Microcephaly as a risk factor for dental alterations: A case-control study.

OBJECTIVE: This study aimed to assess whether microcephaly is a risk factor for alterations in the chronology and sequence of tooth eruption and for developmental defects of enamel. MATHERIALS AND METHODS: In this case-control study, 81 children aged 30-36 months, including 40 normoreactive children and 41 with microcephaly, were submitted to oral clinical examination to determine the frequency of alterations in the chronology and sequence of tooth eruption and developmental enamel defects. The sample was matched for sex and age (1:1) and allocated to the case (presence of dental alterations) and control (absence of dental alterations) groups. Gestational age, birthweight and socioeconomic characteristics were also analyzed. Chi-square test and Fisher's exact test were applied (α = 0.05). RESULTS: Microcephaly was significantly associated with delayed tooth eruption, alterations in the sequence of tooth eruption, and defects in dental enamel (p < 0.001). Low birthweight also showed a significant association with this alterations (p < 0.005) and prematurity was associated with defects in enamel development (p < 0.005). CONCLUSION: Microcephaly is a risk factor for alterations in the tooth eruption process and enamel formation in primary teeth.

Association of congenital Zika syndrome with dental alterations in children with microcephaly.

The effects of congenital Zika syndrome (CZS) on the tooth development of infected children are not well known. The aim of this study was to analyze the association of CZS with dental alterations in children with microcephaly seen at a referral hospital in Rio Grande do Norte, Brazil. The chronology and sequence of tooth eruption and the presence of dental alterations were evaluated by a single calibrated examiner (kappa > 0.80) in 62 children aged 7 to 35 months with microcephaly associated with CZS and other congenital infections. Medical data of the mother and child were collected from the records and the parents responded to a socioeconomic questionnaire. Descriptive analysis and Fisher's exact test were used (5% significance level). The mean age of the children was 26.4 months (SD = 7.52). The mean weight and head circumference at birth were 2,593 g (SD = 0.60) and 29.6 cm (SD = 2.48), respectively. Microcephaly was associated with congenital Zika virus infection in 79% of cases and with other congenital infections in 21%. No significant association was found between CZS and alterations in the chronology (p = 1.00) or sequence of tooth eruption (p = 0.16) or changes in enamel development (p = 1.00). In conclusion, children with microcephaly exhibit a delay and alterations in the sequence of tooth eruption of primary teeth, as well as developmental defects of enamel, which are not associated with Zika virus infection.

Prevalence of malocclusions in children with microcephaly associated with the Zika virus.

INTRODUCTION: The objectives of this study were to determine the prevalence of malocclusion among children with Zika virus-associated microcephaly (MZV) and to describe the most common malocclusion in this population. METHODS: This was a cross-sectional study including patients aged between 30 and 36 months diagnosed with MZV. Healthy children were randomly selected with the same sociodemographic characteristics as the control group. Information about arch-type, primate spaces, arch form, overbite, overjet, midline deviation, anterior crossbite, anterior open bite, and the posterior crossbite was recorded. The statistical analysis used descriptive analysis, Pearson chi-square test, and multivariate logistic regression. RESULTS: Forty children comprised the MZV group, and 40 comprised the control group. Our results demonstrated a significantly higher prevalence of malocclusions in children who had MZV than the control group (P <0.001). Patients with MZV were more likely to have late eruption (P <0.001), hypoplastic maxillary arch (P <0.001), hypoplastic mandibular arch (P <0.001), excessive overjet (P <0.001), and posterior crossbite (P = 0.004). CONCLUSIONS: The prevalence of malocclusion was higher among children with MZV. Late eruption, hypoplastic maxillary arch, hypoplastic mandibular arch, excessive overjet, and posterior crossbite were the most common characteristics for this population.

Alterações dentárias em crianças com microcefalia associada à Síndrome Congênita do Zika Vírus e outras infecções congênitas / Dental changes in children with microcephaly associated with Congenital Zika Virus Syndrome and other congenital infections

