RCAAP Repository

The present study evaluate the bone mechanical properties and structural characteristics in femur of diabetic rats submitted to hyperbaric oxygen therapy (HBO). Twenty-four rats were divided into groups, as follows: Control (CG); Control + HBO (CH); Diabetes (DG) and Diabetes + HBO (DH). The HBO was performed each 48h and started 30 days after streptozotocin diabetic induction. All animals were euthanized 60 days after diabetic induction. The mechanical properties, crosslink ratio (AI), crystallinity index (CI) and two mineral:matrix ratio (M:MI and M:MIII) were quantified in the femurs. ANOVA TWO-WAY and Tukey test were applied, statistical differences were considered when α < 0,05. In mechanical analysis, DG and DH showed lower values of strength, stiffness and energy than healthy animals CG and CH (P<0.007). However, there were increase strength and stiffness in HBO groups (CH and DH) compared with CG and DG (P<0.042). Fourier Transform Infrared Spectroscopy analyses showed that in DG there was decrease of mature crosslinks compared another groups (CG, CH and DH) (P=0.003). The CI values was reduced in DG and DH, compared with CG and CH (P=0.034). Mineral:matrix ratio the M:MI showed no statistical difference between CG, CH, DG and DH (P>0.278). In M:MIII there was increase of matrix mineral ratio in DH compared to CG and DG (P=0.035). The results suggest that the diabetic change the architecture of hydroxyapatite and collagen, characterized by reduction in the capacity to absorb energy, strength, stiffness and increase risk of fracture. However, HBO showed that important treatment to improved bone properties in diabetic rats.

In the periodontal disease, to eliminate pathological conditions and search the permanence of the dental element in the oral cavity in healthful conditions are some of the joined challenges currently. The present work clinically evaluated the behavior of periodontal tissues in 06 patients with chronic and advanced periodontal disease after nonsurgical periodontal therapy associated with collagen-based device impregnated with tetracycline. After the measure of the Plaque Index (PI), Gingival Index (GI), Margin Gingival (MG) and Probing Depth (PD), the patients were submited to scaling (S) and root planing (RP) procedures. From there, they are separated in control and experimental groups. The teeth of control group were submitted only S and RP and the experimental group received small cuts of membrane inside deep periodontal pockets, around of the tooth. This phase was repeated in 7º, 14º and 21º days. In 28º day, a new similar clinical examination to the first one was done. Wilcoxon test were used for GI and PI and Student test for MG and PD. The results indicated that values statistically significant had been found for the GI (p=0,027), MG for control (CG) (p=0,005; 0,003; 0,025) and experimental groups (EG) (p=0,000; 0,0,006; 0,039). Such result were also observed for the PD on the values of the initial and final phase for CG (p=0,038; 0,000; 0,000) and EG (p=0,000) and also between both groups, only for palatine face (p=0,016). In the same way, the use of tetracycline membrane revealed important in reduction gingival bleeding when it is associated with S and RP. Even so the good results showed by literature in mechanical therapy associated with plaque control, new studies show more favorable results when this therapy is associate with medicines release devise.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

