Neumológico Benéfico-Jurídico, en el período comprendido de junio de 2018 a junio de 2019, con indicación para la realización de fibrobroncoscopía con cepillado bronquial. Resultados: El 53,1 por ciento de los pacientes corresponden al sexo masculino. Un 46,1 por ciento presentó un índice tabáquico de paquetes/año entre 21-40. Predominaron las criptas y estrías como hallazgos broncoscópicos con un 51 por ciento y 40,8 por ciento respectivamente en pacientes con índice paquetes/año mayor que 40. De los pacientes con índice paquetes/año mayor de 40 (13 para un 26,5 por ciento) presentaron hiperplasia de células basales. El 46,9 por ciento de los pacientes presentaron un patrón inflamatorio neutrofílica. Conclusiones: Se identificaron a los pacientes con EPOC que presentaron patrón inflamatorio neutrofílica en la vía aérea y elevado índice tabáquico y desde el punto de vista broncoscópico tienen varios hallazgos que sugieren cronicidad(AU)

Introduction: Chronic obstructive pulmonary disease presents with an inflammatory pattern in the airway that includes neutrophils, macrophages, and lymphocytes, which can be obtained by cytological bronchial brushing. Objectives: To identify inflammatory pattern according to inflammatory cells present in the airway, through cytological bronchial brushing and smoking rate of packs/year in patients with chronic obstructive pulmonary disease. Methods: A cross-sectional descriptive study was carried out in patients with chronic obstructive pulmonary disease, who attended Benefico-Jurídico Pneumological Hospital, from June 2018 to June 2019, with an indication for fiberoptic bronchoscopy with bronchial brushing. Results: 53.1percent of the patients correspond to the male sex. 46.1percent ad a smoking rate of packs/year between 21-40. Crypts and striae predominated as bronchoscopic findings with 51percent and 40.8percent respectively in patients with a pack/year index greater than 40. Patients with a pack/year index greater than 40 (13 for 26.5percent) showed basal cell hyperplasia. 46.9percent of the patients had a neutrophilic inflammatory pattern. Conclusions: Patients with COPD who had a neutrophilic inflammatory pattern in the airway and high smoking index were identified, and from the bronchoscopic point of view they have several findings that suggest chronicity(AU)

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OBJECTIVE: This study evaluated the in vitro and in situ effects of phytosphingosine (PHS) associated with tooth brushing on color stability, surface roughness, and microhardness of dental enamel. METHODS: Sixty-four specimens of bovine teeth (6 × 6 × 2 mm) were separated into 8 groups (n = 8): S + TB: PHS (spray) + tooth brushing; TB + S: tooth brushing + PHS (spray); I + TB: PHS (immersion) + tooth brushing; TB + I: tooth brushing + PHS (immersion); TB: tooth brushing; S: PHS spray; I: immersion in PHS solution, and Saliva: immersion in saliva. Tooth brushing simulation (Mavtec, Brazil) was performed (356 rpm on 3.8 cm area by the toothbrush - Soft Tek) for 1, 7, 15, and 30 days. PHS remained in contact with specimens for 15 min. The specimens were evaluated before and after tooth brushing for color alteration (Easy Shade, VITA), and surface roughness (Model SJ-201P Mitutoyo), and Knoop microhardness (HMV-2, Shimadzu Corporation). For the in situ analyses, 8 participants were recruited and received an intraoral device with 6 fragments of bovine enamel (6 × 6 × 2 mm). The properties evaluated were the same as those of the in vitro study. Participants were randomized following best results of in vitro tested protocols, for 15 days: TB, TB + S, I + TB. Data obtained by in vitro (two-way ANOVA, Tukey, p < .05) and in situ (one-way ANOVA, Tukey, p < .05) studies were analyzed. RESULTS: The in vitro study showed that greater color change was found after 30 days. The greatest differences in surface roughness occurred between the initial value and after 1 day. Regarding microhardness, the highest values occurred after 15 and 30 days, which showed similar results. The in situ study showed greater color changes for the TB and I + TB, and greater surface roughness changes for TB as well as a similar increase in microhardness for the PHS protocols, which were higher than TB. CONCLUSIONS: Phytosphingosine leads to an increase in performance regarding color stability, surface roughness, and microhardness when applied. In general, the application of PHS after brushing showed a positive impact on its performance. CLINICAL RELEVANCE: Phytosphingosine proved to be interesting for compound prevention formulations in the dentistry field.

