ABSTRACT Objective: To evaluate and compare antibiotic prescriptions for endodontic infections of last-year undergraduate Dentistry students and dental surgeons from Brazil. Material and Methods: A questionnaire comprised of 15 questions was applied, including a series of hypothetical clinical cases through multiple choice questions. The survey respondents had the option to respond in favor or against the prescription of antimicrobials in each case. Afterwards, the commented answer keys of all topics contained in the survey form were released for educational purpose. Results: A total of 42 undergraduates and 115 dental surgeons answered the survey. Regarding the questions about antimicrobial prescriptions, 91.3% of the professional dentists and 69.8% of the dentistry students indicated that they prescribe antibiotics for a limited number of patients. However, when they responded about drug recommendations, most professionals (76.5%) and students (76.7%) chose to recommend antimicrobials without any clinical recommendation. Conclusion: In the groups herein evaluated, many antibiotic prescriptions could have been avoided. The rational use of these drugs is still a conduct that needs further disclosure and commitment among prescribers.

O objetivo deste estudo in vitro foi mensurar a concentração de ions hidroxila (pH) de pastas de hidróxido de cálcio manipuladas com diversos veículos em 7 intervalos de tempo. As pastas foram manipuladas com os seguintes veículos: (i) água destilada estéril; (ii) idodofórmio + água destilada estéril; (iii) anestésico local (Lidocaína a 2% com 1:100.000 epinefrina); (iv) polietilenoglicol (Calen); (v) glicerina; (vi) clorexidina gel 2%; (vii) paramonoclorofenol canforado (PMCC); (viii) PMCC + glicerina; e (ix) PMCC + polietilenoglicol (Calen PMCC). As pastas foram manipuladas em consistência de pasta de dente e os pH mensurados 5 min; 1, 24, 48 h; 7, 14 e 28 dias após manipulação. Os resultados foram analisados estatisticamente através do teste Kruskal-Wallis (p<0,05). Aos 5 min, 1 e 2 h após manipulação o pH de todas as pastas ficou entre 13.05 e 11.16. Aos 48 h e 7 dias após a manipulação, o pH de todas as pastas testadas variou de 11.66 a 8.92. Aos 14 e 28 dias, quase todas as pastas mostraram pH menor que 10. Concluiu-se que o pH de todas as pastas hidróxido de cálcio decresceram de acordo com o tempo. Pastas feitas com veículos aquosos (especialmente com água destilada), seguida de veículos oleosos (especialmente com CMCP + glicerina) mantiveram as maiores médias de pH durante os períodos testados.

The purpose of this in vitro study was to measure the concentration of hydrogen ions (pH) of calcium hydroxide [(Ca(OH)2] pastes combined with different vehicles over 7 periods of time. The Ca(OH)2 was manipulated with the following vehicles: i: sterile water; ii: iodoform plus sterile water; iii: local anesthetics (Lydocaine 2% with 1: 100,000 epinephrine); iv: polyethyleneglycol; v: glycerin; vi: 2.0% chlorhexidine gel; vii: camphorated paramonochlorophenol (CMCP); viii: (CMCP) + glycerin; and ix: polyethyleneglycol plus CMCP. The pastes were made on a glass plate to toothpaste consistency and the pH was measured at the following times: 5 min, 1, 24, 48 h; 7, 14 and 28 days. The data were statistically analyzed (Kruskal-Wallis at p<0.05). At 5 min, 1 and 24 h, the pH of all tested pastes ranged from 13.05 to 11.16. At 48 h and 7 days the pH of all tested pastes ranged from 11.66 to 8.92. At 14 and 28 days almost all pastes had pH means lower than 10. In conclusion, the mean pH of all tested calcium hydroxide pastes decreased with the time. Pastes made with aqueous vehicles (especially with sterile water), followed by oily vehicles (especially with CMCP + glycerin), held the highest pH means over the periods of time tested.

