Genetics and sleep bruxism: a systematic review and meta-analysis of studies with twins.

OBJECTIVE: To systematically review the literature regarding the concordance of sleep bruxism (SB) between monozygotic (MZ) and dizygotic (DZ) twins. METHODS: The registration for this systematic review was accomplished in the International Prospective Register of Systematic Reviews (PROSPERO, No. CRD42021251751). As of July 2022, four databases were searched, including PubMed, Scopus, Embase, and Web of Science, as well as the grey literature in Google Scholar and OpenGrey. Observational studies evaluating SB in MZ and DZ twins of any age and sex were included. For the evaluation of the risk of bias, the Joanna Briggs checklist was utilized. The certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Pooled and subgroup meta-analyses were performed to estimate concordance of SB ​​between twins (p < 0.05). RESULTS: In total, 3,155 records were identified. In the qualitative analysis, eleven studies were included; of these, seven were included in the meta-analysis. The majority of the articles exhibited a low risk of bias (63.6%). Greater SB concordance was observed between MZ twins than between DZ twins in the analysis of general concordance (OR = 1.47; 95% CI = 1.07-2.02) and also positive concordance (OR = 1.53; 95% CI = 1.29-1.81). Within the subgroup analyses, the significance of the findings remained only for the reported/self-reported SB regarding general concordance (OR = 1.44; 95% CI = 1.07-1.95) and positive concordance (OR = 1.55; 95% CI = 1.28-1.88). Low certainty of the evidence was observed for the general concordance analysis, while moderate certainty was observed for the positive concordance. CONCLUSION: There was a higher concordance of SB in MZ twins compared to DZ twins, indicating a possible genetic influence on the condition's occurrence.

Does outpatient dental treatment have impact on the quality of life of children with early childhood caries?

AIM: To assess the impact of outpatient dental treatment on oral health-related quality of life (OHRQoL) of children and their families. MATERIALS AND METHODS: This prospective observational study was conducted with children with untreated dental caries, recruited from a public university/the pediatric dentistry clinic of a public university in the northeastern Brazil. Sociodemographic data were collected, a clinical examination was carried out before and after dental treatment, and the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was applied to those responsible for the children, before and after dental treatment. Descriptive and bivariate statistics were used, and the Wilcoxon and Student's t tests were applied (p < 0.05). RESULTS: The study included 64 children, of both sexes, aged between 3 and 5 years old. The majority had a dmft index higher than or equal to 6 (60.9%), with a mean value of 7.11 (± 4.11). Sociodemographic conditions such as sex, age, and socioeconomic status had no impact on their OHRQoL (p > 0.05). The mean total ECOHIS questionnaire scores and those of its domains decreased after completion of the treatments (p < 0.05), except for scores in the self-image and distress domains of the parents (p > 0.05). This study reinforces the relevance of adopting oral health policies aimed at the prevention and treatment of ECC. CONCLUSION: Outpatient dental treatment had a positive impact on the OHRQoL of children and their families. CLINICAL RELEVANCE: The possibility of evaluating the services provided by the pediatric dentistry clinic.

Impact of hypomineralised second primary molar on preschoolers' oral health-related quality of life-A hierarchical approach.

BACKGROUND: Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries. AIM: To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis. DESIGN: This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P < .05). RESULTS: Severe HSPM was associated with OHRQoL in bivariate analysis (P < .05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P < .05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26-3.65), family impact section (RR = 1.99; 95% CI = 1.16-3.42), and total score (RR = 2.09; 95% CI = 1.25-3.49) of the ECOHIS. CONCLUSION: Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact.

Breathing problems, being an only child and having parents with possible sleep bruxism are associated with probable sleep bruxism in preschoolers: a population-based study.

