Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis.

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.

The Thickness of the Adhesive Layer Increases the Misdiagnosing of the Radiolucent Zones and Restoration Replacement Indication.

OBJECTIVE: To evaluate the influence of the thickness of the adhesive layer and demineralized dentin on the decision to replace composite restoration. MATERIALS AND METHODS: Eighty human third molars with occlusal preparations (Class I) were randomly assigned to eight groups (n = 10): adhesive system (Clearfil SE Bond [CSE] or Scotchbond Universal Adhesive [SBU]); the number of adhesive layers (one or two); and substrate (sound or demineralized dentin). A blinded examiner evaluated radiographs of each restored tooth. Obtained scores for the presence or absence of radiolucent zone under restoration were submitted to a relative risk (RR) calculus and Z-test, and the scores for the decision to replace restorations were submitted to Fisher's exact test (p < 0.05). RESULTS: The relative risk of identifying a radiolucent zone under restoration in sound and demineralized dentin were, respectively, 2 and 1.85 times higher when two layers of adhesive were applied. Demineralized dentin did not increase the probability of identifying a radiolucent zone. A higher relative (1.6, p = 0.01) was observed when two layers of SBU were applied. The number of layers did not influence the relative risk for CSE (RR = 1.3, p = 0.13). CONCLUSION: Thicker layers of SBU increase the relative risk of identifying a radiolucent layer under restoration and the decision to replace a/composite restoration, irrespective of the substrate. The presence of demineralized dentin did not increase the probability of identifying a radiolucent zone when compared to sound dentin. CLINICAL SIGNIFICANCE: The results of this in vitro study suggest that thicker layers of a particular adhesive under resin composite restorations can negatively influence the decision to replace them. (J Esthet Restor Dent 29:193-200, 2017).

Does Bonding Approach Influence the Bond Strength of Universal Adhesive to Dentin of Primary Teeth?

OBJECTIVE: To evaluate the effect of bonding strategy on microtensile bond strength (µTBS) of a new universal adhesive system to primary tooth dentin. STUDY DESIGN: Flat dentin surfaces from 25 primary molars were assigned to 5 groups according to the adhesive and bonding approach: Adper Single Bond 2 (two-step etch-and-rinse adhesive) and Clearfil SE Bond (two-step self-etch system), as controls; Scotchbond Universal Adhesive-self-etch, dry or wet-bonding etch-and-rinse strategies. Composite buildups were constructed and the teeth were sectioned to obtain bonded sticks (0.8 mm2) to be tested under tension at 1mm/min. The µTBS means were analyzed by one-way ANOVA and Tukey's tests (α = 0.05). Failure mode was evaluated using a stereomicroscope (400×). RESULTS: Universal adhesive applied following both dry and wet-bonding etch-and-rinse strategies showed similar bond strength compared with control adhesive systems. Self-etch approach resulted in the lowest µTBS values. For all groups, adhesive/mixed failure prevailed. The percentage of premature debonded specimens was higher when the universal adhesive was used as self-etch mode. CONCLUSION: The universal adhesive does not share the same versatility of being used in the etch-and-rinse and self-etch approaches; however, the use of the new adhesive following either wet or dry-bonding may be a suitable option as alternative to two-step etch-and-rinse adhesive protocol.

Is It Possible to induce Artificial Caries-affected Dentin using the Same Protocol to Primary and Permanent Teeth?

