Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties.

AIM: To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties. MATERIALS AND METHODS: An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied. RESULTS: The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques. CONCLUSION: Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found. CLINICAL RELEVANCE: Identify dentist's knowledge about MI.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH).

AIM: The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. METHODS: For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). RESULTS: MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. CONCLUSION: No association was found between dental fear and dental hypersensitivity in children with MIH.

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis.

OBJECTIVE: The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before. MATERIALS AND METHODS: Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. RESULTS: The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively. CONCLUSIONS: ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect. CLINICAL RELEVANCE: ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

Replacing amalgam with a high-viscosity glass-ionomer in restoring primary teeth: A cost-effectiveness study in Brasilia, Brazil.

OBJECTIVES: When planning primary oral health care services the cost implications of adopting new intervention practices are important, especially in resource-strapped countries. Although on a trajectory to be phased-out, amalgam remains the standard of care in many countries. METHODS: Adopting a government perspective, this study compared the costs of performing amalgam and ART/high-viscosity glass-ionomer cement (HVGIC) restorations and the consequences of failed restorations over 3 years in suburban Brasilia, Brazil. Cost data were collected prospectively; cost estimates were developed for the study sample and a projection of 1000 single- and 1000 multiple-surface restorations per group. Probabilistic sensitivity analysis was conducted in TreeAge Pro. RESULTS: Results were mixed. For single-surface restorations, ART/HVGIC will cost US$51 per failure prevented, while for multiple-surface restorations, ART/HVGIC was cost-effective with a savings of US$11 compared to amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost-effective 49.2% of the time compared to HVGIC at 50.6% of the time at a willingness to pay threshold of US$237 per failure prevented. Personnel accounted for more than half the cost burden for both methods; instruments and supplies accounted for about one third. The per restoration cost to replace amalgam with HVGIC ranges from US$1 to a savings of US$0.84. CONCLUSION: Replacing amalgam with a high-viscosity glass-ionomer as part of the ART method comes at a minimal increase in cost for governments. Increasing the number of restorations seems to diminish the cost burden. CLINICAL SIGNIFICANCE: ART/HVGIC could be considered a viable alternative to amalgam in primary teeth.

Caries-preventive Effect of Supervised Toothbrushing and Sealants.

To investigate the effectiveness of 3 caries-preventive measures on high- and low-caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-randomized controlled clinical trial covered 242 schoolchildren, 6 to 7 y old, from low socioeconomic areas. At baseline, caries risk was assessed at the tooth surface level, through a combination of ICDAS II (International Caries Detection and Assessment System) and fissure depth codes. High-caries risk occlusal surfaces were treated according to daily supervised toothbrushing (STB) at school and 2 sealants: composite resin (CR) and atraumatic restorative treatment-high-viscosity glass-ionomer cement (ART-GIC). Low-caries risk occlusal surfaces received STB or no intervention. Evaluations were performed after 0.5, 1, 2, and 3 y. A cavitated dentine carious lesion was considered a failure. Data were analyzed according to the proportional hazard rate regression model with frailty correction, Wald test, analysis of variance, and t test, according to the jackknife procedure for calculating standard errors. The cumulative survival rates of cavitated dentine carious lesion-free, high-caries risk occlusal surfaces were 95.6%, 91.4%, and 90.2% for STB, CR, and ART-GIC, respectively, over 3 y, which were not statistically significantly different. For low-caries risk occlusal surfaces, no statistically significant difference was observed between the cumulative survival rate of the STB group (94.8%) and the no-intervention group (92.1%) over 3 y. There was neither a difference among STB, CR, and ART-GIC on school premises in preventing cavitated dentine carious lesions in high-caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low-caries risk occlusal surfaces of first permanent molars over 3 y.

Minimal intervention dentistry in the management of the paediatric patient.

Minimal intervention dentistry (MID) is a philosophy of care that aims to conserve tooth tissues throughout a persons' life. This paper aims to review the literature on topics that are related to MID approaches for the management of dental caries and that can be applicable to the paediatric patient. Tools for caries diagnosis and early lesion detection are presented and discussed. More conservative and less invasive techniques for managing enamel and dentine carious lesions in primary and permanent teeth are compared to the traditional treatments. The traditional treatments are centred on the disease and on restoring its sequels, and have been shown to be insufficiently effective in controlling caries disease over time. In contrast, the MID philosophy has created potentially very suitable options for treating children that are considered more child-friendly, less anxiety provoking, preserve more tooth tissues and are equally good as the traditional treatments.

