Educational strategies and atraumatic restorative treatment effect on salivary characteristics: A controlled clinical trial.

OBJECTIVE: To evaluate educational strategies and atraumatic restorative treatment (ART)-restoration impact on salivary physicochemical and microbiological characteristics. DESIGN: Two groups of 6- to 7-year-old children were included: GART , with at least one decayed primary molar (n = 36), submitted to four sessions of oral health educational strategy (OHES) and ART restoration; GC , a paired caries-free group (n = 36), submitted to four sessions of OHES. Three evaluations were carried out: baseline, 1 week after OHES, and 1 month after OHES or ART, when biofilm and gingivitis frequencies, salivary flow, pH, buffer capacity, calcium and phosphorus concentrations were assessed. Total bacteria and Streptococcus mutans were quantified in unstimulated saliva (qPCR). RESULTS: Improvement in biofilm and gingivitis scores, salivary pH, and buffering capacity after OHES was observed in GC , with a decrease in total bacteria and S. mutans counts. GART also showed changes in salivary parameters, even before ART restoration was delivered, and total bacteria count remained lower than baseline 1 month after ART restoration, although a trend to increase the proportion of S. mutans was observed. CONCLUSION: Improvements in salivary physicochemical and microbiological characteristics were observed after educational strategies, thus reducing the caries risk of children with decayed teeth, although a trend to increase the S. mutans percentage was observed 1 month after ART restoration.

Assessment of quality of life, anxiety, socio-economic factors and caries experience in Brazilian children with overweight and obesity.

PURPOSE: This study evaluated the association between excess weight and quality of life (QoL), symptoms of anxiety, caries experience and socio-economic factors in a representative sample of 8- to 10-year-old children from three public schools of Piracicaba (SP, Brazil). MATERIALS AND METHODS: The Autoquestionnaire Qualité de Vie Enfant Image was applied to explore family and social relations, activities, health, body functions and separation domains, and, by means of the Multidimensional Anxiety Scale for Children, symptoms of anxiety were screened. Clinical examination was performed using DMFT/dmft indexes to assess oral health and caries experience. Medical and nutritional history, parents' schooling, monthly income and ownership of household goods and services were also evaluated. RESULTS: Of the 313 subjects included, four subjects were underweight, 188 normal weight, 67 overweight and 54 presented obesity (38.7% with excess weight). Measures of QoL, anxiety scores and caries experience did not differ between groups. The regression model showed a significant association between excess weight and the ownership of household goods and services (OR = 5.4/CI = 1.6-18.3). CONCLUSIONS: High prevalence of excess weight was observed among prepubertal children, emphasizing the need for continued health programmes to limit risk factors for obesity. QoL, anxiety scores and caries experience did not differ between subjects with different body weights, although children from public schools with higher ownership of goods and services were more likely to present excess weight.

Changes in the oral-health-related quality of life of Brazilian children after an educational preventive programme: an 1-month longitudinal evaluation.

OBJECTIVE: This 1-month longitudinal study assessed whether the oral status and the oral-health-related quality of life (OHRQoL) of children changed after four sessions of an educational preventive programme. STUDY POPULATION AND METHODS: Fifty Brazilian students (11-12 year old) were examined for signs and symptoms of gingivitis using the Community Periodontal Index and two questions about gingival bleeding. The OHRQoL was measured using the Brazilian Portuguese version of the Child Oral Impacts on Daily Performances (Child-OIDP). Higher scores indicated worse OHRQoL. The results were analysed using the Shapiro-Wilk, Chi-square, Wilcoxon signed-rank and Mann-Whitney tests. The magnitude of the mean change was calculated using the effect size. RESULTS: Twenty-four percentage of children had more than six sites with bleeding at follow-up compared with 58% at baseline. There was a significant decline in the intensity and extension of impacts at follow-up. A significant improvement in the clinical status and oral hygiene was observed for both transitional categories. There was a significant decline in the Child-OIDP scores of those reporting 'much improved'. A significant improvement in the global ratings of oral health was observed at follow-up. CONCLUSIONS: In the studied sample, an improvement occurred with respect to the severity of disease, intensity and extension of impacts and global ratings of oral health after 1-month follow-up. These results suggest that improving the global transition in health by enhancing coping and management skills while inducing slight changes in the clinical status and the specific aspects of health compromised by the disease is possible.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents.

