Impact of the COVID-19 pandemic on sleep bruxism among adolescents in Brazil: A longitudinal study.

AIM: To evaluate the immediate and late impact of the COVID-19 pandemic on the occurrence of possible sleep bruxism (SB) among adolescents in Brazil. DESIGN: This is a longitudinal study performed with adolescents (11-15 years old) from Southern Brazil. Baseline data were collected before the Brazilian COVID-19 outbreak (T1). Posteriorly, data were collected after 3 (T2) and 15 months under the Brazilian COVID-19 outbreak. The possible SB was evaluated by the question: 'Do you grind your teeth during your sleep?'. Sociodemographic, psychosocial and clinical variables were also collected. Changes in SB were evaluated by multilevel logistic regression models for repeated measures. RESULTS: Of the 290 adolescents assessed at T1, 182 were reassessed at both follow-ups. The prevalence of possible SB was 13% at T1, 11% at T2 and 22% at T3. There were no immediate effects of the COVID-19 pandemic on the occurrence of possible SB (T2). Adolescents had odds 2.77 times greater of presented possible SB after 15 months (T3) of COVID-19 pandemic scenarios when compared to T1. CONCLUSION: There was a considerable and late increase in the possible SB in adolescents in Brazil during the COVID-19 pandemic.

Pathways to dental fear from childhood to adolescence: A 10-year cohort study.

BACKGROUND: Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence. AIM: This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time. DESIGN: This is a prospective cohort study, with 10 years of follow-up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1-5 years from Southern Brazil. For this study, the follow-up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Socio-economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS-DS scores at T2. RESULTS: Of the 639 children, 429 were re-evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow-up. CONCLUSION: Our findings suggest that socio-economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence.

Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort.

OBJECTIVE: Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time. MATERIAL AND METHODS: This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time. RESULTS: About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90). CONCLUSION: There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups. CLINICAL RELEVANCE: The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.

Sense of coherence moderates the relationship between perceived racial discrimination and oral health-related quality of life in schoolchildren.

AIM: To evaluate the moderating effect of the sense of coherence (SOC) in the relationship between racial discrimination and oral health-related quality of life (OHRQoL) in schoolchildren. METHODS: This is a cross-sectional study nested in a cohort performed in southern Brazil. OHRQoL was assessed using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The perception of racial discrimination was measured using a question contained in the Bullying Questionnaire by Olweus, and SOC through the shortened version of the 13-item Sense of Coherence Scale. Sociodemographic and dental caries following the International Caries Detection and Assessment System (ICDAS) characteristics were also collected. A simple slop test and Poisson regression analysis were performed to test the interaction effects of the predictors on OHRQoL. RESULTS: A total of 429 schoolchildren were included in this study. About 6.7% reported had perceived racial discrimination. The simple slope test indicated that the negative effects of racial discrimination on OHRQoL were significant under different SOC levels. Among schoolchildren who suffered racial discrimination, those who had higher SOC reported lower impact on OHRQoL when compared to those with low SOC. CONCLUSION: SOC can be considered a moderating variable in the relationship between racial discrimination and OHRQoL. CLINICAL SIGNIFICANCE: These findings highlight that psychosocial factors such as SOC could attenuate the impact of perceived discrimination on OHRQoL in adolescence.

Effect of the COVID-19 pandemic on behavioural and psychosocial factors related to oral health in adolescents: A cohort study.

BACKGROUND: The impact of the COVID-19 pandemic on behavioural and psychosocial aspects related to oral health is unknown. AIM: This study evaluated the psychosocial and behavioural changes related to oral health in adolescents immediately before and during the pandemic period of COVID-19, enabling a longitudinal assessment of the perceived changes. DESIGN: This cohort study evaluated 290 adolescents from November 2019 to February 2020 (T1-before the pandemic in Brazil) and from June to July 2020 (T2) in southern Brazil. Sociodemographic, behavioural, and psychosocial variables were measured before and during the pandemic. Issues related to social distancing and job loss were also collected. The differences between the variables in T1 and T2, as well as the effect of social distancing, were assessed using a multilevel-adjusted logistic regression model for repeated measures. RESULTS: A total of 207 adolescents were re-evaluated at T2 (a response rate of 71.3%). During the pandemic, the frequency of toothbrushing, the use of dental services, and the self-perceived need for dental treatment significantly decreased. Sugar consumption, bruxism, and quality of sleep did not change significantly. CONCLUSION: Behavioural and psychosocial factors showed significant changes due to the COVID-19 pandemic in adolescents.

Incidence and prognosis of crown discoloration in traumatized primary teeth: A retrospective cohort study.