AIM: This in vitro study compared the mineral loss of natural and artificially-created caries-affected dentin in primary and permanent teeth using the same protocol to induce caries lesions. MATERIALS AND METHODS: Twenty molars presenting natural occlusal dentin caries lesions (10 primary-PriC and 10 perma-nent-PermC; control group), and 20 sound molars (10 primary -PripH and 10 permanent-PermpH; experimental group), were selected. Occlusal cavities were prepared in teeth of the experimental group that were submitted to pH-cycling for 14 days to simulate caries-affected dentin. All specimens were longitudinally sectioned and prepared in order to obtain Knoop micro-hardness values from 15 to 250 urn depth, starting in bottom of center of natural lesions or cavities. The microhardness (KHN) data were submitted to three-way repeated measures analysis of variance (ANOVA) and Tukey's tests (α = 0.05). RESULTS: Considering all depths, there was no statistically significant differences (p > 0.05) between the mineral loss of the control (PriC = 30.9 ± 6.4 and PermC = 40.8 ± 8.6) and experimental (PripH = 27.3 ± 11.1 and PermpH = 35.5 ± 14.0) groups, neither between primary and permanent teeth. CONCLUSION: The mineral loss of the artificially-created caries-affected dentin is similar to that from naturally developed dentin caries lesions. CLINICAL SIGNIFICANCE: The pH-cycling model may be a suitable method to simulate caries-affected dentin in both permanent and primary teeth.

Survival rate of approximal-ART restorations using a two-layer technique for glass ionomer insertion.

OBJECTIVE: Good survival rates (SR) have been reported for occlusal-atraumatic restorative treatment (ART) restorations but not for approximal-ART restorations. The high-viscosity consistency of the glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and thus to failure of the restoration. Because the use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro, we evaluated whether the use of an intermediate flowable GIC layer would improve the SR of approximal-ART restorations. METHODS: A total of 208 children (6-7 years old) with at least one occluso-proximal carious lesion in a primary molar were selected and randomly allocated to two groups: G1, conventional technique, one-layer GIC (powder/liquid ratio 1:1); and G2, two-layer technique, consisting of a first layer of GIC with a flowable consistency (powder/liquid ratio 1:2) and a second layer of a regular consistency. Restorations were made by final-year students and evaluated after 1, 6, 12 and 18 months. Restoration survival was evaluated using Kaplan-Meier survival and logrank test. Poisson regression analyses (α = 5) were used to verify the influence of factors such as insertion technique, restoration surface and operators. RESULTS: The overall SR of the restorations after 18 months was 68 %. There was no difference in SR between the techniques, neither did the other factors influence the SR. CONCLUSIONS: Over 18 months, the use of an intermediate flowable GIC layer in approximal-ART restorations does not improve the restoration survival. CLINICAL RELEVANCE: This study suggests that the two-layer technique is not the answer for increasing approximal-ART restoration longevity.

Does selective carious tissue removal of soft dentin increase the restorative failure risk in primary teeth?: Systematic review and meta-analysis.

BACKGROUND: The authors conducted a systematic review of randomized controlled trials comparing the risk of experiencing restoration failure in primary teeth after complete and selective carious tissue removal of soft dentin. METHODS: The authors searched electronic databases (PubMed [MEDLINE], Scopus, Cochrane Central Register of Controlled Trials) and the ClinicalTrials.gov Web site with manual searching and cross-referencing for trials reporting restoration failure after follow-up of 6 months or longer. Two reviewers independently selected studies, extracted data, and assessed the risk of bias and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The authors performed intention-to-treat and per-protocol meta-analyses and calculated odds ratios (OR) as effect estimates in the random-effects model. RESULTS: From 327 potentially eligible studies, the authors selected 23 for full-text screening and included 4. Results showed increased risk of experiencing restoration failure (intention-to-treat analysis, OR [95% confidence interval] 1.74 [1.01 to 3.00], and per-protocol analysis, OR [95% confidence interval] 1.79 [1.04 to 3.09]) after selective carious tissue removal of soft dentin. The risk of bias was high, and the quality of evidence was low. CONCLUSIONS: Selective carious tissue removal of soft dentin may increase the risk of experiencing restoration failure in primary teeth. However, the evidence level is insufficient for definitive conclusions. PRACTICAL IMPLICATIONS: Patients with restorations performed after selective carious tissue removal of soft dentin should have shorter recall visit intervals to evaluate the restorations' quality and control caries disease, allowing for more conservative approaches, such as repair, in cases of defective restorations.