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OBJECTIVES: The aim of this cross-sectional study was to evaluate the effect of brushing discomfort (BD) on peri-implant health in sites exhibiting inadequate keratinized mucosa (KM) width. MATERIAL AND METHODS: Patients presenting with at least one implant exhibiting KM <2 mm and in function for ≥1 year were eligible for inclusion. BD was assessed with the visual analogue scale (VAS), and implants were classified into two groups: Absence (aBD; VAS = 0) or Presence (pBD; VAS > 0) of BD. Bleeding on probing (BoP), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), suppuration (Sup), and marginal bone level (MBL) were recorded. Mann-Whitney, chi-square test, and a multilevel model were used for analysis. RESULTS: Fifty-nine patients with 155 dental implants were analyzed, of which 60 presented no BD, and 95 presented some level of BD. BoP, PD, CAL, and MBL were significantly higher in the pBD than in the aBD group (p < .05). The prevalence of peri-implant diseases at implant level was also higher in the pBD group than in the aBD group. However, after controlling for confounding factors, only mPI showed an effect on BoP. In addition, difficulty to perform oral hygiene was statistically higher in the pBD group. CONCLUSIONS: The findings of the present study suggest that although BD around implants exhibiting KM <2 mm did not influence tissue inflammation, it could represent a symptom of peri-implant diseases. Further clinical trials assessing the long-term effect of BD must be considered to better ascertain its effects on peri-implant health.

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The objective of the study was to evaluate the volumetric wear of four composite materials for CAD/CAM (computer-aided design/computer-aided manufacturing) systems. The materials evaluated were: Cerasmart (CER), Shofu Block HC (SBH), Tetric CAD (TEC) and Brava (BRA). All the samples (n = 40) were subjected to simulated brushing (100,000 cycles). Wear was evaluated by superimposing pre-and post-brushing scans obtained with an intraoral optical scanner (CEREC Primescan; Dentsply Sirona, Germany), which were subsequently imported into the OraCheck software 5.0 (Dentsply Sirona, Germany). The data were analyzed by ANOVA test and Tukey's HSD test was used for multiple comparisons. Cerasmart showed the least wear after brushing. All the tested materials exhibited mass loss.

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Introducción: La salud oral es un problema actual en la sociedad, las medidas preventivas como técnicas de cepillado deben de ser acorde a la destreza motriz. Objetivo: Evaluar la relación entre las condiciones bucales y el desarrollo psicomotor en los niños de 6 y 7 años. Métodos: La muestra estuvo conformada por 30 niños en el rango de edad de 6 y 7 años, que acuden al colegio "Manuel Bonilla" (Lima, Perú). Estuvo dividida por 2 grupos, a los cuales se les enseñó dos técnicas de cepillado: técnica de Bass modificada y técnica de Fones. Se obtuvieron valores de condiciones bucales, según los niveles de índice gingival, índice de higiene y el nivel de severidad. Por otro lado, se adquirieron los niveles de psicomotricidad, evaluados mediante el test de Bruininks-Oseretsky. El análisis de los datos estadísticos se ejecutó con el programa SPSS y R. Resultados: Un grupo de 29 niños se incorporaron en la muestra y fueron analizados un total de 631 dientes. Los resultados demostraron una asociación positiva con un solo rango (índice de sangrado gingival) de condiciones bucales y aspectos psicomotores de niños entre 6 y 7 años. Adicionalmente, se encontró una asociación positiva entre la técnica de cepillado Bass Modifica y condiciones bucales óptimas. Conclusiones: Los resultados actuales sugieren una asociación marginal entre las variables estudiadas, que puede ser potencialmente más significativa con una ampliación sobre el número de muestra. A medida que el ser humano va desarrollando nuevas habilidades motoras, debería de tener un mejor dominio sobre las necesidades básicas de salud como la ponderación de una buena higiene bucal. Por lo tanto, es necesario recomendar técnicas de cepillado de acuerdo al nivel de desarrollo psicomotor del niño(AU)