PURPOSE: To determine the prevalence of probable sleep bruxism (SB) in preschoolers and associated factors. METHODS: A cross-sectional, population-based study was carried out with 862 dyads of parents/preschoolers aged 5 from Teresina, Brazil. Data collection was performed through a questionnaire answered by parents/guardians about socioeconomic, demographic, and health condition data. Each child was examined for diagnosis of probable SB based on the presence of dental wear associated or not with the report of teeth grinding by parents/guardians. The analysis of independent variables was stratified into four levels of determinants: demographic characteristics of the child (distal), characteristics of the family, environmental factors (intermediate), and health conditions (proximal). Descriptive analysis and bivariate and multivariate Poisson's regression were performed using a hierarchical approach (p < 0.05). RESULTS: The prevalence of probable SB was 36%. In the final adjusted multivariate hierarchical model, a preschooler who was the only child (PR = 1.25; 95%CI = 1.02-1.51), with breathing problems (PR = 1.43; 95%CI = 1.19-1.73), and having parents/guardians with possible sleep bruxism (PR = 1.65; 95%CI = 1.32-2.07) had a higher prevalence of probable SB. CONCLUSION: The prevalence of probable SB in preschoolers was high and associated with the condition of being an only child, the presence of breathing problems, and having parents/guardians with possible sleep bruxism.

Oromandibular Limb Hypogenesis Syndrome: Overlap of Moebius and Ankyloglossia Superior With Severe Limb Defects.

The oromandibular limb hypogenesis syndromes (OLHS) represent a group of rare conditions characterized by congenital malformations involving the tongue, mandible, and limbs. In this report, we describe a newborn girl with paralysis of abducens and facial nerves, transverse agenesis of the distal segments of the limbs, micrognathia, cleft lip and palate, and ankyloglossia superior. This observation confirms an overlap between Moebius syndrome and ankyloglossia superior syndrome with severe limb defects. The etiology of the OLHS is not clearly understood. The intriguing link between facial and limb anomalies can result from their simultaneous development from the fourth to eighth week of gestation, making both areas susceptible to the same teratogenic stimuli. There is an overlap between OLHS conditions, supporting a clustering, rather than a divided nosology and requiring an appropriate classification of these conditions. Patients with OLHS can be successfully managed using a multidisciplinary approach.

Pre-term birth and asthma is associated with hypomineralized second primary molars in pre-schoolers: A population-based study.

BACKGROUND: Hypomineralized second primary molar (HSPM) is a developmental enamel defect that represents a caries-risk factor. There are few studies about HSPM epidemiology in representative populations. AIM: To determine the prevalence and factors associated with HSPM in pre-schoolers. DESIGN: This is a cross-sectional population-based study of 5-year-old pre-schoolers from Teresina, Brazil. The sample was randomly selected and stratified by geographic region of the city, type of school (public and private), and sex of the pre-schoolers (n = 811). Sociodemographic status and pre-, peri-, and post-natal conditions were collected by structured questionnaires. Two calibrated examiners diagnosed HSPM using the criteria of the European Academy of Paediatric Dentistry for molar-incisor hypomineralization. Severity, colour, location, and extent of lesions were also evaluated. Descriptive analysis of the data and a Poisson regression analysis were performed (P < .05). RESULTS: The prevalence of HSPM was 14.9. Demarcated opacities (75.6%) and white/cream colour were the most prevalent (71.4%). Pre-term pre-schoolers had 66% (PR = 1.66, 95% CI = 1.07-2.58), and those who reported asthma in the first year of life had 69% (PR = 1.69, 95% CI = 1.01-2.85) higher prevalence of HSPM. CONCLUSIONS: Pre-term birth and reported asthma in the first year of life were associated with HSPM. The prevalence of HSPM in pre-schoolers aged 5 years old in Teresina was high.

Enamel of Premolars whose Predecessors Presented Rupture of the Follicle Bone Crypt from Periapical Infections.

OBJECTIVE: To observe if dental alterations in premolars are associated with the rupture of the follicle bone crypt caused by a periapical lesion in the predecessor molars. STUDY DESIGN: This is a cross-sectional study. Data collection consisted of the analysis of medical records, a socioeconomic questionnaire, and dental clinical examination. Records from patients with a history of a radiographically visible periapical lesion in lower primary molars submitted to pulp therapy or extraction from a university dental clinic were selected. Successor premolars were clinically evaluated for the presence of enamel development defects, shape alterations, and eruption deviations. The descriptive analysis of data was performed, and Fisher's exact tests, linear trend chi-square, and the Student's t-test were applied. RESULTS: Forty-eight permanent teeth were from 36 patients were evaluated in this study, and 20 (41.7%) of the 48 examined premolars showed a radiographic image suggestive of the rupture of the bone crypt. Rupture of the follicle bone crypt was not associated with the occurrence of enamel alterations in premolars (p = 0.418). An association between dental alterations and age over six years at the time of intervention was observed (p = 0.043). CONCLUSION: The presence of enamel alterations of premolars was not associated with the rupture of the follicle bone crypt caused by a periapical lesion in predecessor molars.