The destruction of internal regions of the root are suitable weakness dental structure remaining release more susceptible to fracture. Therefore, the preservation and restoration of severely weakened remaning radicular engaged launch a challenge for dentists. Thus, in order to avoid the extration of weakened roots is suggsted the use of restorative materials to fill defects and intraradicular reinforcement. The purpose of this study was to evalute the resistance to fracture of internally weakened bovine roots and reconstructed with three differents materials comparative the control roots, restored with cast post-core and full crown, after mechanical load cycling. Forty bovine incisors had been selected and the roots sectioned with 15 mm of length, endodontically treated, immediate removal the obturador material and distribuiton in four experimental groups (n=10). Group C (control), roots prepared with 2 mm thickness of dentine in the cervical wall and groups R (composite resin), I (glass ionomer) and Z (zinc-phosphate), whose roots were submit to wear for simulation weakned roots, so that remaining dentine in the cervical wall was of 0,5 mm and were reconstructive with the respective materials. All roots restored with cast post-core and metallic full crown, were cast in copper-aluminum league and cemented with cement zinc-phosphate. The specimens had been inclusion in block of polystyrene resin and simulated the periodontal ligament with polyether impression material. Were submit to the fatigue test, in machine of simulation of mechanical cycles, with 50 N, 2 Hz and temperature 37°C ± 1°C, until 250.000 cycles. After that, submitted to assay of loading for tangential compression, with a conpressive load, in lingual face, at an angle of 135° in relation to the long axis of the root, in universal testing machine, at a speed of 0,5 mm/min, until to fracture. The data had been analyzed by the statistical test of analysis of variance in only factor (p<.05). The fractures had been examined in stereomicroscope (magnification 10 and 40x) and classified in agreement with affected region radicular. The means (N) and standard-deviation for groups were: C) 470,7±190,5; R) 375,2±122,2; I) 381,0±152,8; Z) 364,1±97,6. There were not significant difference among experimental groups. In analysis of mode the fracture, in groups C and R the fractures were, mainly, in cervical radicular region (8), in I had extended the apical radicular region (2) and Z had concentrated in medium radicular region (7). Within the limitations imposed for the methodology applied, concluded that the weakened roots reconstructed with the tested materials offer similar resistance to fracture than control roots. Into to materials tested, de glass ionomer had presented better numerical mean of fracture resistance. However, the fractures of group I were more severity than other groups. It seems convenient if to base on the possibilities of success of the restorative treatment throught of reconstruction radicular, in order to keep the tooth in function, before condemning it due to loss of structure radicular.

The aim of this study was access the rate of acceptance, anxiety and variation of heart rate (HR), oxygen saturation (SpO2) and both diastolic (DBP) and systolic (ABP) blood pressure with the inhalation sedation using nitrous oxide and oxygen (N2O/O2). Twenty healthful volunteers with average age of 20.55 years old (±2,93 years) undergoing removal of third molars had participated of this study, carried through in 3 phases: A stage sedation with N2O/O2 without surgery; B and C stages - extraction of one of the sides, of random form, with (C-N2O) or without (S-N2O) sedation techinque. The anxiety degree was evaluated by Corah s Dental Anxiety Scale (EADC); the painful sensation during and after the surgery was evaluated by Eleven points in box Scale (EC); e analysis of the degree of acceptance of the volunteer through the subject questionnaire (QS). It was used the test of Wilcoxon and Friedman (α= 0,05) and the answers of QS by explorative analysis. The QS showed that 60% of the volunteers had given maximum note for C-N2O, being 8.75(±1.71) the average. All the volunteers had affirmed that C-N2O was more pleasant. However, 20% of the volunteers had told some adverse symptom in the C-N2O. In relation to the time of the surgery, 15% of the volunteers had considered that the C-N2O was slower, equal 30% and faster 55%, with significant differences between the stages of surgery (p=0.020). The pain story after the C-N2O was lesser or equal for 85% and greater for 15% of the volunteers. The volunteers had moderately revealed anxious in all the phases, without significant difference between them (p=0.229). It did not have difference for pain during surgery (p=0,864) and pain after surgery (p=0.816). The HR presented significant difference enters the stages of surgery (p=0.020) and between phases C-N2O and S-N2O (p=0,000), differently of the SpO2 between phases (p= 0.153), DBP C-N2O and S-N2O before(p=1.000) and after(p=0.730) and of ABP C-N2O and S-N2O before(p=0.350) and after(p=0.975). These results suggest that the volunteers moderately revealed anxious in all the phases, and the C-N2O being most pleasant. The C-N2O reduced the HR significantly, but it did not influence in the ABP, DBP and SpO2. The C-N2O did not modify the pain during and after surgery.