Introduction: Oral health is a current problem in society; preventive measures such as brushing techniques must be according to motor skills. Objective: Evaluate the relationship between oral conditions and psychomotor development in children aged 6 and 7 years. Methods: The sample consisted of 30 children in the age range of 6 and 7 years, who attend "Manuel Bonilla" school (Lima, Peru). It was divided by 2 groups, which were taught two brushing techniques: Bass-modified technique and Fones technique. There were obtained values of oral conditions, according to the levels of gingival index, hygiene index and the level of severity. On the other hand, the levels of psychomotricity were acquired, evaluated by the Bruininks-Oseretsky test. The analysis of the statistical data was executed with the SPSS and R program. Results: A group of 29 children were incorporated into the sample and a total of 631 teeth were analyzed. The results demonstrated a positive association with a single range (gingival bleeding index) of oral conditions and psychomotor aspects of children between 6 and 7 years. Additionally, a positive association was found between the Bass Modifica brushing technique and optimal oral conditions. Conclusions: The current results suggest a marginal association between the variables studied, which may be potentially more significant with an increase in the sample number. As humans develop new motor skills, they should have a better command of basic health needs such as weighing good oral hygiene. Therefore, it is necessary to recommend brushing techniques according to the level of psychomotor development of the child(AU)

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Objetivo: Realizar uma revisão sistemática para avaliar os principais agentes e métodos de descontaminação das escovas dentais contra vírus, bactérias e fungos encontrados na literatura. Métodos: Foi realizada uma busca nas bases de dados LILACS® (Literatura científica e técnica da América Latina e Caribe/BVS ­ Biblioteca Virtual em Saúde), MEDLINE® (Medical Literature Analysis and Retrieval System Online / PubMed)®, EMBASE® (Elsevier), em agosto de 2020. Como critério de inclusão, foram selecionados artigos publicados entre os anos de 2010 e 2020, nos idiomas português, inglês e espanhol, estudos de ensaios clínicos controlados randomizados, ensaios clínicos não randomizados e estudos in vitro, que avaliaram diferentes agentes e métodos de descontaminação das escovas dentais. Resultados: Foram recuperados um total de 2523 artigos, sendo qualificados para o estudo um total de 6 artigos "in vivo" e 4 "in vitro". O agente de descontaminação mais estudado e eficaz foi a clorexidina 0,12% (em forma de imersão ou spray), seguida pelo hipoclorito de sódio 1% e 2,5% (imersão), vinagre branco 50% (imersão), solução de cloreto de cetilpiridínio (imersão ou spray), micro-ondas e máquina de lavar-louças. Conclusão: Considerando as evidências de qualidade encontradas, a clorexidina 0,12% constitui o agente mais estudado e eficaz, seguido pelo hipoclorito de sódio 1 % e cloreto de cetilpiridínio, utilizados em forma de spray ou imersão, constituem soluções eficazes, de fácil acesso, que podem ser utilizadas pela população para descontaminação das escovas dentais.

Aim: To carry out a systematic review of articles found in the literature in order to evaluate the main agents and methods for decontaminating toothbrushes against viruses, bacteria, and fungi. Methods: A search was performed in LILACS® (Scientific and Technical Literature of Latin America and the Caribbean/VHL ­ Virtual Health Library), MEDLINE® (Medical Literature Analysis and Retrieval System Online /PubMed)®, and EMBASE® databases (Elsevier), in August 2020. As inclusion criteria, articles published between 2010 and 2020, in Portuguese, English, and Spanish, studies of randomized controlled clinical trials, non-randomized clinical trials, and in vitro studies were selected, which evaluated different agents and methods for decontaminating toothbrushes. Results: A total of 2,523 articles were retrieved, with a total of 6 in vivo and 4 in vitro articles deemed to be eligible for the study. The most studied and effective decontamination agent was 0.12% chlorhexidine (in immersion or spray form), followed by 1% and 2.5% sodium hypochlorite (immersion), 50% white vinegar (immersion), solution of cetylpyridinium chloride (dip or spray), microwave, and dishwasher. Conclusion: Considering the quality evidence found, 0.12% chlorhexidine is the most studied and effective agent, followed by 1% sodium hypochlorite and cetylpyridinium chloride, used in spray or immersion form; these are effective, easily accessible solutions that can be used by the population to decontaminate toothbrushes.

