Maternal apical periodontitis is associated with insulin resistance in adult offspring.

AIM: To investigate the plasma concentrations of glucose, insulin and tumour necrosis factor-α (TNF-α) of rats with maternal apical periodontitis (AP) and to explore the effect of maternal inflammation on the initial steps of insulin signalling and the inflammatory pathway in the gastrocnemius muscle (GM) and periepididymal white adipose tissue (pWAT) of adult offspring. METHODOLOGY: Fifteen female Wistar rats were distributed into a control group (CN), a group with 1 tooth with AP (1AP) and a group with 4 teeth with AP (4AP). Thirty days following induction of AP, female rats from all groups were mated with healthy male rats. When male offspring reached 75 days of age, plasma concentrations of glucose, insulin and TNF-α were quantified. Insulin resistance was evaluated by the homoeostasis model assessment of insulin resistance (HOMA-IR) index. Phosphorylation status of pp185 tyrosine, insulin receptor substrate 1 (IRS-1) serine, IκB kinase α/ß (IKKα/ß) and c-Jun N-terminal kinase (JNK) in the GM and pWAT were measured by Western blot. Analysis of variance was performed, followed by the Tukey's post hoc test. P values <0.05 were considered to be statistically significant. RESULTS: Maternal AP promoted insulin resistance, impaired the initial steps of insulin signalling, significantly increased plasma concentrations of insulin (P < 0.001) and TNF-α (P < 0.05), and enhanced IKKα/ß phosphorylation in the GM and pWAT (P < 0.05) of adult offspring. However, maternal AP did not affect fasting glycaemia and JNK phosphorylation in the GM and pWAT of adult offspring. CONCLUSIONS: Maternal AP was associated with insulin resistance in adult offspring through alterations in insulin signalling and inflammation pathways. The study provides information on the impact of maternal AP on the development of metabolic alterations such as insulin resistance in adult offspring and reinforces the importance of preventing maternal AP in order to maintain the general health of offspring.

Knowledge, attitude and behaviour regarding hepatitis C virus infection amongst Brazilian dental students.

AIM: Dental health professionals, including dental students, are at high risk of exposure to infection with the hepatitis C virus (HCV) through occupational percutaneous injuries and eye exposure. Further, fear of HCV infection is associated with discriminatory attitudes. The current study aimed to evaluate the knowledge about HCV infection amongst dental students and their attitudes towards patients infected with HCV. METHODS: A cross-sectional survey was conducted amongst 340 Brazilian dental students from two public universities using an instrument containing information regarding demographic characteristics, knowledge of HCV and attitudes towards patients with HCV infection. Descriptive statistics, Fisher's exact test, Student's t-tests, Mann-Whitney U-test and multiple logistic regression (MLR) were carried out (P < 0.05 was considered significant). RESULTS: Response rate was 90% (n = 306), and more than half (54%, n = 165) of participants had high knowledge level (above the mean); 97.7% (n = 299) demonstrated positive attitudes. MLR showed that high knowledge of dental students regarding HCV was substantially influenced by advancement in year of study (last year; P < 0.001) and type of university (federal; P = 0.049). Positive attitude towards HCV-infected patients was mainly influenced by age (P = 0.004) and male gender (P = 0.022). CONCLUSIONS: These results demonstrated a satisfactory knowledge about HCV infection amongst dental students, but some gaps were observed, suggesting the importance of continuous education about HCV in this population to prevent HCV infection as well as discrimination and prejudice towards patients with hepatitis C.

Factors affecting intention to breastfeed of a group of Brazilian childbearing women.