Endodontic Treatment of Primary Molars with Antibiotic Paste: A Report of 38 Cases.

OBJECTIVE: This study presents 38 cases of primary molars with necrotic pulps treated with antibiotics-based paste. CASE REPORT: The technique consisted of necrotic tissue removal of the pulp chamber, using spoons excavators and low speed drills. Pulp cavity was washed with saline solution and dried with sterile cotton balls. Then an antibiotic paste composed of chloramphenicol, tetracycline, zinc oxide and eugenol - CTZ paste - was inserted at the entrance of root canals. Patients were evaluated clinically and radiographically at different times. The criteria that defined clinical success were the lack of periapical abscess and mobility compatible with chronological age. Radiographic assessments consisted in absence of radiolucency in the region of root bifurcation and pathological bone resorption. CONCLUSION: There were 100% and 93% of clinical and radiographic success, respectively. The results suggest that the CTZ paste is an optional therapy for pulp of primary molars.

Salivary fluoride levels after use of high-fluoride dentifrice.

The aim of the study was to evaluate salivary fluoride (F) availability after toothbrushing with a high-F dentifrice. Twelve adult volunteers took part in this crossover and blind study. F concentration in saliva was determined after brushing with a high-F dentifrice (5000 µg F/g) or with a conventional F concentration dentifrice (1100 µg F/g) followed by a 15 mL distilled water rinse. Samples of nonstimulated saliva were collected on the following times: before (baseline), and immediately after spit (time = 0) and after 1, 2, 3, 4, 5, 10, 15, 20, 30, 45, 60, 90, and 120 min. F analysis was performed with a fluoride-sensitive electrode and the area under curve of F salivary concentration × time (µg F/mL × min(-1)) was calculated. At baseline, no significant difference was found among dentifrices (P > 0.05). After brushing, both dentifrices caused an elevated fluoride level in saliva; however salivary F concentration was significantly higher at all times, when high-F dentifrice was used (P < 0.01). Even after 120 min, salivary F concentration was still higher than the baseline values for both dentifrices (P < 0.001). High-F dentifrice enhanced the bioavailability of salivary F, being an option for caries management in patients with high caries risk.

Crown-root fracture with pulp exposure: a case report with 16-year follow-up.

A 12-year-old boy presented for dental care 35 days after he fell from his bicycle. Clinical and radiographic examinations revealed a longitudinal crown-root fracture with pulp exposure in the maxillary left central incisor. The radiograph also suggested necrosis of the maxillary right central incisor. Urgent treatment of the left central incisor involved gingivectomy followed by autogenous bonding of the tooth fragment with self-curing composite resin. Immediately after bonding, coronal access was prepared, chemical and mechanical preparation was completed, and a calcium hydroxide intracanal dressing was placed. One week after the initial appointment, endodontic treatment was initiated in the right central incisor. The root canal of the maxillary left central incisor was maintained with calcium hydroxide paste (replaced at 45-day intervals) for 1 year and then definitively obturated. At the 16-year follow-up, satisfactory periodontal, esthetic, and clinical conditions were observed, and a radiograph revealed no resorption or periapical changes.

Is there an association between dental caries and genetics? Systematic review and meta-analysis of studies with twins.