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RESUMEN Fundamento: Los pacientes con tratamiento de ortodoncia presentan alteraciones por la acumulación de placa que provoca los aparatos, lo que requiere de mayor control de la higiene bucal. Objetivo: Profundizar en los criterios actuales sobre la higiene bucal en pacientes con tratamiento de ortodoncia para mantener su salud bucal. Desarrollo: Se realizó una búsqueda bibliográfica en las bases de datos biomédicas: PubMed, Cochrane, Scopus, Ebsco, Cumed y Lilacs. De 86 artículos científicos se seleccionaron los 39 de mayor actualización. Se constataron las particularidades de la higiene bucal durante el tratamiento con aparatos fijos de ortodoncia, la existencia del Índice de placa de ortodoncia como índice ajustado para estos pacientes, los procedimientos para el control de la placa bacteriana, la relación entre el uso de aparatos y el pH salival, así como la importancia de la educación para la salud para aumentar la motivación de los pacientes hacia la higiene bucal. Conclusiones: La higiene bucal es el factor más importante en el mantenimiento de la salud periodontal y la prevención de caries dental durante el tratamiento de ortodoncia. Se requiere de la orientación por parte de los profesionales para motivar a los pacientes mediante la promoción y prevención de salud bucal.

ABSTRACT Background: Patients with orthodontic treatment present alterations due to the plaque addition caused by the appliances, which requires greater control of oral hygiene. Objective: To delve into the current criteria on oral hygiene in patients with orthodontic treatment to maintain their oral health. Development: A bibliographic search was conducted in biomedical databases: PubMed, Cochrane, Scopus, Ebsco, Cumed and Lilacs. Out of 86 scientific articles, the 39 most updated were selected. The accuracies of oral hygiene during the treatment with fixed orthodontic appliances, the existence of the Orthodontic Plaque Index as an adjusted index for these patients, the procedures for bacterial plaque control, the relationship between the use of appliances and salivary pH, as well as the importance of health education to increase patients' motivation towards oral hygiene were ascertained. Conclusions: Oral hygiene is the most important factor to preserve periodontal health and prevent dental caries during orthodontic treatment. Guidance by professionals is required to motivate patients through oral health promotion and prevention.

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Background: The implementation of the self-cleaning practice is of fundamental importance for the maintenance of oral health and to remove the human dental biofilm which is considered the main etiological factor for the development of caries and periodontal diseases. Objective: This study aimed to evaluate the use of chewing gum, Rolly Brush® and apples as forms of mechanical control and removal of the dental biofilm in the absence of brushing. Materials and Methods: Eighteen volunteers were submitted to plaque index evaluation after a period of 24 hours of no oral hygiene. Then, they would use one of the methods: chewing gum, Rolly Brush®, apple or tooth brushing, chosen by a draw, for one minute, and then, plaque index was evaluated again. This stage was repeated until all participants were submitted to all selected methods, in periods of 24 hours each. Results: Dental brushing was more effective when compared to each of the other methods applied and there was a statistically significant reduction of dental plaque index after apllying all methods of cleaning in all groups. Conclusion: Chewing gum, Rolly Brush® and apple may be used as auxiliary to dental brushing or when such method is impossible to be performed. Clinicaltrials.gov: number of protocol NCT 03.601.585.

Fundamento: A implementação da prática de autolimpeza é de fundamental importância para a manutenção da saúde bucal e remoção do biofilme dental humano que é considerado o principal fator etiológico para o desenvolvimento de cáries e doenças periodontais. Objetivo: Este estudo teve como objetivo avaliar a utilização de goma de mascar, Rolly Brush® e maçã como formas de controle mecânico e remoção do biofilme dental na ausência de escovação. Materiais e Métodos: Dezoito voluntários foram submetidos à avaliação do índice de placa após um período de 24 horas sem higiene bucal. Em seguida, utilizariam um dos métodos: goma de mascar, Rolly Brush®, ingerir uma maçã e escovar os dentes, escolhida por sorteio, por um minuto, e então, o índice de placa era novamente avaliado. Essa etapa foi repetida até que todos os participantes fossem submetidos a todos os métodos selecionados, em períodos de 24 horas cada. Resultados: A escovação dentária foi mais eficaz quando comparada a cada um dos outros métodos aplicados e houve redução estatisticamente significativa do índice de placa dentária após a aplicação do método de limpeza em todos os grupos. Conclusão: Goma de mascar, Rolly Brush® e maçã podem ser utilizados como auxiliares da escovação dentária ou quando tal método for impossível de ser realizado. Clinicaltrials.gov: Número do protocolo NCT 03.601.585.