BACKGROUND: Knowing the intention of mothers is important to plan actions to improve exclusive breastfeeding rates. AIM: The objective of this retrospective study was to verify the intention to breastfeed and the intended breastfeeding duration of a group of women participating in a public prenatal dental care program in the city of Araçatuba, Brazil. METHODS: The records of 933 childbearing women were analyzed and their intention to breastfeed and intended breastfeeding duration were associated to women's age, ethnicity, marital status, education, employment, number of gestations, previous breastfeeding experience, previous breastfeeding guidance, presence of complications during pregnancy, and systemic diseases. Data were inserted into Epi Info 2000 and analyzed with Biostat, at a 5% level of significance, and confidence interval of 95%. FINDINGS: Participants mean age was 26.1±5.9years. The majority of women (96.5%) declared their intention to breastfeed their babies. The main variables to affect the intention to breastfeed were the number of gestations (p=0.001), previous breastfeeding experience (p=0.03), and previous breastfeeding guidance (p=0.01). Intended breastfeeding duration was significantly affected by women's age (p=0.04), employment (0.02), the number of gestations (p=0.001), and previous breastfeeding experience (p=0.04). CONCLUSIONS: Previous positive breastfeeding experience and guidance during prenatal examinations positively affected women's intention to breastfeed; while older, unemployed women in their second or more gestation and previous breastfeeding experience intended to breastfeed their children for longer periods of time.

Access of children to the oral health service.

BACKGROUND: Dental caries still affect a considerable proportion of children, however the epidemiological profile of oral diseases is changing, social inequalities cause different disease patterns. The same problems occur for the use of services, which damage those who are more susceptible to oral diseases in numerous ways. AIM: To verify the association between the variables: socioeconomic condition, oral health and access to dental services providing oral health care for preschool children. METHODS: The study population consisted of 2,759 children up to 6 years-old. The clinical exams followed the World Health Organization (WHO) criteria. The data were collected using a self-applied questionnaire, answered by the carers of children, with questions about socioeconomic variables and access to dental services. RESULTS: In terms of social class, a majority of the subjects came from the middle socioeconomic level (babies, 84.7%; children, 82.8%). Babies who had caries, 48.4% and 67.2% of the children that had decayed teeth had access to dental service. There was a association between the variables: the reason for the last dental appointment and the parent's perception of the treatment need of their children (babies p=0.0004 and children p < 0.0001); the parent's perception of the treatment need of their children and the oral health condition (babies p=0.0008 and children p < 0.0001); access to dental services and oral health condition (babies p=0.0021 and children p < 0.0001). CONCLUSION: The majority of the population studied sought care from public dental service and was from the middle class.

Analysis of association between posterior crossbite, median line deviation and facial asymmetry / Análisis de la asociación entre mordida cruzada posterior, desviación de la línea mediana y asimetría facial

Facial asymmetry is a common human characteristic and can occur on many levels, originate of genetic factors, and can be caused by traumas or due to cross bite and/or muscular disability. The aim of this study was to evaluate the relation between posterior crossbite, median line deviation and facial asymmetry. For this study 70 children aged between 3 and 10 years-old were examined and photographed. Using Microsoft Office Power Point 2007, horizontal lines and one vertical line on median line were drawn, to subjectively analyze facial discrepancies. In relation to overjet, the majority of children (78.6%) showed normal relation, followed by high overjet (17.1%), anterior crossbite (4.3%). In relation to overbite, the majority of children (60%) showed normal relation, 27.1% anterior opened bite (negative overbite), and 12.9% showed high overbite. Posterior crossbite was present in 27.1% of children. Among them, 68.4% showed unilateral crossbite on right side, 21.1% bilateral crossbite and 10.5% unilateral crossbite on left side. The relation between posterior crossbite and facial asymmetry, according to Fisher´s Exact Test (p=0.0970), there was no statistically significant association. In relation to median line, the association was statistically significant with posterior crossbite (p=0.0109) and with facial asymmetry (p=0.0310). There was association between posterior crossbite and median line deviation. There was no association between posterior crossbite and facial asymmetry

La asimetría facial es una característica humana común que puede ocurrir en diferentes niveles, originarse por factores genéticos, ser causada por traumas o mordida cruzada como resultado o discapacidad muscular. El objetivo de este estudio fue evaluar la relación entre la mordida cruzada posterior, desviación de la línea mediana y asimetría facial. Fueron evaluados 70 niños entre 3 y 10 años de edad mediante examen clínico y fotográfico. Utilizando Microsoft Power Point Office 2007, se dibujaron líneas horizontales y una línea vertical en la línea mediana, para analizar subjetivamente las diferencias faciales. En relación con el resalte, la mayoría de los niños (78,6%) mostró relación normal, seguido por un resalte aumentado (17,1%) y mordida cruzada anterior (4,3%). En relación con la sobremordida, la mayoría de los niños (60%) mostró relación normal, 27,1% una mordida abierta anterior (sobremordida negativa) y 12,9% mostró una sobremordida aumentada. La mordida cruzada posterior estuvo presente en 27,1% de los niños. Entre ellos, el 68,4% presentaba mordida cruzada unilateral del lado derecho, 21,1% mordida cruzada bilateral y el 10,5% mordida cruzada unilateral en el lado izquierdo. No hubo asociación estadísticamente significativa entre la mordida cruzada posterior y asimetría facial según la prueba exacta de Fisher (p=0,0970). En relación a la línea mediana, se observo una asociación estadísticamente significativa entre mordida cruzada posterior (p = 0,0109) y asimetría facial (p=0,0310). Existe asociación entre la mordida cruzada posterior y la desviación de línea mediana. No hubo asociación entre la mordida cruzada posterior y asimetría facial

