Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial.

OBJECTIVE: To compare dental arch relationships in children with unilateral cleft lip and palate (UCLP) between two surgical techniques for repair of cleft lip/palate and two ages of palate repair. SETTINGS AND SAMPLE: Dental models were taken for a group of 448 subjects at a mean age of 7 years and were evaluated by means of the Goslon Yardstick. The patients studied consisted of an initial group of 673 infants with complete UCLP randomized into 8 study groups according to lip repair procedures (Millard versus Spina techniques); palate repair procedures (von Langenbeck versus Furlow techniques); and palate repair timing (early: 9 to 12 months versus late: 15-18 months). METHODS: Four surgeons performed all surgeries. Dependent variables included the following: lip repair technique, palate repair technique, age at time of palate repair and surgeon; with sex as an independent variable. The data were analysed using a general linear model (P < .05). RESULTS: There were no significant differences for occlusal index scores as a function of lip or palate surgical technique, palatal repair timing and sex. Significant differences were found for occlusal index scores as a function of the surgeon. CONCLUSION: Dental arch relationships were not influenced by lip and palatal repair techniques or patient age at palatal repair. The surgeon was the major factor that influenced the dental arch relationship outcome.

Mesial and distal alveolar bone morphology in maxillary canines moved into the grafted alveolar cleft: Computed tomography evaluation.

INTRODUCTION: The aims of this study were to qualitatively assess the mesial and distal alveolar bone of maxillary canines mesially moved to replace absent lateral incisors in patients with unilateral cleft lip and palate after secondary alveolar bone graft and to assess the reproducibility of the proposed cone-beam computed tomography (CBCT) method. METHODS: The sample comprised CBCT examinations of 30 patients with unilateral cleft lip and palate from 1 center. CBCT images were taken at least 6 months after comprehensive orthodontic treatment. The noncleft side was used as the control group. Using axial sections, scores from 0 to 4 (bone absence to complete bone filling, respectively) were given to the mesial and distal alveolar bones of the maxillary canines. Interexaminer and intraexaminer reproducibility was assessed using kappa statistics. Intergroup comparisons were performed using Wilcoxon tests. RESULTS: Interexaminer and intraexaminer agreement was excellent. Intergroup comparison identified smaller scores at the cervical and middle root levels of the cleft side mesial alveolar bone of the maxillary canines. At the cleft side, 85 mesial sites showed favorable scores (3 or 4); 1 had a score of 1, and 4 had scores of 2. At the distal surface, 78 sites were evaluated, and only 1 site received a score of 1. The noncleft side had scores of 4 for all sites. CONCLUSIONS: The new CBCT scale showed good reproducibility. CBCT axial sections are reliable for a qualitative appraisal of alveolar bone in a grafted alveolar cleft. Mesial bone defects can be observed in maxillary canines moved into grafted areas after comprehensive orthodontic treatment, especially at the cervical root half.

Taurodontism, Root Dilaceration, and Tooth Transposition: A Radiographic Study of a Population With Nonsyndromic Cleft Lip and/or Palate.

OBJECTIVES: In an effort to contribute to proper dental planning and define possible dental phenotypes of nonsyndromic cleft lip and/or palate (CL/P), this study aimed to investigate the occurrence of taurodontism, root dilaceration, and tooth transposition in persons with nonsyndromic CL/P, specifically analyzing the differences among gender, cleft types, and the most affected teeth. DESIGN: This retrospective study analyzed 974 panoramic x-rays from nonsyndromic Brazilians older than 16 years and categorized into the following four groups: group 1, 250 persons with unilateral cleft lip and palate; group 2, 250 persons with unilateral cleft lip; group 3, 224 persons with cleft palate; and a control group of 250 persons without clefts. Radiographs were digitalized with a scanner and analyzed. RESULTS: In the Brazilian population studied, the prevalence of taurodontism was 60.4% in group 1, 62.4% in group 2, 67.0% in group 3, and 42.8% in the control group. Root dilacerations had a prevalence of 31.2% in group 1, 29.6% in group 2, 26.3% in group 3, and 27.2% in the control group. The teeth most affected by taurodontism were 17 and 27; whereas root dilacerations were most common in teeth 38 and 48. No tooth transpositions were found in any radiograph analyzed. CONCLUSIONS: Taurodontism is significantly more prevalent in Brazilians with nonsyndromic CL/P than in persons without clefts; whereas the prevalence of root dilaceration no different from that in the control group. However, root dilacerations in anterior teeth were increased in groups 1 and 2 when compared to the control group.