Survival and Associated Risk Factors of Composite Restorations in Children with Early Childhood Caries: A Clinical Retrospective Study.

PURPOSE: The purpose of this clinical retrospective study was to assess survival and risk factors associated with failures of resin composite restorations placed in patients with early childhood caries. METHODS: Seventy-eight restorations in primary teeth from records of 24 high caries risk children were included in the study. The restorations' longevity up to 30 months of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P<0.05). RESULTS: Mean survival time was 26 months (95 percent confidence interval = 24.5 to 26.7). The survival of the restorations reached 34.8 percent up to 30 months, with an overall annual failure rate of 20 percent. Restorations involving two or more surfaces had 2.50 times more risk of failure than restorations involving single surface (P=0.03). Restorations performed in vital teeth had a lower risk of failure than those performed in teeth that underwent pulp intervention (hazard ratio equals 0.25; 95 percent confidence interval =0.10 to 0.65; P=0.00). Patients with a plaque index more than 20 percent had 3.63 times more risk of failure in their restorations (P=0.01). CONCLUSION: Clinical variables, such as the number of restored surfaces, pulp therapy, and poor biofilm control, may affect the survival of composite restorations performed in patients with early childhood caries.

Is Caries Associated with Negative Impact on Oral Health-Related Quality of Life of Pre-school Children? A Systematic Review and Meta-Analysis.

Purpose: The purpose of this systematic review and meta-analysis was to assess the impact of dental caries on the oral health-related quality of life (OHRQoL) of preschool children. Methods: A literature search was undertaken through PubMed/MEDLINE, Scopus, and TRIP databases to verify available studies about the topic. Two reviewers independently selected the studies, extracted the data, and assessed the bias risk. Global meta-analysis was carried out comparing means and standard deviations of the OHRQoL overall score from preschool children with and without caries. Subgroup analysis was conducted using different cutoff points for caries: decayed, missing, or filled teeth (dmft) greater than or equal to one and greater than or equal to six. Results: From 597 potentially eligible studies, 63 were selected for full-text analysis and 29 were included in the review: 12 for quantitative analysis and 17 for qualitative analysis. Most studies were conducted in Brazil; Early Childhood Oral Health Impact Scale (ECOHIS) was the instrument used in most studies to evaluate OHRQoL. A dmft index at least of one was sufficient to negatively impact the OHRQoL of preschool children, although a higher cutoff point for caries augmented the difference between groups. Bias risk was low. Conclusions: Caries might be associated with negative impact on the oral health-related quality of life of preschool children, and this association tends to increase as the disease severity worsens.

Clinical effectiveness of toothbrushes and toothbrushing methods of plaque removal on partially erupted occlusal surfaces.

PURPOSE: The aim of this crossover study was to compare the efficacy of conventional and end-tufted toothbrushes and two methods of plaque removal on partially erupted occlusal surfaces in schoolchildren. MATERIALS AND METHODS: Thirty-seven subjects, aged 5-7 years, with at least one partially erupted lower permanent first molar, were randomly divided into three groups. Occlusal plaque (baseline) was scored using a disclosing solution applied to the occlusal surface of an erupting molar. Subjects were instructed to use a conventional toothbrush with horizontal scrubbing (conventional group); a conventional toothbrush with transverse technique (modified group); or an end-tufted toothbrush (end-tufted group). Subjects returned after a one-week washout period and brushed with the alternate toothbrush or technique. Final plaque condition was evaluated again using the same scoring as at baseline. Occlusal plaque reduction (baseline to final) percentiles were compared using paired t-test. RESULTS: No statistically significant difference was found among transverse and end-tufted techniques (modified and end-tufted groups respectively) (p > 0.05). The conventional group was less effective on occlusal plaque removal in erupting first molars than the other groups (p < 0.05). CONCLUSION: The conventional toothbrushing technique was not satisfactory compared with other tested techniques on occlusal plaque removal. Moreover, the use of a conventional toothbrush with a modified technique was very effective on erupting first permanent molars without any additional costly device.