OBJECTIVE: This review aimed to assess the agreement of dental caries experience between monozygotic (MZ) and dizygotic (DZ) twins. DATA RESOURCES: This systematic review was performed by reviewers in the databases Embase, MEDLINE-PubMed, Scopus, Web of Science and manual searches and gray literature Google Scholar® and Opengray. Observational studies that evaluated dental caries in twins were included. The risk of bias was analyzed using the Joanna Briggs checklist. Meta-analyses were performed to assess the pooled Odds Ratio to estimate the agreement values of dental caries experience and DMF index between pairs of twins (p < 0.05). To assess the certainty of evidence, the GRADE scale was used. STUDY SELECTION: 2533 studies were identified, of which 19 were included in the qualitative analysis, six in the quantitative synthesis, with two meta-analyses being carried out. Association between genetics and the development of the disease was observed in most studies. In the risk of bias analysis, 47.4% had moderate risk. Higher agreement of dental caries experience was observed in MZ twins than DZ in both dentitions (OR: 5.94; 95% CI: 2.00-17.57). However, there was no difference between the MZ and DZ twin groups in the analysis comparing DMF index agreement (OR: 2.86; 95%CI: 0.25-32.79). The certainty of evidence was considered low and very low for all studies included in meta-analyses. CONCLUSION: With very low certainty of the evidence, the genetic factor seems to influence the agreement of the caries experience. CLINICAL RELEVANCE: Understanding the genetic influence on the disease has the potential to contribute to the development of studies that may use biotechnologies for prevention and treatment as well as guide future research involving gene therapies aiming to prevent the occurrence of dental caries.

Crown-root fracture of fused primary teeth--a case report.

In the primary dentition, traumatic injuries affecting the tooth-supporting structures are common due to increased bone resilience in children. Crown-root fracture, defined as a fracture involving enamel, dentin, and cementum, is uncommon in the primary dentition, comprising only 2% of dental traumas. This article reports the treatment and follow-up of a 2-year-old boy who suffered a traumatic crown-root fracture involving a primary anterior incisor that was fused to a supernumerary tooth.

Impact of Pulp Necrosis on Oral Health-Related Quality of Life of Children with Early Childhood Caries.

Purpose: To assess the impact of pulp necrosis on the oral health-related quality of life (OHRQoL) of children with early childhood caries and their caregivers.
Methods: A cross-sectional study was performed with a consecutive sample of children who were divided into three groups: (1) caries-free children; (2) with untreated carious lesions and without pulp necrosis; and (3) with untreated carious lesions and at least one tooth with pulp necrosis. Data were collected using a sociodemographic questionnaire, the Early Childhood Oral Health Impact Scale (ECOHIS) and a dental clinical examination using the International Caries Detection and Assessment System index. Descriptive statistics, Kruskal-Wallis tests, Mann-Whitney tests and Poisson regression were performed (P <0.05).
Results: A total of 532 children and their legal guardians participated in the study. Children with pulp necrosis had a greater negative impact on the OHRQoL versus those with untreated carious lesions without pulp necrosis (ratio of unadjusted and adjusted rates [RR] = 1.59; 95 percent confidence interval [95% CI] = 1.36 to 1.86; P <0.001), as measured by the total ECOHIS score. in Group 3, four- and five-year-old children had a greater negative impact on the OHRQoL than two- and three-year-old peers (RR = 1.36; 95% CI = 1.08 to 1.72; P <0,001).
Conclusion: The presence of pulp necrosis increased the negative impact on OHRQoL of children with untreated carious lesions and their guardians.

Fluoridated water impact on tooth decay and fluorosis in 17-20-year-olds exposed to fluoride toothpaste.

OBJECTIVE: To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste. METHODS: The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis. RESULTS: Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively. CONCLUSION: Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.

Reattachment of fractured fragment of an anterior tooth: case report and nine-year follow-up.

This article reports the treatment and follow-up of a 10-year-old boy who had a politraumatic accident that resulted in severe displacement and fracture of the maxillary right central incisor. After clinical and radiographic examination, the tooth fragment was bonded with adhesive and the tooth crown underwent nonrigid splinting. Follow-up appointments were scheduled once a week during the first month, once during the second month, and every three months thereafter. Each follow-up appointment included a clinical examination, followed by radiographic and pulp sensitivity tests. After the fifth year, pulp necrosis was diagnosed following a sensitivity test and a periapical radiograph. Endodontic treatment was performed; the chemical-mechanical preparation and root canal fillings used calcium hydroxide paste manipulated with saline solution. The abovementioned paste was replaced twice during the first month; after that, propylenoglycol was used as the vehicle for manipulating the calcium hydroxide. The filling paste was replaced whenever the radiographic image showed resorption of the paste. The root canals were filled definitively seven years postaccident. Nine years postaccident, clinical and radiographic examination revealed a normal aspect.