Sublingual ketorolac and sublingual piroxicam are equally effective for postoperative pain, trismus, and swelling management in lower third molar removal.

OBJECTIVE: Lower third molar removal provides a clinical model for studying analgesic drugs. The present study's aim was to compare the clinical efficacy of sublingual ketorolac and sublingual piroxicam in managing pain, trismus and swelling after lower third molar extraction in adult volunteers. STUDY DESIGN: In this double-blinded, randomized, crossover investigation, 47 volunteers received for 4 days ketorolac sublingually (10 mg 4 times daily) and piroxicam sublingually (20 mg once daily) during 2 separate appointments after lower third molar extraction of symmetrically positioned lower third molars. A surgeon evaluated objective parameters (surgery duration, mouth opening, rescue analgesic medication, and facial swelling) and volunteers documented subjective parameters (postoperative pain and global evaluation), comparing postoperative results for a total of 7 days after surgery. The means of the objective and subjective parameters were compared for statistical significance (P < .05). RESULTS: Volunteers reported low pain scores during the postoperative period when treated with either sublingual ketorolac or piroxicam. Also, volunteers ingested similar amounts of analgesic rescue medication (paracetamol) when they received either drug sublingually (P > .05). Additionally, values for mouth openings measured just before surgery and immediately after suture removal 7 days later were similar among volunteers (P > .05), and the type of nonsteroidal antiinflammatory drug (NSAID) used in this study showed no significant differences between swellings on the second or seventh days after surgery (P > .05). CONCLUSIONS: Pain, trismus, and swelling after lower third molar extraction, independent of surgical difficulty, were successfully controlled by sublingual ketorolac (10 mg 4 times daily) or sublingual piroxicam (20 mg once daily), and no significant differences were observed between the NSAIDs evaluated.

Fat cell invasion in long-term denervated skeletal muscle.

There are several differences between red and white muscles submitted to different experimental conditions, especially following denervation: a) denervation atrophy is more pronounced in red than white muscles; b) the size of the fibers in the red muscles does not vary between different parts of the muscle before and after denervation, when compared to white muscles; c) the regional difference in the white muscles initially more pronounced after denervation than red muscle; d) red muscle fibers and fibers of the deep white muscle present degenerative changes such as disordered myofibrils and sarcolemmal folds after long-term denervation; e) myotube-like fibers with central nuclei occur in the red muscle more rapidly than white after denervation. Denervation of skeletal muscles causes, in addition to fibers atrophy, loss of fibers with subsequent regeneration, but the extent of fat cell percentage invasion is currently unknown. The present article describes a quantitative study on fat cell invasion percentage in red m. soleus and white m. extensor digitorum longus (EDL) rat muscles at 7 weeks for up to 32 weeks postdenervation. The results indicate that the percentage of fat cells increase after denervation and it is steeper than the age-related fat invasion in normal muscles. The fat percentage invasion is more pronounced in red compared with white muscle. All experimental groups present a statistically significant difference as regard fat cell percentage invasion.

Prevalence of four putative periodontopathic bacteria in saliva of a group of Brazilian children with mixed dentition: 1-year longitudinal study.

AIM: This study aimed at evaluating the prevalence of putative periodontal pathogens (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella nigrescens, Treponema denticola) in saliva of children with mixed dentition at two different time points, correlating these findings with a clinical parameter of gingival health. DESIGN: Polymerase chain reaction (PCR) detection was used to determine the prevalence of these bacteria in saliva of 64 children in 2003 and 60 children in 2004. Gingival health was assessed by gingival index. RESULT: Sixty-two (96.9%) and 50 (83.3%) children presented low gingival inflammation, whereas 2 (3.1%) and 10 (16.7%) had moderate scores in 2003 and 2004, respectively. Majority of the children (81.3% in 2003 and 73.3% in 2004) had detectable levels of at least one of the bacteria. The prevalence found was of 4.7% and 1.7% for A. actinomycetemcomitans, 6.3% and 8.3% for P. gingivalis, 23.4% and 48.3% for P. nigrescens (P < 0.05), and 71.9% and 50% for T. denticola (P < 0.05) in 2003 and 2004, respectively. No significant relationship between gingival index and presence of these bacteria and combination of different species was found. CONCLUSION: A high percentage of children harboured at least one of the putative periodontal pathogens in saliva, but presented periodontally healthy conditions.