The process of bone reabsorption in the crest edge, around of the implants, it is a clinical occurrence accepts for the scientific community, however, the causal factor is not still totally elucidated. Among the processes more accepted is the induction for bacteria and the occlusal overload. The objective of this work is to evaluate the stress gradient comparatively dissipated in the bone, in the proximities of two implants interlinked for a bar type Dolder, in a system of overdentures mandibular keep for clip. The intention is to know which disposition of clips of 7 mm (Connection Systems of Prosthesis, SP, Brazil) and 5 mm (Lifecore Biomedical Chaska, MN, USA) of lengths, among five analyzed, it provides the smallest stress levels in the surface peri-implant. Five models 3D were developed in finite elements, simulating different dispositions of the clips along the bar. The applied force was of 100N, in the axial direction of the implants. For the qualitative analysis all of the studied situations presented similar pattern in the distribution stress, with larger incidence of stress compressive in the faces distains to the implants. Evaluating Von Mises stress quantitatively in the different configurations, it can be verified that two clips more near of the implants produced better results, and the two clips of 5 mm, the ones that showed better performance.

Dentistry in our days has been working in an incessant manner so that its results be well-known. New techniques, new materials, ultimately, even if the indexes of dental decay still reach a number that characterize risk. Not only the evolution of the disease decay, but also the iatrogenic make it necessary to have endodôntic treatment that consists in the removal of all necrosis inflamed and infected material from the system of root channels, disinfection of the same system and its substitution by felling material. It also verifies, in the present day, the lack of consent among researchers, as to the ideal material to be used in the endodontic fillings. In this way, the present work aimed at the accomplishment of a comparative histological evaluation, through biological tests, according to criteria established by the International Dental Federation of three materials indicated for this end. In this experiment the following materials were tested: AHPlus, another endodontic material recently introduced to the market Epiphany and MTA, Aggregated Trioxide Mineral. Thirty (30) guinea-pigs were used (" Guinea Pig ") ten (10) for each material, divided in experimental periods of 30 and 90 days. Two (2) inter-bone implants were accomplished in each animal, in the lateral area to the mandible sínfisis, on the side of the incisive teeth. So as to condition the tested materials Teflon cups were used, as the sides served as control. Terminating the experimental periods, the animals were sacrificed and the specimens were prepared for routine histological exam. The results showed that MTA as much as the Epiphany cement presented biocompatibility characteristics according to the criteria adopted and AHPlus did not. The results allowed us to conclude, according to FDI and ADA /ANSI protocols, that the Epiphany and MTA materials are biocompatible, presenting biological conditions for their use as endodontic filling material.

The Implant-retained prostheses need passivity and justness in their settlement, which are considered prerequisites for the osseointegration success. To minimize distortions and to promote passive settlement it is used the cut and solder of the piece. This work investigated, through photoelasticity, the distribution of stress generated by implants interconnected with a laser welded, sectioned, molten and metallic bar. Six photoelastics models, which contain the implant groups/pillars/indexed and cut bars, were obtained from silicone molds avoiding supposed stress proceeded from dimensional alterations caused by the acrylic resin polymerization process, which is utilized bars indexation. Stress absence was observed In the models, on a polariscopic. Afterwarsds, the bars were soldered by laser in the laboratory and repositioned into the photoelastics models; twenty-five points, in the body of implants and inter-implant region, were evaluated under two conditions: after torque of 20 Ncm and under loading of 2 KgF. In the first condition, the maximum shear tension gradients were practically null in all evaluated points, the developed patterns of fringes- in all the models (1 to 6) - were uniform, suggesting symmetry among the system components during the adaptation process and some possible positive influence caused by the laser soldering process on the level of generated stress; it - the process has been characterized as a technical-sensitive procedure. The uniform distribution of stress patterns was observed with the application of external loading because of stress absence after the laser soldering process.