BACKGROUND/AIM: Knowledge of factors influencing the occurrence of crown discoloration following traumatic dental injuries in primary teeth and understanding its possible consequences can help dentists to provide appropriate care. The aim of this retrospective cohort study was to investigate the incidence of crown discoloration following trauma in primary teeth. This study also estimated the risk of pulp necrosis with subsequent infection of the root canal system and pulp canal obliteration in discolored teeth. MATERIAL AND METHODS: Records of children treated at the specialized trauma center of the Federal University of Pelotas during a period of 10 years were analyzed. Patient details including the type of injury, presence of crown discoloration, pulp necrosis, and pulp canal obliteration were collected. Photographs of teeth with crown discoloration were assessed to evaluate the color presented (yellow or dark). Chi-square tests and Poisson regression were used for data analyses (P < .05). RESULTS: A total of 355 children with 628 traumatized teeth were included in the study. The incidence of crown discoloration was 27.9%, and 20.5% of the teeth were affected. Discoloration was higher in children whose age at the time of trauma was 2-4 years (P = .020), and it was associated with the type of injury (P = .019). Discolored teeth had a twofold risk of pulp necrosis and subsequent infection of the root canal system (RR 1.98 95% CI 1.42-276; P < .001) and a higher risk of pulp canal obliteration (RR 8.47; 95% CI 4.95-14.51; P < .001) than did teeth without discoloration. Teeth with dark and yellow discoloration were significantly associated with pulp necrosis and pulp canal obliteration, respectively (P < .001). CONCLUSIONS: This study demonstrates the importance of monitoring traumatized primary teeth with crown discoloration, particularly those appearing darker, owing to their higher risk of pulp necrosis and subsequent infection of the root canal system.

Estudo de 19 anos dos procedimentos odontológicos realizados no Sistema Único de Saúde brasileiro / A 19-years study of the dental procedures performed in the Brazilian Unified Health System

Resumo Introdução A saúde pública no Brasil sofreu grandes mudanças nas últimas décadas. Objetivo Descrever o panorama da produção odontológica realizada pelo SUS de 1999 a 2017 no Brasil e suas macrorregiões. Método Os dados foram obtidos no Sistema de Informação Ambulatorial (SIA-SUS) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram criadas taxas de procedimentos (por 100 mil habitantes/ano) realizados em cada macrorregião: procedimentos restauradores, protéticos, coletivos, endodontia, exodontia, periodontia e preventivos de 1999 a 2017. A análise estatística das séries temporais foi realizada utilizando um modelo de regressão linear. Resultados Procedimentos protéticos e de periodontia foram os únicos que apresentaram uma tendência linear positiva em todas as macrorregiões brasileiras (p<0,001). A Endodontia não apresentou tendência positiva no Brasil (p=0,173). Restaurações apresentaram um crescimento na macrorregião Norte (p=0,003) e Centro-Oeste (p<0,001). Exodontias apresentaram na macrorregião Norte uma tendência de aumento (p=0,046) enquanto que, no Centro-Oeste, apresentaram uma diminuição (p=0,049). Procedimentos preventivos (p=0,042) e coletivos (p=0,017) apresentaram uma diminuição da sua produção durante o período. Conclusão A saúde bucal apresentou um grande crescimento dentro do Sistema Único de Saúde nos 19 anos avaliados. Procedimentos de periodontia e de prótese dentária foram aqueles com as maiores tendências de crescimento.

Abstract Background Public health in Brazil has undergone major changes in recent decades. Objective To describe the overview of dental production performed by the Brazilian Unified Health System from 1999 to 2017 in Brazil and its macroregions. Method Data were obtained from the Outpatient Information System (SIA/SUS) and from the Brazilian Institute of Geography and Statistics (IBGE). Procedures rates (per 100,000 inhabitants per year) were established in each macroregion: restorative, prosthetic, collective, endodontic, exodontia, periodontic and preventive procedures. Statistical analysis of the time series was performed using a regression linear model. Results Prosthetic and periodontal procedures were the only ones with a positive linear trend in all Brazilian macroregions (p<0.001). Endodontics did not show a positive trend in Brazil (p=0.173). Restorations showed a growth in the North (p=0.003) and Center-west (p<0.001) macroregions. Exodontia presented a tendency to increase in the North macroregion (p=0.046), while the Midwest presented a decrease of it (p=0.049). Preventive (p=0.042) and collective (p=0.017) procedures showed a decrease in their production during the period. Conclusion Oral health showed great growth within the single health system in the 19 years evaluated. Periodontal procedures and dental prostheses were those with the highest growth trends.

Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study.

