Given the importance of bacteria in the development of periradicular lesions, the eradication of the root canal infection is paramount in endodontic treatment. This study evaluated the in vitro intracanal bacterial reduction produced by instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite (NaOCl) or saline solution. Root canals inoculated with Enterococcus faecalis were instrumented and irrigated with the solutions tested. Canals were sampled before and after preparation. After serial dilution, samples were plated onto Mitis salivarius agar, and the colony-forming units grown were counted. Inhibitory effects of the three NaOCl solutions on E. faecalis were also evaluated by means of the agar diffusion test. All test solutions significantly reduced the number of bacterial cells in the root canal (p < 0.05). There was no significant difference between the three NaOCl solutions tested (p > 0.05). Nonetheless, all NaOCl solutions were significantly more effective than saline solution in reducing the number of bacterial cells within the root canal (p < 0.05). The three NaOCl concentrations showed large zones of inhibition against E. faecalis. The results of this study suggest that regular exchange and the use of large amounts of irrigant should maintain the antibacterial effectiveness of the NaOCl solution, compensating for the effects of concentration.

Endodontic sealers that possess both optimum flow ability and antimicrobial properties may theoretically assist in the elimination of microorganisms located in confined areas of the root canal system. The antimicrobial effects and the flow rate of the following sealers were investigated and compared: Kerr Pulp Canal Sealer EWT, Grossman's Sealer, ThermaSeal, Sealer 26, AH Plus, and Sealer Plus. The agar diffusion test was used to assess the antimicrobial activity of the sealers. In the flow assay, the sealers were placed between two glass slabs and a weight of 500 g was placed on the top of the glass. The diameters of the formed discs were recorded. All root canal sealers tested showed some antimicrobial activity against most of the microorganisms. There were no significant differences between the materials tested (p > 0.05). All root canal sealers also flowed under the conditions of this study. Statistical analysis of the results revealed that AH Plus and Kerr Pulp Canal Sealer EWT had flow values significantly superior to the other sealers tested (p > 0.05). Taken together, these findings suggest that these sealers have the potential to help in the microbial control in the root canal system.Endodontics is essentially a clinical discipline concerned with the prevention and control of the root canal infection. Cleaned and shaped root canals must be three-dimensionally filled, eliminating the empty space, which has the potential to be infected or reinfected. In addition, by creating a fluid-tight apical, lateral, and coronal seal, root canal fillings may confine residual initants within the root canal system, impeding their egress to the periradicular tissues. A fluid-tight seal of the root canal system also prevents both coronal recontamination by saliva and seeping of periradicular tissue fluids into the root canal, denying a nutrient supply to the remaining microorganisms. Therefore, root canal obturation plays an important role in both the prevention and control of endodontic infections (1).Most root canal filling techniques use core materials associated with endodontic sealers. Core obturating materials, such as guttapercha, usually occupy space, whereas the endodontic sealers enhance the possible attainment of an impervious seal by serving as a filler for canal irregularities and minor discrepancies between the root canal wall and the core material. Several properties are required to an ideal endodontic sealer (2). Among them sealing ability, biocompatibility, and antimicrobial activity probably influence the success of the root canal treatment (1).To create and maintain a three-dimensional seal of the entire root canal system, sealers should have adhesiveness, be dimensionally stable, be insoluble to oral and tissue fluids, and have an adequate flow rate. This latter property allows the material to penetrate into irregularities, isthmi fins and ramifications, which increases the likelihood of obtaining an adequate seal of the root canal system. Moreover, sealers that possess both optimum flow ability and a...

O objetivo deste estudo dentro dos Estudos de Linha de Base do Proesf foi avaliar o impacto do Programa Saúde da Família sobre indicadores relacionados à saúde da criança em municípios com mais de 100 mil habitantes. Foram pesquisados quatro municípios na região Nordeste, e em cada um deles foram sorteados 20 setores censitários em áreas cobertas pelo PSF e emparelhados a outros 20 setores em áreas não cobertas pelo PSF, a partir de critérios socioeconômicos. Os resultados mostraram que, na maior parte dos indicadores, não se observam diferenças significativas entre os resultados de áreas cobertas e não cobertas pelo PSF, destacando-se apenas a redução na taxa de internação por diarréia. Em relação a esta, a redução significativa se deu às expensas do Programa de Agentes Comunitários de Saúde, não trazendo o PSF efeito adicional sobre a redução do indicador. Pôde-se observar, também, que o modo como o programa é implementado em cada município influencia diretamente nos resultados, de modo que não há subsídios claros para decretar o PSF "per si" pouco resolutivo e sem diferencial em seus padrões de assistência à saúde. Torna-se, portanto, necessário levar em conta a análise do contexto da implantação e condução do PSF, além de suas características mais gerais relativas ao campo socioeconômico e de políticas públicas.

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Este estudo objetivou verificar se a incorporação da equipe de saúde bucal no Programa Saúde da Família (PSF) gerou uma maior utilização dos serviços odontológicos no Município de Natal, Rio Grande do Norte, Brasil. Tomou-se como referência 22 setores censitários, 11 inseridos em áreas cobertas pela saúde bucal no PSF há pelo menos um ano, emparelhados com base em critérios sócio-econômicos, com 11 setores de áreas não-cobertas. A amostra final constou de 4.604 indivíduos. Foram comparadas áreas cobertas pela saúde bucal no PSF (modelo 1) com áreas cobertas por unidades de PSF porém sem saúde bucal (modelo 2) e com áreas cobertas por unidades básicas de saúde tradicionais ou sem nenhuma cobertura (modelo 3). Os resultados mostraram que, nas áreas cobertas pelo modelo 1, 32% referiram assistência odontológica, sendo este resultado igual a 45,4% para o modelo 2 e 17,5% para o modelo 3 (p < 0,001). Analisando-se as faixas etárias, o modelo 1 supera o modelo 2 apenas na faixa de até 12 anos. Conclui-se, portanto, que a saúde bucal no PSF apresenta impacto positivo sobre o indicador avaliado somente quando comparada com áreas sem cobertura (modelo 3).