OBJECTIVES: To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents. METHODS: One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Children's Manifest Anxiety Scale (R-CMAS) and Children's Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearson's correlation test, and multiple linear regression analyses. RESULTS: 11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Children's Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (ß =0.312; P < 0.001) and the OWB model retained TMD (ß = 0.271; P < 0.001) and CDI scores (ß=0.175; P < 0.05). CONCLUSIONS: Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Evaluation of masticatory performance and bite force in children with sleep bruxism.

The aim of this study was to evaluate the association between masticatory performance (MP) and bite force (BF) in children with sleep bruxism (SB) during the mixed dentition stage, considering also the occlusal characteristics. The sample was composed by 52 healthy children of both genders, aged 6-10 years. From those, 22 presented signs and symptoms of SB and 30 were the controls. SB diagnosis consisted of both parental report and presence of tooth wear. MP was evaluated by the individual's ability to communicate an artificial chewable test material for determining the median particle size (X50) and distribution of particles in the different sieves (b). BF was measured using a digital gnathodynamometer with fork strength of 8 mm. The results were submitted to descriptive statistics, Mann-Whitney and chi-square tests, Spearman's correlation and multiple logistic regression. Mean BF and X50 did not differ between groups with and without SB. A significant negative correlation was observed between BF and X50 only in the group of children with SB. Moreover, the logistic regression model showed an association between the presence of SB and higher b index. The other independent variables included in the model showed no association with SB. BF did not differ between children with and without SB. Besides, higher BFs in children with SB meant better MP; however, they were more likely to present chewed particles retained in the larger aperture sieves, consequently requiring more chewing cycles to break down the test material in smaller particles.

Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children.

OBJECTIVE: Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). STUDY DESIGN: In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after and one ten minutes later. Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wilcoxon (alpha = 0.05). RESULTS: Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. CONCLUSIONS: In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after the event; moreover a significant correlation between amylase levels and heart rate was observed Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

Aesthetic perception in children with molar incisor hypomineralization.

PURPOSE: To investigate the relationship between aesthetic perception and molar incisor hypomineralization (MIH) in schoolchildren aged 8-12 years. METHODS: The study included 467 pupils enrolled in elementary schools. Once authorization was received, the students were examined for DMFT and dmft indexes (WHO criteria), and for MIH (EAPD criteria). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA), a questionnaire divided into several items, including physical, psychological and social domains; perception about tooth pleasantness, tooth alignment, tooth discoloration and tooth health; and reported pleasant colour. Data analysis was carried out using descriptive statistics, the Chi-square, the Mann-Whitney and the Kruskal-Wallis tests, and linear regression at a significance level of 0.05. RESULTS: The tooth health perception was worse when the child had MIH, and the tooth alignment and tooth discoloration perceptions, when MIH affected the incisors. The number of teeth affected by MIH was associated with higher averages in the tooth discoloration perception. CONCLUSIONS: Children with MIH showed more negative perceptions toward tooth health, tooth alignment and tooth discoloration. However, none of the clinically investigated variables negatively impacted the reported pleasant colour question.

Oral health-related quality of life in children: part I. How well do children know themselves? A systematic review.