Achievement of centric relation (CR) is one of the most important steps in dental clinical procedures. This study evaluated the percentage of discrepancy between Centric Relation and Maximum Intercuspation (MI) positions and compared three methods (frontal technique of manipulation; bilateral technique of manipulation; and swallowing technique) for achievement of maxillomandibular position in CR, according to the reproducibility and accuracy of positioning. The sample was composed of 42 patients with mean age of 32.3 years and complete dentition. The individuals answered a questionnaire to categorize and quantify the subjective analysis of temporomandibular dysfunction symptoms and used an occlusal jig for nearly 5 minutes before achievement of CR by each technique, to allow muscular relaxation. Comparison of the mean values between CR and MI positions achieved by the three techniques was performed by one-way ANOVA for repeated measurements. The Pearson coefficient of correlation was employed to verify the correlation between techniques. All statistical tests were performed at a significance level of 5% (p<0.05). Among the characteristics related to temporomandibular dysfunction, 76.19% of patients presented some type of dysfunction, with predominance of parafunctional habits including eccentric bruxism and onychophagia, demonstrating the possibility to reproduce the Centric Relation in patients with temporomandibular dysfunction. The mean values between CR and MI positions achieved by the three techniques did not reveal any statistically significant difference (p= 0.425). Also, there was a clear correlation between techniques. A total of 2.38% of patients did not present discrepancy between MI and CR mandibular positions; thus, these mandibular positions exhibited different positional relationships in the majority of the population.

At childhood, specifically, dentistry has been restricted to dentition and periodontal tissues maintenance, which is basically evidenced by caries, periodontal illness and malocclusion prevention and treatment. This approach leaves lacunae as to diagnosis and treatment of soft and hard tissues lesions. Studies aiming this knowledge are sparse, restricted to that epidemiological ones of population database or isolated clinical cases reports. The aim of this study was to perform an epidemiological retrospective study of oral illness at pediatric age, based on diagnosed cases searched from Uberlândia s Federal University Oral Pathology Laboratory between 1978 and 2004 periods. For this study 7292 recorded cases were obtained in this period (27 years) from Laboratory records. From the total, 8.5% of the cases, corresponding to 620 biopsies, matched limit age criteria (0-14 years old) and were located on oral tissues. For its ranking, a modified Happonen et al. (1982) criteria, grouping lesions in 10 categories. Our results evidenced that major of cases were located in the older group between 10-14 years (375/620), females were more affected (356/620) and lower lip was the most frequent location (198/620). Ten recognized categories from samples presented the following frequency: hyperplasic and soft tissue reaction lesions (20.2%); soft tissue benign tumors (7.0%); oral mucosa lesions (3.4%); maxillary and oral soft tissue cysts (14.4%); periapical and fibrous scar illness (4.2%); odontogenic tumors (6.1%); bone lesions (2.7%); salivary glands lesions (35.5%); malign lesions (0.9%) and normal tissue and dental specimens (5.5%). Major number of lesions was found on salivary glands lesions group (35.5%), hyperplasic and soft tissue reaction lesions (20.2%) and maxillary and soft tissues cysts (14.4%). Mucocele was the most prevalent entity (33.7%) in all study followed by dentygerous cyst (6.8%) and fibrous hyperplasia (5.3%). Twelve most frequent lesions were responsible for 74% of the whole sample.

The success of autogenous bone graft is related to the graft cells viability transferred to receptor site. During surgical bone grafting procedures, a time passes by the graft removal till its fixation in receptor site. Various media for temporary storage of bone grafts during the surgical procedure have been suggested to minimize the deleterious effect during this period. This study performs histomorphometric analysis of autogenous bone graft, stored in different medias during surgical period. Two grafts were removed bilaterally from calvarian of 18 rabbits. One graft was removed and immediately fixed in one of the mandibular angles (control group). The other graft was stored during 30 minutes in one of the following storage media: salin solution (saline group), air (dry group), platelets poor-plasma (PPP group), and then screwed in the symmetrical side of the first graft, in the same animal. Four weeks later the animals were killed and the grafted areas were harvested and fixed in formaldehyde in PBS and embedded in parafin. The 5 μm sections were stained in Hematoxilin Eosin and Mallory. Osteoclasts, blood vessels and total graft area were assessed and analyzed through, ANOVA 1, Tukey and t-matched pair tests. Histological analysis of all groups showed vascularized, preserved bone graft well-incorporated to receptor site. Statistical analysis of saline group shows higher amount of osteoclasts (p=0,02) and lower amount of blood vessels (p=0,03) than the control group. No differences between control and experimental groups were observed in dry and PPP groups. Comparing experimental groups, PPP group presented higher amount of blood vessels (p<0,001) and larger total graft area (p<0,001) than dry and saline group. The platelets poor plasma favored the vascularization and maintenance of graft area, being considered a better storage media than air way and saline solution.