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Introducción: Las enfermedades periodontales junto con la caries dental son las patologías más frecuentes que afectan los dientes y tejidos circundantes. El principal agente etiológico es el acúmulo de biopelícula dental bacteriana ya sea en las fosas y fisuras de los dientes como en el surco gingival. Objetivo: La presente revisión narrativa tuvo por objetivo sintetizar los resultados de la terapia mecánica sobre la higiene oral al ser indicadas en pacientes con diagnóstico de periodontitis. Material y Métodos: Se realizó un estudio descriptivo que se basó en una revisión crítica de las publicaciones relacionadas a la terapia periodontal mecánica en las bases de datos: Scopus, SciELO (Scientific Electronic Library Online), MEDLINE (Pubmed), ScienceDirect así como el buscador Google académico. En cada base de datos se realizó una búsqueda libre de la información con un límite de 10 años de antigüedad de las fuentes de información para analizar tanto fuentes antiguas como actuales. Resultados: De una búsqueda inicial de 678 artículos se incluyeron 52 estudios que compararon técnicas de higiene oral, así como revisiones sistemáticas que sintetizaron el efecto de la terapia mecánica periodontal. Conclusiones: El tratamiento periodontal debe ser considerado la terapia inicial para la periodontitis, debe incluir instrucción en técnicas de higiene para el control de la biopelícula dental y el debridamiento mecánico de las zonas afectadas. No se ha demostrado que una técnica de cepillado manual específica sea superior a otras, por tanto, se debería aplicar aquella que mejor pueda manejar el paciente. No se encontró evidencia que demuestre que el uso del hilo dental disminuya eficientemente los índices de biopelícula dental y parámetros gingivales debido a la dificultad por parte del paciente para emplear adecuadamente la técnica(AU)

Introduction: Periodontal diseases together with dental caries are the most frequent pathologies affecting the teeth and surrounding tissues. The main etiological agent is the accumulation of bacterial dental biofilm in the pits and fissures of the teeth and the gingival sulcus. Objective: The present narrative review aimed to synthesize the results of mechanical therapy on oral hygiene when it is indicated in patients with the diagnosis of periodontitis. Material and methods: A descriptive study was conducted. It was based on a critical review of some articles related to mechanical periodontal therapy published in databases such as Scopus, SciELO (Scientific Electronic Library Online), PubMed/ MEDLINE and ScienceDirect. Google search engine was also used. A free search for information was carried out in each database. An age limit of 10 years was established for the analysis of both old and current sources. Results: The initial search included 678 articles. Of these, 52 studies that compared oral hygiene techniques as well as systematic reviews that synthesized the effect of mechanical periodontal therapy were included. Conclusions: Periodontal treatment should be considered as the initial therapy for the treatment of periodontitis. It should include oral hygiene instructions for the control of dental biofilm and mechanical debridement of the affected areas. A specific manual brushing technique has not been proven to bebetter than others; therefore, the one that can best be performed by the patient should be used. There was no proven evidence that effective flossing reduces dental biofilm indexes and gingival parameters due to the patient difficulty to adequately perform the technique(AU)

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Objective: Correlate the number of brushes per day and the decay-missing-filled teeth (DMFT) index in 12-year-old school children from the parish "El Vecino Cuenca - Ecuador 2016". Materials and Methods: The study was communicational, quantitative, descriptive and relational. The population consisted of 279 records from the study of the epidemiological map of schoolchildren in the "El Vecino" parish. The database included the registration number, age, sex, parish and DMFT Index. Results: There was an statistically significant inverse correlation between the number of brushes per day and the DMFT index with a p value = 0.029. Conclusion: The present study shows that there is a correlation between the number of brushes per day and the DMFT index.