O objetivo do estudo foi avaliar, in vitro, a efetividade antimicrobiana da clorexidina gel 2% (CHX) e hidróxido de cálcio, isoladamente e associados com iodofórmio e pó de óxido de zinco como medicamentos intracanais frente a microrganismos e medidos pHs das diferentes medicações. A atividade antimicrobiana foi determinada pelo método de difusão em ágar. As áreas de inibição de crescimento foram medidas e os resultados estatisticamente analisados utilizando-se o teste de Kruskal-Wallis (p<0,05). O pH das pastas foi mensurado após a manipulação, após 24 h e após uma semana. Os resultados mostraram que a maior zona de inibição foi da CHX gel 2%, seguida pelo Ca(OH)2 + 2% CHX gel, Ca(OH)2 + 2% CHX gel + iodofórmio, Ca(OH)2 + 2% CHX gel +óxido de zinco, Ca(OH)2 + água. A média de pH de todos os medicamentos intracanais foi de 12 durante todo o experimento, exceto com CHX gel 2% (pH=7,0). Estes resultados permitiram concluir que todos os medicamentos tiveram atividade antimicrobiana, no entanto, a maior foi da CHX gel 2%, seguido da associação com o Ca(OH)2. e iodofórmio.

The purposes of this study were to evaluate the effectiveness of 2% chlorhexidine (CHX) gluconate gel, calcium hydroxide [Ca(OH)2] and their combination with iodoform and zinc oxide powder as intracanal medications against select microorganisms, and to measure the pH changes caused by these medications. Antimicrobial activity was determined by the agar diffusion method. The zones of growth inhibition were measured and the results were analyzed statistically by Kruskal-Wallis test (p<0.05). The pH of the pastes was measured right after preparation, after 24 h and 1 week later. The largest mean zones of microbial inhibition were produced by 2% CHX gel, followed by Ca(OH)2 + 2% CHX gel + iodoform, Ca(OH)2 + 2% CHX gel, Ca(OH)2 + 2% CHX gel + zinc oxide, and Ca(OH)2 + water. The mean pH of all medications stayed above 12.0 during the whole experiment, except for CHX gel (pH=7.0). The results of this study showed that all medications had antimicrobial activity, but the most effective against the tested microorganisms were 2% CHX gel, followed by its combination with Ca(OH)2 and iodoform.

O objetivo deste estudo foi avaliar in vitro a atividade antimicrobiana do hidróxido de cálcio [Ca(OH)2] em associação com diferentes veículos frente a patógenos endodônticos. O teste de difusão em caldo foi utilizado. Foram preparadas pastas com pó de Ca(OH)2 e os seguintes veículos: água destilada, glicerina, PMCC (paramonoclorofenol canforado), PMCC + glicerina, e PMCC + polietilenoglicol. O tempo necessário para as pastas produzirem culturas negativas frente aos microorganismos testados foi registrado e analisado estatisticamente por meio do teste de Kruskal Wallis com nível de significância de 5%. Foram necessárias de 6 a 24 h para eliminar os microrganismos aeróbios e facultativos e de 30 s a 5 min para os anaeróbios estritos. A suscetibilidade microbiana em ordem crescente foi: Enterococcus faecalis (patógeno mais resistente), Candida albicans, Staphylococcus aureus, Porphyromonas gingivalis, Porphyromonas endodontalis e Prevotella intermedia (os últimos dois microrganismos necessitaram do mesmo tempo para serem eliminados). Concluiu-se que as pastas de hidróxido de cálcio necessitaram de maior tempo para eliminar os microrganismos facultativos do que os anaeróbios. Esses achados sugerem que a propriedade antimicrobiana está relacionada tanto à formulação da pasta quanto à suscetibilidade microbiana.

The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide [Ca(OH)2] in combination with different vehicles against endodontic pathogens. For such purpose, a broth dilution test was performed. Pastes were prepared with Ca(OH)2 powder and the following vehicles: sterile water, glycerin, camphorated monochlorophenol (CMCP), CMCP + glycerin, polyethyleneglycol and CMCP + polyethyleneglycol. The time required for the pastes to produce negative cultures against the tested microorganisms was recorded and analyzed statistically using the Kruskal Wallis test at 5% significance level. Timing for pastes to eliminate the aerobic and facultative anaerobic microorganisms ranged from 6 to 24 h, while strict anaerobic microorganisms were inhibited within 30 s to 5 min. Microbial susceptibility, ranked from weakest to strongest, can be presented as follows: Enterococcus faecalis (the most resistant microorganism), Candida albicans, Staphylococcus aureus, Porphyromonas gingivalis, Porphyromonas endodontalis and Prevotella intermedia (the last two microorganisms required the same time to be eliminated). In conclusion, calcium hydroxide pastes needed more time to eliminate facultative than anaereobic microorganisms. These findings suggest that the antimicrobial property is related both to paste formulation and to microbial susceptibility.