Xenogenic graft of bone origin has been used to favor bone regeneration and to reduce autogenous bone needs. The purpose of this study was to evaluate the bone repair induced by particulate bovine organic bone grafted in rabbit calvaria. Two standardized bone defects were prepared in both parietal of 20 adult rabbits. The defects were filled by clot, autograft, medular organic bovine bone or cortical organic bovine bone. Thirty days following surgery animals were killed; the calvaria were removed, fixed in formol, demineralized in EDTA and embedded in paraffin. Histological sections were stained in HE or Mallory Trichrome and analyzed by light microscope. On group filled with clot only the half of the defect was repaired by new bone tissue, which was formed from lesion border, central area presented cellular connective tissue. In defects filled with autograft almost all defect was repaired by bone tissue. Defects grafted with medular or cortical bovine bone exhibited near ¼ of defect filled by bone tissue, formed from border, with central area occupied by fibrous connective tissue. Almost all xenogenic grafts were reabsorbed, remaining few fragments that were associated to foreign body giant cell reaction and few showing bone neoformation around. Therefore, the graft of organic bovine bone, medular or cortical, used in an isolated way, didn't favor the process of bone repair.

The efficacy of the sodium hypochlorite and chlorhexidine over the Enterococcus faecalis present in endodontic infections was evaluated in longitudinal studies through a systematic review. Bibliographic catalogue sources, electronically identified as MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed), from 1966 until January 1st, and Cochrane Library on the same period, were used. On the searching strategy, the following combination of keywords were used faecalis and sodium hypochlorite or faecalis and chlorhexidine or faecalis and root canal infections or faecalis and endodontics infections or faecalis and root canal irrigants or faecalis and irrigant solution or faecalis and endodontics irrigants or faecalis and intracanal irrigant. The studies were selected by two independent reviewers that determined the inclusion and exclusion criteria. The search presented 229 related articles, with 6 of these as literature review articles, 39 articles were related with in vivo studies (humans or animals), and 189 included in vitro studies. From the 39 in vivo studies, 5 studies satisfied the inclusion criteria. The methodological structure of the included studies prohibited the combination of results. The efficacy of the sodium hypochlorite and chlorhexidine over the E. faecalis was demonstrated in vitro by direct contact test. On the studies involving contaminated dentin, either the sodium hypochlorite or the chlorhexidine were inefficient. On the 5 studies included, from the total of 159 teeth with endodontic infections primary or secundary, the E. faecalis was detected initially in 16 teeth by PCR and 42 by culture, and after the sanitization process in 11 teeth by PCR and 12 by culture. It was observed the absence of longitudinal studies in humans about the efficacy of chlorhexidine over the E. faecalis. The sanitization process with the emptying, enlargement and action of the sodium hypochlorite reduces the remaining endodontic microbiota, what certainly potentiates the action of the intracanal dressing and favors a higher level of success of the endodontic treatment.