Ex vivo evaluation of caries infiltration after different application times in primary molars.

Low viscosity resins (infiltrants) have been shown to penetrate the lesion body of natural caries lesions almost completely in vitro. However, penetration depths (PD) have not been evaluated in vivo. Therefore, the aim of the present study was to evaluate the penetration of an infiltrant into proximal caries lesions in primary molars after different application times using an ex vivo model. 59 proximal lesions from 34 children were randomly allocated to one of the application times and were infiltrated under clinical conditions for 1, 3, or 5 min. After extraction or exfoliation (n = 48), teeth were sectioned perpendicular to their surfaces and lesion depths (LD) as well as lesion areas (LA) were evaluated using polarized light microscopy. PD and penetration areas (PA) were measured on scanning electron microscopic images. Percentage penetration depth (PPD) and percentage penetration area (PPA) were calculated. The mean (±SD) LD and LA were 596 ± 203 µm and 4.03 ± 2.75 × 10(5) µm(2), respectively. PPD ranged from 70 to 80% and PPA from 54 to 60%. Longer application times did not result in significantly deeper or more complete penetration (p > 0.05; ANOVA). In conclusion, proximal caries lesions in primary molars can be infiltrated in vivo to a similar extent as observed previously in vitro. Moreover, 1-min application of the infiltrant led to PD and homogeneity similar to those observed with longer application times up to 5 min.

Untreated cavitated dentine lesions: impact on children's quality of life.

The aim of the present investigation was to assess the impact of dental caries prevalence and the consequences of untreated cavitated dentine lesions on quality of life of 6- and 7-year-old Brazilian children. A total of 826 schoolchildren were assessed using ICDAS and pufa (to score consequences of dental caries on soft tissues) indices. History of extraction and toothache was recorded. Oral health-related quality of life was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). A multiple logistic regression model was used to analyze the relationship between the prevalence of dentine carious lesions, pufa, history of extraction and toothache with the B-ECOHIS scores. A total of 587 questionnaires were analyzed. The prevalence of cavitated dentine lesions and pufa was 74.8 and 26.2%, respectively. Some 21.8% of children reported toothache and 9.2% had had at least one tooth extraction. The chance (OR) for children with cavitated dentine lesions, pufa ≥1, history of extraction and toothache of having higher B-ECOHIS scores than those not affected was 1.90 (95% CI: 1.18-3.06), 6.26 (95% CI: 3.63-10.83), 6.87 (95% CI: 2.75-17.16) and 3.68 (95% CI: 2.12-6.39), respectively. Children's quality of life was negatively influenced by untreated cavitated dentine lesions and their consequences.

Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars.

OBJECTIVE: This study aimed to validate the MicroCT for detection of proximal carious lesions in primary molars, using histology as the gold standard. METHODS: Forty-eight proximal surfaces of primary molars were examined. Two calibrated examiners conducted the examinations independently. Proximal surfaces were visually scored, using ICDAS. Bitewing radiographs, Micro-CT and histological analyses used caries scores: 0=sound; 1=outer enamel; 2=inner enamel; 3=not spread dentine; 4=outer dentine; 5=inner dentine. Axial and sagital images were used for Micro-CT analysis, whilst for histology, tooth sections (400µm) were analyzed stereomicroscopically (×15). RESULTS: Inter-examiner agreement ranged from 0.87 to 0.93 kappa coefficient (k). Histological analysis revealed a frequency of sound tooth surfaces (18.8%) enamel carious lesions (E1) (48%) and dentine carious lesions (D1) (33.3%). MicroCT showed high correlation with histology (r(s)0.88). At both diagnostic thresholds (E1 and D1), sensitivity and accuracy were higher for MicroCT. Inter-device agreement between MicroCT and histology was k=0.81. No difference was found between MicroCT and histology as gold standards for detecting carious lesions using ICDAS. CONCLUSION: MicroCT can be used as a gold standard for detecting carious lesions in proximal surfaces in primary molars.

Patterns of dental anxiety in children after sequential dental visits.

AIM: To determine whether gradually exposing Brazilian children to the dental environment would decrease their levels of dental anxiety over a 14.5-month period. STUDY DESIGN AND METHODS: The study was carried out on 302 children of both genders, aged 6-7 years old. Dental anxiety was assessed using the Facial Image Scale (FIS) at five time points: 1) before an epidemiological examination; 2) before the first treatment session; 3) before the second treatment session; 4) before the first evaluation session 5) before the second evaluation session. STATISTICS: ANOVA, Student-t tests and ANCOVA were used to analyse the data. RESULTS: There was a statistically significant decrease in levels of dental anxiety between time points 1 and 5. Eighty-nine percent of the children with FIS score 1 or 2 at baseline had the same scores at the last time point, whereas 82% of children with FIS score 4 or 5 at baseline had a FIS score of 1 or 2 at the last time point. CONCLUSION: A gradual exposure of children to the dental environment in sequential dental visits of different natures in a school premise decreased their levels of dental anxiety over a 14.5-month period.

Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil.

Disadvantaged children suffer because tooth cavities are not being treated and their clinical consequences not being surveyed. The present study aimed to assess the prevalence and severity of clinical consequences of untreated dentine carious lesions in schoolchildren from a deprived area of Brazil and to investigate the determinants of the pufa index. A sample of 835 children aged 6-7 years, from six public schools, was examined by 3 calibrated examiners. Clinical consequences of untreated dentine carious lesions in primary teeth were diagnosed using the four codes of the pufa index: 'p' (pulpal involvement), 'u' (ulceration), 'f' (fistulae), 'a' (abscess). Effects of gender, age, school, history of extraction, and toothache on the prevalence of pufa codes were tested. The prevalence of pufa codes was 23.7%. The mean pufa score was 0.4 ± 0.9. Code 'p' was the most prevalent (19.5%), whereas code 'u' was least prevalent (0.1%). Children with a history of extracted primary teeth due to caries had a 2.7 times higher chance to have a pufa code than children with no previous extraction. Children with toothache had a 5.6 times higher chance to have a pufa code than children without toothache. The prevalence of clinical consequences of untreated dentine carious lesions was moderate and the severity was low. The pufa index is an epidemiological tool complementary to existing caries indices aimed to assess dental caries. However, there appears to be no need to include code 'u' nor to score codes 'f' and 'a' separately.

Absence of carious lesions at margins of glass-ionomer and amalgam restorations: a meta- analysis.

AIM: To report on the absence of carious lesions at margins of glass ionomer cement (GIC) and amalgam restorations. METHODS: Six Anglophone and 1 Lusophone databases were searched for articles up to 5 January 2008. Inclusion criteria for articles were: (i) titles/abstracts relevant to topic; (ii) published in English, Portuguese or Spanish language; (iii) reporting on a randomised control trial. Exclusion criteria were: (i) insufficient random allocation of study subjects (ii) operator and subject not blinded, where appropriate; (iii) not all entered subjects accounted for at trial conclusion; (iv) subjects of both groups not followed up the same way. Articles were accepted only if they complied with all the criteria. Ten articles complied with the inclusion criteria and were selected for review. From these 4 were rejected and 6 articles reporting on 8 separate studies accepted. Due to aspects of heterogeneity, studies were sub-grouped before meta- analysis. RESULTS: Significantly less carious lesions were observed on single-surface GIC restorations in permanent teeth after 6 years as compared to restorations with amalgam (OR 2.64 - CI 95% 1.39 - 5.03, p= 0.003). No studies investigating multiple-surface restorations on permanent teeth were identified. Studies investigating carious lesions at margins of restorations in primary teeth showed no difference between both materials after 3 and 8 years. CONCLUSIONS: Carious lesions at margins of single-surface GIC restorations are less common than with amalgam fillings after 6 years in permanent teeth. No difference was observed in primary teeth. More trials are needed in order to confirm these results.

The Escherichia coli K-12 sheA gene encodes a 34-kDa secreted haemolysin.

Haemolytic toxins belong to one of several classes of virulence factors that contribute to bacterial pathogenicity. The non-pathogenic Escherichia coli K-12 laboratory strain was considered for years to be non-haemolytic. However, overproduction of several transcriptional regulators induced the appearance of a haemolytic activity that is absent under usual laboratory growth conditions. In this work, we have cloned and characterized an E. coli K-12 gene, sheA, whose overexpression results in a haemolytic phenotype. It maps to min 27 on the genetic map, and codes for a 34-kDa polypeptide with at least one putative transmembrane segment. This polypeptide, which has neither signal peptide nor other known secretory motifs, is secreted to the medium during the exponential growth phase. In vitro coupled transcription/translation assays, using a plasmid carrying only the sheA gene as template, resulted in the production of a polypeptide with haemolytic activity per se. Our results demonstrate that the sheA gene actually encodes the E. coli K-12 chromosomal haemolysin. The SheA haemolysin does not resemble other known cytolytic toxins, and it may represent the prototype of a novel family, as suggested by the presence of homologues in several E. coli pathogenic strains and in Shigella flexneri.