Risk factors in the mother-child relationship that predispose to the development of early childhood caries.

AIM: This study focused on the risk factors in mother-child relationship that predispose babies to the development of dental caries. METHODS: A prospective cohort study with 80 mother-child pairs was conducted. The mothers responded at 12, 18 and 30 months after their children's birth, to questions about variables related to diet, sucking habits, and oral care. Children were clinically examined to verify caries lesions (white spot lesions or cavitation). Data were analysed using Chi squared or Fisher's exact tests. The significance level was set at 5%. RESULTS: Of the total, 3.75% showed cavitated lesions after 18 months; 6.25 and 45% had spot white lesions, respectively, at 18 and 30 months. The cariogenic diet was high at 12 (63.75%) and 30 (88.75%) months. Good oral hygiene was present in a minority of children at 12 months (46.25%), but increased at 30 months (65%), helping to prevent cavities and white spot lesions over this period (p = 0.0005). The variables of the blocks sucking habits and diet were not associated with caries. CONCLUSION: The lack of oral care in children was a risk factor for dental caries development.

Prevalence of deciduous tooth erosion in childhood.

OBJECTIVES: The objective of this study was to estimate the prevalence of deciduous tooth erosion and to identify possible associations with sex, age and toothbrushing frequency in children aged 4-6 years. METHODS: The sample was drawn from attendants (n = 7058) of 57 public preschools in a Brazilian city. Tooth wear index was used to evaluate erosion. Descriptive statistical analysis consisted of the calculation of the prevalence of dental erosion; chi-squared and Fisher's exact tests were performed to verify the association between dental erosion and sex, age and toothbrushing frequency. RESULTS: Two thousand and seven hundred and fifty-nine preschool students were examined. Deciduous tooth erosion was observed in 0.6% of children and its incidence did not differ between sexes. The highest prevalence was observed in children aged 6 years (58.3%) and the most affected sextants were the fourth (22.86%) and sixth (20.00%), indicating that lingual and occlusal tooth surfaces were most frequently involved. The degree of involvement was classified as incipient in 54.29% of children and moderate in 45.71%. The significance level was set at 5%. No association was found between erosion and sex, age or toothbrushing frequency. CONCLUSIONS: The prevalence of deciduous tooth erosion was low in Brazilian children, and this disorder is not considered a public health problem in this part of the population.

Dental students' knowledge of ergonomic postural requirements and their application during clinical care.

AIM: To examine how much final-year undergraduate dental students know about postural dental ergonomic requirements, and how well they apply these requirements clinically. BACKGROUND: Dentists are vulnerable to diverse mechanical (e.g. postural) and non-mechanical occupational risks. MATERIALS AND METHODS: Eight postural requirements found in normalising documents were identified, reproduced, photographed, and analysed to develop a test of visual perception (TVP). Photographs of the 69 participating students were taken during their clinical care to ascertain ergonomics compliance, after which the students were administered the TVP. Pearson's test was used to correlate the level of knowledge (TVP) and its clinical application (photographic analysis) among the 552 observations made for each test (total of 1104 observations). RESULTS: 65.7% of the TVP questions were answered correctly and 35% of the photographic cases were in compliance with ergonomic requirements (+ 0.67, P < 0.0001). CONCLUSION: The knowledge of ergonomics postural requirements and their clinical application among the dental students surveyed were not satisfactory. The reasons for the learning difficulties encountered by the students should be identified to improve the learning process. The didactic use of digital images in this study may help in this endeavour.