The aim of this study was to evaluate the influence of different endodontic irrigants on the cohesive and flexural strength of the root dentin. One hundred of bovine incisor roots were selected, instrumented and randomly divided into 10 experimental groups (n = 10), according to the irrigation solution used: Control - physiological solution; N1 - sodium hypochlorite 1.0%; N5 - sodium hypochlorite 5.25%; N1EDTA - sodium hypochlorite 1.0% associate to EDTA 17%; N5EDTA - sodium hypochlorite 5.25% associate to EDTA 17%; Sclx chlorhexidine gluconate solution 2.0%; Gclx - chlorhexidine gluconate gel 2.0%; SclxEDTA - chlorhexidine gluconate solution 2.0% associate to EDTA 17%; GclxEDTA - chlorhexidine gluconate gel 2.0% associate to EDTA 17% and EDTA - EDTA 17%. The roots were axially sectioned in two halves. Half of them were used for the microtensile cohesive strength test: six 1.0mm thick slices were trimmed to produce hourglass shaped samples with a test area of 1mm2. The other halves were used in a 3-point bend flexural strength by means of dentine bars with 1X1X12 mm. Each sample remained two hours in contact with the irrigant solutions, except for EDTA, which remained for five minutes. After irrigants treatment, samples were rinsed with distilled water, and tested. Specific devices for each test were used, in a universal testing machine with a load cell of 20Kgf, and a crosshead speed of 0.5 mm/minute. Date were recorded and statistically analyzed with one-way ANOVA and Tukey test. Significant reduction in the ultimate cohesive strength and flexural strength was verified only for the groups that used sodium hypochlorite irrespective of the concentration and additional solution, differing significant from the group control. The use of chlorhexidine and EDTA separately did not cause alteration in the mechanical properties of root dentine.

Longitudinal studies about the influence of the vehicle on the efficacy of calcium hydroxide pastes in endodontic infections were studied through a systematic review. Bibliographic tabulation sources identified electronically by MEDLINE, since 1966 until January 2nd of 2007 and Cochrane Library, on the same period, were used. As searching strategy the following terms were used in different combinations: calcium hydroxide, chlorexidine, root canal infection, faecalis, intracanal dressing, endodontic infection, intracanal medicament, paramonochlorophenol, paramonochlorophenol or p-monochlorophenol. The studies were selected by two independent reviewers that also determined the inclusion and exclusion criteria. The search presented 303 related articles, and from these, 22 articles were literature reviews, 71 articles were related to in vivo studies (humans or animals), 34 studies were cases reports, and 178 included in vitro studies. From the 71 in vivo studies, 5 studies satisfied the inclusion criteria, what enabled the data analysis. The impossibility of results combination caused by the methodology differences of the studies did not allow the execution of meta-analysis. In vitro studies showed that the vehicle influences the chemical characteristics of the calcium hydroxide paste on what concerns to the speed of diffusion an ionic dissociation, like occurs with aqueous Hydro-solvable vehicles. This chemical characteristic reflects on the antimicrobial potential. On the five studies in humans that satisfied the inclusion criteria for analysis of scientific evidence, from a total of 110 teeth with endodontic infections, after the sanitization process combined with the calcium hydroxide paste associated to saline solution, in 35 teeth were detected microorganisms on the final samples. The saline solution was the only vehicle present in all the included studies, what limited comparisons. Considering the estimative of clinical success, the adequate sanitization process assisted by the calcium hydroxide paste with aqueous vehicle reduces the endodontic microorganisms, what favors the prognostic.

The efficcacy of the treatment of the endodontic-periodontal lesion was evaluated in longitudinal studies, by means through a systematic review. Bibliographic tabulation sources identified electronically by MEDLINE, from 1966 up to March, 26 of 2007 and Cochrane Library, in the same period. As search strategy one used the terms - endodontic-periodontal lesion or endodontic-periodontal lesions or endodontic periodontal lesion or endodontic periodontal lesions or endo-perio lesion or endo-perio lesions or endodontics periodontal lesion or endodontics periodontal lesions - as word-key. The studies had been selected by two copyholders, independent, that also they had determined the criteria of inclusion and exclusion. The search presented 257 related articles, being that, of these, 55 articles were of literature revision, 27 articles became related with prospectives studies, 70 studies was cases reports, 19 studies had been developed in animals and 25 had involved retrospective studies. Absence of longitudinal studies that satisfied the inclusion criteria, with sights to the analysis based on evidences was observed. However, front to applied literature was verified that the success of the treatment of the endodontic-periodontal lesions is related to the brief identification of the etiology, to the control of microbiota present, to the immunological characteristics of the individual, being that one of the strategies and possible prognostic the origin of the infectious process is associated to it. Considering the estimate of success of the clinical success of the endodontic-periodontal lesion an initial microorganisms control in the oral cavity is suggested, followed for the control of endodontical microorganisms and, to follow, the periodontal, for then carrying through the treatment. The immunological system of the individual participates actively of the process as component manager.