Effect of caries preventive measures directed to expectant mothers on caries experience in their children.

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3% of the infants in the control group and 14.7% in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors.

Effect of caries preventive measures directed to expectant mothers on caries experience in their children

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3 percent of the infants in the control group and 14.7 percent in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors

[Periodontal conditions and diabetes mellitus in the Japanese-Brazilian population]. / Condições periodontais e diabetes mellitus na população nipo-brasileira.

OBJECTIVE: To evaluate the relationship between diabetic status and periodontal conditions in the Japanese-Brazilian population. METHODS: The sample consisted of 1,315 subjects, of both sexes, first (Issei) and second (Nisei) generations, aged 30 to 92 years, living in Bauru, Brazil. Edentulism and presence of 6 null sextants were the exclusion criteria for the sample. The Community Periodontal Index and Periodontal Attachment Loss Index were determined using the probing of 10 teeth in a sample of 831 subjects. The diagnosis of diabetes mellitus was based on fasting blood sugar and blood sugar 2 hours after 75 mg of glucose overload. Statistical analysis was conducted using Kappa test and Chi-square test. RESULTS: Regarding periodontal conditions, 25.5% of the sample were healthy people, 12.5% showed bleeding on probing, 49.4% calculus, 10.4% pockets of 4-5 mm deep, and 2.2% pockets deeper than 6 mm. The percentage of subjects with an attachment loss of 0-3 mm was 24.2%; 4-5 mm, 36.7%; 6-8 mm, 23.7%; 9-11 mm, 11.3%; and up to 12 mm or more, 4.1%. The association between the periodontal condition and diabetes mellitus showed no statistical significance (p<0.05), although diabetic subjects have a higher percentage of deeper pockets and attachment loss >6 mm than non-diabetics, as tested by Chi-square test. CONCLUSIONS: Epidemiological studies relating oral health and systemic disease, such as diabetes mellitus, can provide important contributions for preventing the worsening of such diseases.

Condiçöes periodontais e diabetes mellitus na populaçäo nipo-brasileira / Periodontal conditions and diabetes mellitus in the Japanese-Brazilian population

OBJETIVO: Avaliar as condiçöes periodontais e sua relaçäo com o diabetes mellitus na populaçäo nipo-brasileira. MÉTODOS: Foram examinados 1.315 indivíduos do município de Bauru, SP, na faixa etária de 30 a 92 anos de idade, ambos os sexos, primeira (Isseis) e segunda (Niseis) geraçöes. Os critérios de exclusäo da amostra foram o edentulismo total e a presença de seis sextantes nulos. O índice periodontal comunitário e o índice de perda de inserçäo periodontal foram obtidos mediante sondagem em 10 dentes-índice, em uma amostra de 831 indivíduos. O diagnóstico de diabetes mellitus foi estabelecido através da glicemia em jejum e de duas horas após sobrecarga com 75 g de glicose. Para análise estatística foram utilizados os Testes de Kappa e de Qui-quadrado. RESULTADOS: Quanto às condiçöes periodontais, foram encontrados 25,5 por cento de indivíduos sadios, 12,5 por cento com sangramento à sondagem, 49,4 por cento com presença de cálculo, 10,4 por cento com bolsas superficiais, 2,2 por cento com bolsas profundas. Apresentaram perdas de inserçäo periodontal de 0-3 mm, 24,2 por cento dos indivíduos, de 4-5 mm, 36,7 por cento, de 6-8 mm, 23,7 por cento, de 9-11 mm, 11,3 por cento e de 12 mm ou mais, 4,1 por cento. A avaliaçäo entre diabetes e condiçöes periodontais näo apresentou associaçäo estatística (p<0,05), embora os indivíduos com diabetes tenham maiores percentuais de bolsas profundas e perdas de inserçäo maiores que 6mm que os näo diabéticos, quando testados pelo método do Qui-quadrado. CONCLUSOES: A abordagem epidemiológica da condiçäo periodontal e sua associaçäo com doenças sistêmicas, como o diabetes mellitus, pode oferecer importante contribuiçäo para prevenir suas complicaçöes