Performance of Universal Adhesive in Primary Molars After Selective Removal of Carious Tissue: An 18-Month Randomized Clinical Trial.

PURPOSE: To evaluate the 18-month clinical performance of a universal adhesive, applied under different adhesion strategies, after selective carious tissue removal in primary molars. METHODS: Forty-four subjects (five to 10 years old) contributed with 90 primary molars presenting moderately deep dentin carious lesions on occlusal or occluso-proximal surfaces, which were randomly assigned following either self-etch or etch-and-rinse protocol of Scotchbond Universal Adhesive (3M ESPE). Resin composite was incrementally inserted for all restorations. Restorations were evaluated at one, six, 12, and 18 months using the modified United States Public Health Service criteria. Survival estimates for restorations' longevity were evaluated using the Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty to assess the factors associated with failures (P<0.05). RESULTS: Estimated survival rates of the restorations were 100 percent, 100 percent, 90.6 percent, and 81.4 percent at one, six, 12, and 18 months, respectively. The adhesion strategy did not influence the restorations' longevity (P=0.06; 72.2 percent and 89.7 percent with etch-and-rinse and self-etch mode, respectively). CONCLUSION: Self-etch and etch-and-rinse strategies did not influence the clinical behavior of universal adhesive used in primary molars after selective carious tissue removal; although there was a tendency for better outcome of the self-etch strategy.

Survival and Associated Risk Factors of Resin-based Composite Restorations in Primary Teeth: A Clinical, Retrospective, University-based Study.

PURPOSE: This clinical retrospective study evaluated the survival and risk factors associated with failures of resin-based composite restorations in primary teeth. METHODS: A total of 212 restorations in primary teeth from records of 76 high caries-risk children were included. The restorations' longevity for up to six years of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P<0.05). RESULTS: Mean survival time was 4.3 years (95 percent confidence interval (CI) equals 4.0 to 4.6). The survival of the restorations reached 35.3 percent, up to the sixth year, with an annual failure rate of 18.8 percent. Restorations placed in teeth with pulp treatment had a lower survival rate than those in vital teeth (hazard ratio [HR] equals 2.16, 95 percent CI equals 1.02 to 4.58). Patients who did not use standard fluoride toothpaste had more risk of failure in their restorations (HR equals 6.12, 95 percent CI equals 1.47 to 25.49). CONCLUSIONS: Composite restorations placed in high caries-risk children presented limited survival after six years of follow-up. Standard fluoride toothpaste use was a protection factor, while pulp treatment was a risk factor for restoration failure.

Are topical fluorides effective for treating incipient carious lesions?: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis evaluated the effectiveness of professional topical fluoride application (gels or varnishes) on the reversal treatment of incipient enamel carious lesions in primary or permanent dentition. METHODS: Literature searching was carried out by the authors in PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, Turning Research Into Practice, and ClinicalTrials.gov to verify the clinical trials available about the outcome. From 754 potentially eligible studies, 21 were selected for full-text analysis, 5 were included for review, and 3 for meta-analysis. The statistical analysis was performed only for studies assessing fluoride varnish; there were insufficient data to perform it for fluoride gel studies. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Pooled-effect estimates were expressed as the weighted mean difference between groups. RESULTS: The therapeutic methods ranged considerably regarding the fluoride application protocols. There was a significant trend of effectiveness of fluoride varnish on the reversal of incipient enamel carious lesions (P < .05). High heterogeneity was found in the meta-analysis. CONCLUSIONS: Fluoride varnish seems to be an effective treatment for the reversal of incipient carious lesions in primary and permanent dentition; however, further clinical trials concerning efficacy of topical fluorides for treating those lesions are still required, mainly regarding the fluoride gel. PRACTICAL IMPLICATIONS: Considering the scientific evidence on topical fluorides, pediatric dentists can use fluoride varnishes as an adjuvant for the treatment of active white-spot lesions in primary or permanent dentition.