The aim of this study was to describe the interpretative repertoires used by hearing impaired elders, in interviews, about the decision to use or not to use hearing aids. Ten elderly individuals, five men and five women, who had acquired sensorineural hearing loss, with characteristically high frequency audiometric configuration. Five interviewees had been using hearing aids for at least five months before the interview and five sought hearing aid adaptation services, took tests, but decided not to acquire them. Data analysis was performed according to the proposals of Discourse Analysis influenced by the social constructionism approach, which includes the transcription of all of the interviews followed by their readings, making the identification of interpretive repertoires possible. We observed that the hearing aid users justified their decision through the use of five basic repertoires, which were denominated as: (1) The bothersome of repetition, (2) In search of prevention and self-care, (3) The hearing aid as a beneficial technological resource, (4) The recognition of the hearing aid limitations and (5) The virtue of resignation. On the other hand, those who decided not to use the hearing aids justified their decision using the following repertoires: (1) The use of alternative strategies, (2) The discomfort greater than the benefits, (3) The unsuccess of others, (4) The relativity of necessity and (5) The transitoriness of decision. Repertoire analysis permitted us to identify some functions of its use, as well as moral implications during this use. Therefore we could perceive that when such repertoires were used, the interviewees sought to legitimize their decision to use or not to use hearing aids, demonstrating that this decision was taken in a criterious manner, while taking into account diverse aspects, and so must be respected. Besides this, when using these repertoires, the interviewees searched reaching positive moral images, putting themselves in positions of coherent, flexible, logical, capable, responsible and informed people. In the same manner, they also try to guarantee the distancing of negative images, as difficult, inflexible and uniformed people. Besides identifying interpretive repertoires, this study made it possible for us to visualize these repertoires as mobile, or, socially available, capable of being used in a combined manner by different social groups depending on the conversational intention at the moment. In this sense, this study aimed to highlight the importance of the audiologist to be sensitive to socially available interpretive repertoires which construct, broadening or limiting possibilities regarding the decision to use or not to use hearing aids. The possibilities influence the relations that we establish with our patients, delimiting our actions of taking the patient in, dialogue and negotiation.

The present work is fruit of a research that had as objective to propose an action strategy in Mental Health for the first childhood, starting from the dimension of the relevance of the identification work and precocious intervention of signs of risk of psychic suffering among children range zero to three years old. In order to accomplish that search, we used an instrument denominated "Record of Attendance of the Infantile Development" and we counted with the support from the team of the Health Family Program of the municipal district of Pirajuba-MG, with total population of approximately 3.000 inhabitants. The application of the Instrument was accomplished the 136 children's parents/responsible, that correspond to 4,53% of the general population, close to independently of the general state of health of the same ones. After the application and analysis of the instrument, we can detach that about 14,7% of the children presented some sign of risk of psychic suffering, being necessary the direction of the same ones to the pertinent services. That mapping allows us reaffirming the need of guidelines that you/they prioritize the Infantile Mental Health, front to the prevalence every larger and more precocious of psychic suffering in the childhood. Engaged with the subject of the health and recognizing the urgency and need of creating strategies and attendance devices and reception, we formed a support net and sustainability, starting from inherent resources to each situation. That net was woven and structured starting from three directions: the) the deconstruction of the reparative logic; b) the focus in the "clinic" of the bow parents/child; c) the child's recognition as subject. In that way, we developed an attendance work close to four children that presented indicative signs of risk of psychic suffering using of the technique of Intervention United Parent-children and of the psychoanalytic-interpretative method. Leaving of that experience, we sought to raise questions and discussions on how to face the subject of the psychic suffering of first childhood, establishing reflections about the possible interrelations between the Psychoanalysis and Public Health.