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This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

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Introducción: Se ha documentado que, para tener mejores resultados en el control del biofilm oral, es necesario el uso de controles químicos, antes o después del cepillado dental. Entre éstos, encontramos los enjuagues de aceites esenciales. Objetivo: Determinar la actividad del enjuague con aceites esenciales antes o después del cepillado, en el control del biofilm dental. Material y métodos: El estudio se realizó con 27 voluntarios. Los participantes fueron seleccionados y agrupados. El grupo 1 fue el control, que empleó su técnica de cepillado habitual y dos grupos experimentales que, además del cepillado con dentífrico, usaron un enjuague de aceites esenciales durante ocho días, ya sea antes (grupo 2) o después del cepillado dental (grupo 3). La cuantificación del número de superficies teñidas en los tres grupos, tanto el estado inicial como posterior al uso de los enjuagues, se hizo con el índice de O'Leary y un revelador de placa tritonal, el cual permitió la observación del biofilm de forma clínica, así como su grado de patogenicidad. Resultados y conclusión: El análisis estadístico estableció que no existe diferencia significativa entre no usar y usar el enjuague con aceites esenciales antes o después del cepillado (AU)

Introduction: It has been documented that, to have better results in the control of oral biofilm, it is necessary to use chemical control, before or after tooth brushing. Among these, we find the essential oil rinses. Objective: To determine the activity of the rinse with essential oils before or after brushing, in the control of the dental biofilm. Material and methods: The study was conducted with 27 volunteers. The participants were selected and grouped. Group 1 was the control, which used its usual brushing technique and two experimental groups that, in addition to brushing with toothpaste, used a mouthwash of essential oils, for eight days, either before (group 2) or after tooth brushing (group number 3). For the quantification of the number of stained surfaces in the three groups, to record both the initial and subsequent state of the use of the rinses, it was done with the O'Leary index and a tritonal developer, which allowed the observation of the biofilm of clinical form, as well as its degree of pathogenicity. Results and conclusion: The statistical analysis established that there is no significant difference between not using and using the rinse with essential oils before or after brushing (AU)

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We report a patient with reflex tooth-brushing-triggered epilepsy, associated with a post-central lesion within the right somatosensory face area. Contralateral facial sensory and motor phenomena, associated with contralateral upper limb extension, were present at seizure onset after gingival stimulation, but seizures could also be induced by contact with solid food or liquids. Spontaneous seizures also were recorded. Secondary generalization was infrequent. Stereoelectroencephalography implantation was performed, with seizure recording and cortical/subcortical stimulation for mapping, to identify the precise extent of surgical resection. Complete postoperative control of epilepsy was achieved, accompanied by a mild and transient neurological deficit. [Published with video sequence].

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OBJECTIVE: Whether the understanding of dental caries influences how future dentists manage the disease themselves has not been previously studied. Thus, this study evaluated whether the conceptualization (understanding) of dental caries by dental students is related to their own preventive oral care routine. METHODS: Dental students at a U.S. dental school (n = 517) were invited to voluntarily respond to an anonymous electronic survey in spring 2018. Demographic characteristics, caries conceptualization (CC), dental care habits, and self-caries risk determination were asked. Discursive responses to CC were analyzed by content analysis technique, and categories [c] were created. Chi-square and Fisher's exact tests were used for analysis. RESULTS: Overall response rate was 54.5% (n = 282, 48.2% female). Three researchers independently analyzed discursive answers and classified them into 1 of 6 caries concept categories [c]: [c1] only signs of the disease (10.3%), [c2] bacterial disease-not specifying bacterial metabolism (38.3%), [c3] bacterial byproducts-not specifying substrate (13.8%), [c4] biological or multifactorial concept (24.8%), [c5] comprehensive multifactorial disease (8.2%), or [c6] other (4.6%). Only 33% completely defined dental caries according to the modern understanding of the disease (c4-c5). Statistical differences were found between: CC and diet modification, CC and rinsing after brushing, year of school (YS) and self-determined caries-risk, YS and brushing at school, and YS and rinsing after brushing (P < 0.05). CONCLUSION: Our data suggest that the students' understanding of the disease can influence how they will manage the disease in terms of diet modification and behavior after brushing. Moreover, self-caries risk determination influenced students' brushing behavior.

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Resumen En odontología pediátrica un procedimiento sencillo y que es eficaz para introducir al niño al ambiente del consultorio dental es la profilaxis dental, y a la vez es indispensable para la remoción del biofilme dental a escala profesional. Se analizaron tres de los aditamentos más utilizados, la copa de hule, el cepillo para profilaxis convencional y el microcepillo ICB, este último para reforzar superficies oclusales con el objetivo de conocer cuál presenta una mayor efectividad en la remoción, se utilizó el cepillo dental convencional como control. Como resultado se observó que el cepillo para profilaxis es el aditamento de mayor eficacia en la remoción del biofilm dental en todas las superficies, con un porcentaje de remoción total de 70,57% con diferencia estadísticamente significativa respecto a los demás aditamentos.