O objetivo do presente estudo foi analisar as propriedades antimicrobianas de cinco cimentos endodônticos: Endo Fill, Endomethasone, Endomethasone N, Sealer 26 e AH-Plus, em diferentes períodos pós-manipulação, i.e., imediatamente e após 24 horas, 48 horas e 7 dias, contra os seguintes microrganismos: Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus sanguis e Actinomyces naeslundii. Os métodos usados foram o contato direto através da observação do crescimento microbiano em meio líquido e o teste de difusão em agar. Os resultados, nas duas metodologias usadas, mostraram que: 1) imediatamente após a manipulação, Endo-Fill e Endomethasone apresentaram a maior atividade antimicrobiana, sem diferenças estatisticamente significantes entre eles. Sealer 26 teve a menor atividade antimicrobiana; 2) nos outros tempos pós-manipulação, não houveram diferenças estatisticamente significantes entre os cimentos testados. Foi concluído que nenhum dos cimentos inibiu completamente o crescimento dos microrganismos testados. A atividade antimicrobiana de cada cimento diminuiu com o tempo e dependeu da suscetibilidade microbiana a eles.

The aim of the present study was to analyze the antimicrobial properties of five endodontic sealers: Endo Fill, Endomethasone, Endomethasone N, Sealer 26 and AH-Plus, against the following microorganisms: Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus sanguis and Actinomyces naeslundii. The sealers were tested immediately, 24 h, 48 h and 7 days after manipulation.The direct contact method through the observation of the microbial growth in liquid medium and the agar diffusion test were used to evaluate the antimicrobial properties of the sealers. The results, in both methodologies used, showed that immediately after manipulation, Endo-Fill and Endomethasone demonstrated the highest antimicrobial activity, with no statistically significant difference between them. Sealer 26 demonstrated the lowest antimicrobial activity. At all other times after manipulation, there were no statistically significant differences among all the sealers tested. In conclusion, none of the sealers totally inhibited the growth of the microorganisms. Furthermore, the antimicrobial activity of each sealer decreased with time and was dependent upon the microbial susceptibility to them.

O objetivo deste trabalho foi investigar in vitro a atividade antimicrobiana do hidróxido de cálcio em combinação com vários veículos contra alguns microrganismos mais frequentemente isolados dos canais radiculares. A atividade antimicrobiana foi determinada pelo método de difusão no ágar. Cilindros de aço inoxidável foram colocados sobre as placas de agar já inoculadas, dentro dos quais os medicamentos testados e seus controles foram introduzidos. As zonas de inibição do crescimento microbiano foram medidas e anotadas após o período de incubação de cada placa e os resultados foram analisados estatisticamente. A atividade antimicrobiana in vitro dos medicamentos testados, em ordem decrescente, foi: Ca(OH)2 + PMCF + glicerina, Ca(OH)2 + PMCF, Ca(OH)2 + glicerina, Ca(OH)2 + anestésico, Ca(OH)2 + salina, Ca(OH)2 + H2O, Ca(OH)2 + polietilenoglicol. Pastas com veículos oleosos produziram as maiores zonas de inibição, quando comparadas com as com veículos aquosos ou oleosos. Concluimos que a habilidade de difusão e a atividade antimicrobiana do hidróxido de cálcio estão relacionadas com os tipos de veículos utilizados.

The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide in combination with several vehicles against some microorganisms commonly isolated from root canals. Antimicrobial activity was determined by the agar diffusion method. Stainless-steel cylinders were placed on each inoculated agar medium. The test medicaments and their controls were placed inside the cylinders. The zones of growth inhibition were measured and recorded after incubation for each plate and the results were analyzed statistically (ANOVA). The in vitro antimicrobial effects of the medications were ranked from strongest to weakest as follows: Ca(OH)2 + CMCP + glycerine, Ca(OH)2 + CMCP, Ca(OH)2 + glycerine, Ca(OH)2 + anesthetic, Ca(OH)2 + saline, Ca(OH)2 + H2O, Ca(OH)2 + polyethyleneglycol. The pastes with oily vehicles showed significantly larger mean zones of inhibition compared to those with aqueous or viscous vehicles. It was concluded that diffusion and antimicrobial activity of calcium hydroxide were affected by the type of vehicle used.