Evaluation of toothbrush bristles' deterioration used by preschool children.

The toothbrush is an effective instrument for oral diseases prevention. The flexibility and status of bristles, as well as the size of the handle are fundamental for an effective toothbrushing. Thus, the assessment of physical characteristics of toothbrushes is important. This study evaluated the deterioration and wear of bristles of toothbrushes used by preschool children. For the sample selection, five elementary schools were assorted from a city of the São Paulo State northwest region, one from each city area. All toothbrushes used by preschool children who aged between 5 and 6 years old and who attended the assorted schools were visually analysed by two calibrated examiners, according to the criteria proposed by Rawls HR, Mkwayi-Tulloch NJ, Casella R, Cosgrove R (J Dent Res 1989; 12:1781): 0 - it is impossible to state if the toothbrush was used or not; 1 - the bristles seem to be separated within some tufts; 2 - most tufts are separated, many cover other tufts and present a large number of curved and inclined bristles; 3 - most tufts are covered by others and bristles are folded and tipped. In total, 333 toothbrushes were evaluated. The data obtained revealed that 57.96% of the toothbrushes presented adequate condition for utilization (scores 0 and 1), whereas 42.04% presented inadequate bristles for their function (scores 2 and 3). It was concluded that a great number of toothbrushes presented deterioration of the bristles. Thus, there is the need to guide and promote awareness among teachers, parents and children as well as the need to replace toothbrushes.

Assessment of the diet of 0- to 6-year-old children in municipal schools in a Brazilian city.

Diet control is one of the important factors in the prevention of dental caries because food functions as substratum for fermentation and, consequently, for the formation of the organic acids that demineralize the tooth surface. This study aims to descriptively assess school diet and the associated caries-preventive methods applied to children in all municipal nursery schools of a Brazilian city (Aragatuba/SP). For this, a questionnaire with open and closed questions was used. The results showed that all schools serve school meal, which is composed mainly of sugar, carbohydrates, and proteins. The students enjoy the meal very much because for most of them, the meal served at school is the only source of food. It was observed that 90% of the schools offer other kinds of food besides the main school meal. The snacks served such as cakes, white hominy, and milk fudge are composed of sweet and highly cariogenic foods. It was also verified that in 13.30% of the schools, the daily supervised dental hygiene, an important procedure that should not be neglected, is not carried out. This procedure introduces the children to healthy habits that are added to those acquired in the family environment. It was concluded that the school diet is potentially cariogenic and, in association with the lack of daily dental hygiene, this potential may become even higher.

El consentimiento informado en la clínica odontológica

El consentimiento informado (CI) es la aprobación del individuo expresada a él en lenguaje accesible, antes de empezar el tratamiento, teniendo como base sus aspectoséticos-legales el Código de Ética dontológica, Civil y Penal y la Resolución 196/96. Aunque sea importante como modo de protección judicial para el cirujano-dentista, difícilmente se utiliza en la clínica odontológica. Fue objeto de este estudio elevaluar el conocimiento y prácticas de los cirujanos-dentistas sobre el CI, verificarse la presentación y decisión del tratamiento propuestas al paciente y clase de documento utilizado por cirujanos-dentistas en la clínica odontológica. Los sujetos de esta encuesta eran todos cirujanos-dentistas del municipio de Lucélia, São Paulo, Brasil. Como instrumento de colecta de datos, se elaboró un cuestionario conteniendo 11 cuestiones discursivas y de elección múltiple, dividido en tres partes temáticas: el CI, el contrato de prestación de servicios y el plan de tratamiento. Para interpretación de cuestiones discursivas, fue preconizada la técnica de Análisis de Contenido. Los resultados sugieren que la mayoría de los cirujanos-dentistaspresenta deficiencia al que se refiere al conocimiento acerca del CI, mientras otrosdesconocen totalmente el tema. Su aplicación no se realiza de manera satisfactoria, yla autorización es el documento más utilizado en la clínica odontológica. El tratamiento a realizarse depende de la decisión conjunta del paciente y profesional, presentándoselo al cliente de manera clara. De esa manera, se hacen necesarias la sensibilización y capacitación de los profesionales para la práctica del CI como rutina en la clínica odontológica.