OBJECTIVE: Paediatric oral disorders are likely to have a negative effect on the quality of life. Until recently, children's oral health-related quality of life (OHRQoL) was measured using parents as informants. Instruments have now been developed, which have demonstrated that with appropriate questionnaire techniques, valid and reliable information can be obtained from children. The aim of this study was to make a systematic review of the existing literature about child perceptions of OHRQoL and their validation. METHODS: A computerized search was conducted using Medline, ISI, Lilacs and Scielo for children's perception of OHRQoL. The inclusion criteria were: the articles should contain well-validated instruments and provide child perceptions of OHRQoL. RESULTS: From 89 records found, 13 fulfilled the criteria. All studies included in the critical appraisal of the project suggested good construct validity of overall child perceptions of OHRQoL. However, children's understanding of oral health and well-being are also affected by variables (age, age-related experiences, gender, race, education, culture, experiences related to oral conditions, opportunities for treatment, childhood period of changes, back-translating questionnaire, children self-perceived treatment need). CONCLUSIONS: The structure of children's self-concept and health cognition is age-dependent as a result of their continuous cognitive, emotional, social and language development. By using appropriate questionnaire techniques, valid and reliable information can be obtained from children concerning their OHRQoL.

Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review.

OBJECTIVE: Children are affected by numerous oral and orofacial disorders, which have the potential to compromise functioning, well-being and the quality of life (QoL). The purpose of this paper was to review the literature about children's clinical oral health status and health-related quality of life (HRQoL) and to assess the respective association. MATERIALS AND METHODS: The authors searched Medline, ISI, Lilacs and Scielo for articles from 1985 to 2007. The inclusion criteria were randomized, cross-sectional, longitudinal or retrospective studies that used well-validated oral health-related QoL instruments, children self-applied questionnaires and quantitative measurements of clinical oral health status. RESULTS: Of the 402 articles that were critically assessed, 12 studies were included in the critical appraisal of the project. CONCLUSIONS: There is a relationship between clinical oral health status and HRQoL in children. In the studies that suggested weak relationships between children's oral conditions and HRQoL, the explanations were low disease levels in the sample, the conditions under investigation may have caused immeasurably low levels of impact or the impacts were mediated by inter- and intravariables according to culture and education. Moreover, relationships between biological or clinical variables and HRQoL outcomes are not direct, but mediated by a variety or personal, social and environmental variables, as well as by the child development, which have influence on the comprehension about the relationship among health, illness and QoL. So, longitudinal studies are necessary to determine validity, responsiveness and minimal clinically important difference.

Oral health-related quality of life in children: part III. Is there agreement between parents in rating their children's oral health-related quality of life? A systematic review.

OBJECTIVE: One issue that receives a great deal of attention is the comparison between measurement of children's oral health-related quality of life (OHRQoL) reports with those of their parents. However, the extent to which parents understand the effects of ill-health on their children's lives remains unanswered. The purpose of this systematic review was to identify the literature on the nature, extent and the pattern of agreement/disagreement between parent and child reports about child OHRQoL and assess the association between them. MATERIALS AND METHODS: The literature was searched using MEDLINE, ISI, Lilacs and Scielo, from January 1985 to March 2007. The selected studies used well-validated instruments and provided children's and parent's perceptions of child OHRQoL. RESULTS: A total of 87 articles were retrieved and five were selected for the review, which showed that children and parents do not necessarily share similar views about child OHRQoL. Some parents may have limited knowledge about their children's OHRQoL, particularly the impact on social and emotional well-being. CONCLUSIONS: Valid and reliable information can be obtained from parents and children using appropriate questionnaire techniques. Although the parents' reports may be incomplete due to lack of knowledge about certain experiences, they still provide useful information.