Abstract In pediatric dentistry, a simple procedure that is effective to introduce the child to the environment of the dental office is dental prophylaxis, at the same time it is indispensable for the removal of the dental biofilm at a professional level. Three of the most frequently used additives, the rubber cup, the conventional prophylaxis brush and the ICB microbrush were analyzed, the latter to reinforce occlusal surfaces in order to know which one has a greater effectiveness in the removal, the conventional toothbrush as control. As a result, the prophylaxis brush is the most effective additive in the removal of dental biofilm on all surfaces, with a total removal percentage of 70.57%, with a statistically significant difference with respect to the other accessories.

Resumo Em odontologia pediátrica é um procedimento simples que é eficaz para introduzir a criança para o ambiente de escritório dental é profilaxia dentária, embora seja essencial para a remoção do biofilme dental profissionalmente. Três dos adjuvantes mais vulgarmente utilizados foram analisados, a taça de borracha, o convencional profilaxia e ICB microbrush última escova de reforçar superfícies de oclusão, a fim de saber qual tem uma remoção mais eficaz, a escova de dentes convencional é utilizada como controlo. A profilaxia escova resultante é a remoção mais eficaz de biofilme em todas as superfícies, com uma percentagem de remoção total de 70,57%, com diferen estatisticamente significativa relativamente aos outros adjuntos.

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ABSTRACT BACKGROUND: Cervical cancer screening in Brazil is done using Pap smears. Women who are most likely to have a preinvasive lesion or cervical cancer are immediately referred for colposcopy. OBJECTIVE: The aim of this study was to evaluate the diagnostic performance of endocervical cytological tests in diagnosing preinvasive cervical lesions in women with initial high-grade squamous intraepithelial lesions (HSIL), or atypical squamous cells in which high-grade lesions could not be ruled out (ASC-H), or atypical glandular cells (AGC), and whose colposcopy did not show any abnormalities, with no fully visible transformation zone (types 2 and 3). DESIGN AND SETTING: Retrospective observational study conducted in Rio de Janeiro, Brazil. METHODS: Data from women who came to the cervical pathology outpatient clinic between January 2012 and April 2017 were analyzed. The results from endocervical cytological tests were compared with the final diagnosis, which was obtained through examination of a surgical specimen or, among women who did not undergo an excisional procedure, after cytological and colposcopic follow-up for two years. RESULTS: We included 78 women. The sensitivity of endocervical cytological tests was 72.7%; specificity 98.5%; positive and negative predictive values 88.9% and 95.6%, respectively; and positive and negative likelihood ratios 48.7 and 0.28. CONCLUSION: Endocervical cytological tests are simple, inexpensive and noninvasive, and form a reliable method for determining management among patients with HSIL, ASC-H and AGC cytological findings and negative colposcopic findings without visualization of the squamocolumnar junction.

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OBJECTIVE: To evaluate the efficacy of electric and conventional toothbrushes for a group of elderly individuals. BACKGROUND: Although the electric toothbrush has been recommended for elderly individuals, there had previously never been a study regarding its efficacy. MATERIAL AND METHODS: Sixty independent elders of both genders with different oral conditions from the Center Adult Day Vitória, Espírito Santo, Brazil, were randomly divided into two groups of 30 individuals. One group received the Oral B CrossAction Power electric toothbrush, whereas the other received a conventional Bitufo Class 32 soft toothbrush to perform oral hygiene. The bacterial plaque index (O'Leary Plaque Index) and DMFT index were assessed as a measure of oral hygiene and oral health. The data were analysed using the Shapiro-Wilk, Mann-Whitney and Wilcoxon tests. RESULTS: The results of the efficacy of the Oral B Cross Action Power electric toothbrush demonstrated that on the 7th and 15th days, the bacterial plaque indexes were 24.91 ± 12.81 and 22.11 ± 14.46, respectively, which corresponds to a 50.24% removal of bacterial plaque on the 7th and 55.83% on the 15th days. Although the electric toothbrush removed more bacterial plaque than the conventional toothbrush, the difference was not statistically significant. CONCLUSION: Both the conventional and the electric toothbrushes were effective in removing bacterial plaque within the elderly group. More studies are necessary to test the efficacy of electric toothbrushes in relation to conventional toothbrushes for elderly patients.

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