OBJECTIVE: To investigate whether patients' skin color could exert an influence on the dentist's decision-making for treatment, in four different cities in Brazil. MATERIAL AND METHODS: Lists of dentists were obtained and the sample selection was performed systematically. Two questionnaires were produced for the same clinical case, but the images were digitally manipulated to obtain a patient with a black and a white skin color. Dentists were free to choose treatment without any restrictions, including the financial aspects. A random sequence (white or black) was generated which was placed at random in sealed, opaque envelopes. Dentists were questioned about the decision on the treatment of a severely decayed tooth and an ill-adapted amalgam restoration. RESULTS: A total of 636 dentists agreed to participate in the study. After adjustments (multinomial logistic regression), it was observed that the black patient with a decayed tooth had a 50% lower risk of being referred for prosthetic treatment (p = 0.023) and a 99% higher risk of receiving a composite resin restoration, compared to the white patient (p = 0.027). No differences were observed regarding recommendation for tooth extraction (p = 0.657). In relation to an ill-adapted amalgam, the black patient had less risk of receiving a referral replacement with composite resin (0.09 95%CI [0.01-0.82]) and finishing and polishing (0.11 5%CI [0.01-0.99]) compared with the white patient. CONCLUSION: Patient skin color influenced the dentist's choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures. CLINICAL SIGNIFICANCE: Skin color played an important role in dentists' treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.

Platelet-Poor Plasma as a Supplement for Fibroblasts Cultured in Platelet-Rich Fibrin.

The aim of this study was to evaluate the proliferation and adhesion of mesenchymal cells (3T3/NIH) in Dulbecco's Modified Eagle Medium(DMEM) supplemented with Platelet-Poor Plasma (PPP) in aPlatelet-Rich Fibrin (PRF) scaffold. Human blood was obtained and processed in a centrifuge considering the equation G=1.12xRx(RPM/1000)2 to obtain PRF and PPP.Cell adhesion and maintenance analyses were performed by MTTassays in a 96 well plate withsupplemented DMEM: PPP (90:10) for 24 hours. Besides, the PRF was deposited in a 48 well plate and 10x104 cells were seeded above each PRF (n=3) with 800µl of DMEM: PPP (90:10) and cultured for 7 days. Histological analysis and the immunohistochemical staining for Vimentin were performed. Results were analyzed by one-way ANOVA in Stata12®. A significant decrease (p<0.05) of cells adhesion in relationship to FBSwas observed. However, a similar ability of cell-maintenance for PPP 10% was observed (P>0.05). Fibroblasts culture for 7 days in PRF supplemented with PPP 10% was possible, showing positive staining for Vimentin. Therefore, PPP cell supplementation decreased the initial adhesion of cells but was able to maintain the proliferation of adhered cells and able to support their viability in PRF.It seems that this method has many clinical advantagessince it provides an autologous and natural scaffold with their respective supplement for cell culture by only one process, without using xenogeneic compounds. This could improve the potential of clinical translational therapies based on the use of PRF cultured cells, promoting the regenerative potential for future use in medicine and dentistry.

Terapias para regeneração do disco articular

O presente estudo revisou a literatura científica em busca das perspectivas e dos principais desafios enfrentados pelas terapias de regeneração do disco articular. Revisão de literatura: a disfunção temporomandibular (DTM) é uma desordem de etiologia multifatorial em que patologias, deformidades e mau posicionamento do disco da articulação temporomandibular (ATM) estão presentes em até 70% dos casos diagnosticados. Dessa forma, o emprego de conhecimentos e princí- pios da engenharia tecidual para o desenvolvimento de terapias que busquem a regeneração do disco articular pode ser uma opção de tratamento futuro. Células- -tronco mesenquimais (MSC) são frequentemente empregadas, apresentando a capacidade de se diferenciar em condrócitos e depositar tecido semelhante ao da ATM. Estudos têm apontado que essas células podem apresentar melhor regeneração que células removidas da própria ATM lesionada, que apresentam uma menor deposição de matriz extracelular. Abordagens para reconstrução têm empregado, principalmente, scaffolds sintéticos, como polímeros e hidrogéis, assim como scaffolds naturais de origem colágena. Esses materiais têm possibilitado a proliferação celular e a deposição de matriz extracelular. Técnicas de descelularização com diversos solventes orgânicos têm apresentado a capacidade de não desenvolver resposta imune, sendo possível sua utilização. A utilização de fatores de crescimento parece contribuir significativamente na sinalização e diferenciação celular, incrementando a deposição de tecido cartilaginoso. Considerações finais: apesar de a regeneração tecidual do disco articular se apresentar como uma provável opção de tratamento para os diversos tipos de DTM, a literatura ainda se encontra em fase inicial de investigação, com estudos predominantemente in vitro e in vivo.