Hypomineralized Teeth Have a Higher Frequency of Dental Hypersensitivity.

Purpose: The purposes of this study were to: (1) compare dental hypersensitivity (DH) between hypomineralized permanent first molars and unaffected controls molars in patients with molar-incisor hypomineralization (MIH); and (2) assess the influence of opacity, color, and subject age on DH. Methods: This cross-sectional study identified 40 children/adolescents, who were attending a children's dental clinic and had one to three first permanent molars hypomineralized (demarcated opacities). The severity and color of the hypomineralized lesions were also evaluated. The assessment of DH was made using evaporative stimulus using a jet of compressed air applied by a dental syringe for one second, perpendicular to the occlusal surface employing the visual analogue scale (VAS) and the Schiff cold air sensitivity scale (SCASS). To verify the association between the presence or absence of DH and MIH, Pearson's chi-square and Fisher's exact test (P<0.05) were performed. Results: The frequency of DH was 28.0 percent in hypomineralized teeth and 9.4 percent in normal controls (by VAS; P=0.002). A higher frequency of opacities was observed (P<0.001). Older individuals had DH more frequently (P<0.05). Conclusions: Hypomineralized molars presented a higher frequency of dental hypersensitivity than control teeth, and dental hypersensitivity was associated with darker opacities of the lesion and older-aged subjects.

Interdisciplinary approach to traumatized permanent anterior teeth: case report and 10-year follow-up.

This article presents a case report (including the 10-year follow-up) of a 10-year-old patient who suffered displacement of the maxillary right central incisor, intrusion of the maxillary left central incisor, and crown fractures to the mesial angles of these teeth as a result of dental trauma. Treatment involved an interdisciplinary approach that utilized a pediatric dentist, an endodontist, and an orthodontist.

[Monitoring water fluoridation in three cities in Piauí State, Brazil]. / Heterocontrole da fluoretação das águas em três cidades no Piauí, Brasil.

This study aimed to monitor the fluoride concentration in the public water supply in Teresina, Floriano, and Parnaíba, Piauí State, Brazil. Samples were collected monthly for one year between 2004 and 2005. Six sites in each city were randomly selected for water sampling (total n = 576), 192 in each city. Fluoride assays were performed in duplicate, using a specific electrode. Most samples were below the optimum fluoride concentration, and only 4.3% (n = 25) presented acceptable values (0.60-0.80 ppm). Acceptable samples totaled 7.8% (n = 15), 4.7% (n = 9), and 0.5% (n = 1) in Teresina, Floriano, and Parnaíba, respectively. By conclusion, fluoride levels in the public water supply in the three cities were below the optimum concentration, and a permanent surveillance system is thus needed to guarantee effective water fluoridation in the State of Piauí.

Molar incisor hypomineralization in HIV-infected children and adolescents.

The objective was to determine the prevalence of molar incisor hypomineralization (MIH) among individuals between 7 and 15 years old infected or noninfected with human immunodeficiency virus (HIV). The study was conducted with 33 HIV-infected individuals (study group; SG) and 66 non-HIV-infected schoolchildren (control group; CG), paired by gender and age. Data collection was based on medical records (SG), a questionnaire for caregivers and oral examination for diagnosis of MIH (European Academy of Pediatric Dentistry criteria) and caries (DMFT index and ICDAS). Data were analyzed with Mann-Whitney, chi-square, and Fisher's exact tests and logistic regression. In SG, MIH (45.5%) and caries (87.9%) had higher prevalence. MIH was associated with use of protease inhibitors in SG (OR: 2.14; 95% CI: 1.21 to 3.77) and incubator need in CG (OR: 2.80; 95% CI: 1.71 to 9.10). HIV-infected patients had a higher prevalence of MIH and dental caries in the permanent dentition.