Viability of ovine spermatozoa collected from epididymides stored at 18°-25°C for 48 hours post mortem / Viabilidade dos espermatozoides ovinos coletados de epidídimos armazenados a 18°-25°C até 48 horas após a morte

The objectives of this study were to verify the time during which viable ovine spermatozoa could be recovered from the cauda epididymis kept at ambient temperature (18-25°C). Sperm collected in an artificial vagina (AV) were used as control. Spermatozoa samples were collected with an AV and from epididymis at 0 (G0), 6 (G6), 12 (G12), 24 (G24), and 48 (G48) hours post mortem. Total motility (TM), progressive motility (PM), hypo-osmotic membrane integrity test (HOST) and morphological changes were assessed. TM decreased (P<0.05) from 24 hours post mortem (70.0±1.9%) compared to AV (86.4±1.0%). PM decreased (P<0.05) from 12 hours after death (31.3±4.0%) compared to AV group (73.2±1.4%). The percentage of viable cells in HOST decreased (P<0.05) in the G48 (60.0±8.9%). Spermatozoa recovery was lower (P<0.05) 48 hours after death (2064.2±230.7 x 106 spermatozoa) compared to G0(2623.6±288.4 x 106 spermatozoa). In conclusion, under the conditions of this study, it would be possible to use epididymal spermatozoa recovered up to 24 hours after death for artificial insemination or in vitro fertilization; however, fertility trials are necessary to prove this hypothesis.(AU)

Os objetivos deste estudo foram avaliar o período pelo qual era possível recuperar espermatozoides ovinos viáveis da cauda de epidídimos mantidos em temperatura ambiente (18-25°C). O sêmen coletado em vagina artificial (AV) foi utilizado como controle. Os espermatozoides foram coletados dos epidídimos à zero hora (G0), às seis (G6), 12 (G12), 24 (G24) e 48 (G48) horas post mortem. A motilidade total (TM), a motilidade progressiva (PM), a integridade de membrana plasmática em solução hiposmótica (HOST) e a morfologia espermática foram avaliadas. A TM diminuiu (P<0,05) a partir de 24 horas após a morte (70,0±1,9%) comparado ao sêmen coletado em AV (86,4±1,0%). A PM diminuiu (P<0,05) a partir de 12 horas após a morte (31,3±4,0%) comparado ao grupo AV (73,2±1,4%). A porcentagem de espermatozoides viáveis no HOST diminuiu (P<0,05) no G48 (60,0±8,9%). A recuperação espermática foi menor (P<0,05) 48 horas após a morte (2064,2±498,1 x 106 espermatozoides) comparado ao G0 (2298,4±288,4 x 106 espermatozoides). Em conclusão, nas condições deste estudo, é possível utilizar espermatozoides epididimários recuperados até 24 horas após a morte para inseminação artificial ou fertilização in vitro, porém testes de fertilidade são necessários para comprovar essa hipótese.(AU)

Efeito da suplementação com vitamina E sobre os metabolismos oxidativo e cardíaco em equinos submetidos a exercício de alta intensidade / Effect of vitamin E on oxidative and cardiac metabolism in horses submitted to high intensity exercise

A suplementação antioxidante visa prevenir os danos oxidativos induzidos pelo exercício físico em diversos tecidos, como o miocárdio. Nesse contexto, este estudo objetivou avaliar os marcadores cardíacos e a lipoperoxidação em equinos no teste de exercício de rápida aceleração e curta duração (TRA), em esteira de alta velocidade, antes e após a suplementação com vitamina E. Para tanto, foram utilizados 10 equinos sem treinamento, que realizaram o primeiro TRA (TRA1) com carga de trabalho fundamentada no consumo máximo de oxigênio individual (VO2max) e que induziu a concentração de lactato maior que 4mmol/L, sendo considerado predominantemente anaeróbico. Em seguida, os equinos receberam vitamina E (dl-alfa-tocoferol) na dose de 1.000UI/dia, por via oral, durante 52 dias, e, posteriormente, realizaram um segundo TRA (TRA2) com o mesmo protocolo de TRA1. As amostras de sangue foram colhidas nos momentos antes do exercício, imediatamente após o término do teste e em 1h, 3h, 6h, 12h e 24h subsequentes. Determinou-se o malondialdeído (MDA) plasmático como índice de lipoperoxidação, e as concentrações séricas de troponina I cardíaca (cTnI), isoenzima MB da creatinoquinase (CK-MB) e mioglobina, como marcadores cardíacos. Como efeito do exercício, observou-se aumento discreto de MDA, de cTnI e de CK-MB, sendo significativo apenas para CK-MB. A suplementação foi capaz de amenizar a produção das espécies reativas de oxigênio, evidenciada pela menor concentração de MDA em TRA2, em 24h, além de causar um efeito protetor no miocárdio, devido ao menor valor de cTnI em 6h no TRA2 em relação ao TRA1. Não houve grandes alterações na concentração de mioglobina. Concluiu-se que o exercício de alta intensidade promoveu estresse no miocárdio nos equinos avaliados, bem como houve efeito benéfico da vitamina E na proteção miocárdica e sobre a lipoperoxidação.

Antioxidant supplementation aims to prevent oxidative damage induced by physical exercise in several tissues, including myocardium. This study aimed to assess cardiac and lipid peroxidation markers of horses submitted to a high intensity and short duration exercise test (TRA) on a high speed treadmill, before and after vitamin E supplementation. Ten untrained horses performed the first TRA test (TRA1), with workload based on maximal oxygen uptake (VO2max), which induced a blood lactate higher than 4mmol/L, i.e. predominantly anaerobic exercise test. After TRA1, the horses were supplemented with oral vitamin E (dl-alpha-tocopherol) at a daily dose of 1,000IU for 52 days. Then they performed the second test (TRA2) with the same protocol of TRA1. Blood samples were collected before exercise, immediately after and at 1h, 3h, 6h, 12h and 24h after the end of test. Plasma malondialdehyde (MDA), as lipid peroxidation index, and serum cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB) and myoglobin, as cardiac markers, were determined. There was a slight increase in MDA, cTnI and CK-MB levels caused by the exercise, but statistically significant only for CK-MB levels. Vitamin E was effective on scavenging reactive oxygen species, as evidenced by lower MDA level after supplementation (TRA2) at 24h. Also, vitamin E caused myocardial protection showed by lower cTnI concentration at 6h in TRA2 when compared to TRA1. There were no changes on myoglobin levels. In conclusion, high intensity exercise induced myocardial stress in horses and we also verified the beneficial effect of vitamin E on myocardial protection and lipid peroxidation.

Efeito inibidor do soro urêmico sobre o metabolismo oxidativo dos neutrófilos de cães / Inhibitory effect of uremic serum on neutrophils oxidative metabolism from dogs

Foi testada a hipótese de que, à semelhança do que ocorre em humanos, os componentes do soro urêmico inibem o metabolismo oxidativo dos neutrófilos de cães. Para isto, o sangue total de 10 cães foi incubado com soro homólogo urêmico e não urêmico e posteriormente comparado quanto à produção neutrofílica de superóxido estimada pelo método citoquímico de redução do tetrazólio nitroazul (NBT). A produção de superóxido gerada pelo metabolismo oxidativo dos neutrófilos tratados com soro urêmico apresentou significante redução (P<0,05) em relação aos tratados com plasma autólogo e homólogo com níveis normais de ureia. Concluiu-se que os componentes presentes no soro urêmico inibem ex vivo o metabolismo oxidativo dos neutrófilos de cães portadores de insuficiência renal e que, portanto, têm sua imunidade inata comprometida.

The hypothesis that the uremic compounds decrease the neutrophil oxidative metabolism in dogs, as occurs in humans was tested. Whole blood from 10 dogs was incubated with uremic and non-uremic homologous sera and the superoxide production by activated neutrophils was quantified by the nitroblue tetrazolium reduction test (NBT). The superoxide production generated by neutrophils in the presence of uremic serum was significantly decreased (P<0.05) in comparison with autologous and homologous sera with normal urea levels. It was concluded that the presence of components of uremic serum inhibits the ex vivo neutrophil oxidative metabolism in dogs, suggesting that, similarly to humans, dogs with renal failure may have the innate immunity response compromised.