As consequências da microcefalia associada à Síndrome Congênita do Zika Vírus (SCZ) e outras infecções congênitas no desenvolvimento dentário da criança afetada ainda não são bem conhecidas. Os objetivos deste estudo foram avaliar a frequência de alterações dentárias em crianças com microcefalia, analisar se há associação das alterações dentárias com a SCZ e verificar se a microcefalia é fator de risco para as alterações dentárias. Para isso, foram realizados dois estudos observacionais transversais e um estudo do tipo caso-controle. Um único examinador calibrado (Kappa > 0,8) avaliou a presença de alterações dentárias de número, forma e tamanho, alterações na cronologia e sequência de irrupção dentária e alterações no desenvolvimento do esmalte dentário em crianças com microcefalia, associada à SCZ e outras infecções congênitas, e em crianças normoreativas. Informações relacionadas à gestação da mãe e ao nascimento da criança foram coletadas e um questionário socioeconômico foi aplicado. Os dados foram avaliados descritivamente e, como testes de associação, foram utilizados o teste do Qui-quadrado e Exato de Fisher, considerando um nível de significância de 5% (estudos 2 e 3). A amostra do primeiro estudo foi composta por 49 crianças entre 7 e 35 meses de idade apresentando microcefalia associada à SCZ. As alterações mais prevalentes foram as relacionadas à cronologia de irrupção (93,9%; IC95%= 89­99%), às alterações no desenvolvimento do esmalte dentário (76,1%; IC95%= 64­88%) e sequência de irrupção dentária (71,7%; IC95%= 60­84%). No segundo estudo, 62 crianças, com idade entre 7 e 35 meses, portadoras de microcefalia associada à SCZ e outras infecções congênitas compuseram a amostra. Não houve associação estatisticamente significativa entre a SCZ e a presença de alteração na cronologia (p = 1,00) e sequência de irrupção dentária (p = 0,16) e de desenvolvimento do esmalte dentário (p = 1,00). No estudo de caso-controle, 81 crianças entre 30 e 35 meses de idade, normoreativas e portadoras de microcefalia, fizeram parte da amostra, a qual, após identificadas as frequências de cada uma das alterações dentárias, foi emparelhada pelo sexo e idade, na proporção 1:1, e alocadas nos grupos caso (presença de alterações dentárias) e controle (ausência de alterações dentárias). A presença de microcefalia mostrou-se estatisticamente associada ao atraso na irrupção dentária (p < 0,001), à presença de alterações na sequência de irrupção dentária (p < 0,001) e de defeitos no esmalte dentário (p < 0,001). Concluiu-se que as crianças com microcefalia associada à SCZ apresentaram atraso na irrupção dentária, alterações na sequência irruptiva e opacidade do esmalte dos dentes decíduos, no entanto, a infecção pelo vírus Zika não foi associada à ocorrência dessas alterações dentárias. A microcefalia, independente de sua etiologia, é fator de risco para alterações relacionadas ao processo de irrupção dentária e ao desenvolvimento do esmalte dos dentes decíduos (AU).

The consequences of microcephaly associated with Congenital Zika Virus Syndrome (CZS) and other congenital infections on the dental development of the affected child are not well known. The objectives of this study were to evaluate the frequency of dental alterations in children with microcephaly, to analyze if there is an association of dental alterations with CZS, and to verify if microcephaly is a risk factor for dental alterations. For this, two crosssectional observational studies and one case-control study were performed. A single calibrated examiner (Kappa > 0,8) evaluated the presence of dental alterations of number, shape and size, alterations in the chronology and sequence of tooth eruption, and alterations in the tooth enamel development in children with CZS and other congenital infections, as well as in normoreactive children. Information related to mothers' pregnancies and child births were collected and a socioeconomic questionnaire was applied. Data were descriptively evaluated and chi-square test and Fisher's exact test were used as association tests considering a significance level of 5% (studies 2 and 3). The first study sample consisted of 49 children between 7 and 35 months of age with CZS-associated microcephaly. The most prevalent alterations were related to the eruption chronology (93.9%), changes in the development of the enamel (76.1%) and the dental eruption sequence (71.7%). Next, 62 children aged 7 to 35 months with CZS-associated microcephaly and other congenital infections comprised the sample in the second study. There was no statistically significant association between CZS and the presence of changes in chronology (p = 1.00), sequence of tooth eruption (p = 0.16) and tooth enamel development (p = 1.00). In the case-control study, 81 normoreactive children and children with microcephaly between 30 and 35 months of age were part of the sample, which were then paired by gender and age at a 1:1 ratio after identifying the frequencies of each of the dental alterations, and then allocated to the case (presence of dental changes) or control (absence of dental changes) groups. The presence of microcephaly was statistically associated with delayed tooth eruption (p<0.001), the presence of changes in tooth eruption sequence (p<0.001) and dental enamel defects (p<0.001). It was concluded that children with CZS-associated microcephaly had delayed dental eruption, alterations in the eruptive sequence and hypomineralization of primary tooth enamel; however, a Zika virus infection was not associated with these dental changes. A microcephaly, regardless of its etiology, is a risk factor for changes related to the tooth eruption process and the development of primary tooth enamel. It is concluded that microcephaly associated with CZS and other congenital infections is a risk factor for delayed tooth eruption, alterations in the eruptive sequence and defects in dental enamel development occurring (AU).

Quality of life of patients with cleft lip and / or cleft palate: perspective of parents/guardians

To evaluate the quality of life of children with oral cleft.Material and Methods:The ECOHIS questionnaire was used to assess the quality of life of 31 patients aged 02-05 years from the perception of their parents. Study's variables were divided into impact on children subscale, through the domain of symptoms, limitations, psychological and self-image; and impact on the family subscale, through the domain anguish of parents and family function. Descriptive analysis tests were used in Statistical Software Program -SPSS® version 18.0.Results:71% of sample subjects were male.There was prevalence of cleft lip -palate (38.7%), followed by cleft lip (32.3%) and cleft palate (29%). Cleft transforamen incisive (38.7%) was predominantand the most frequent location was unilateral left (58.3%) and the complete type was the most significant (75%). All participants mentioned some impact of the problem on the child's quality of life. In the impact on children subscale, limitations domain had the highest average (mean: 5.16; SD2.87) and in the impact on family subscale, family function domain was the most significant (mean: 2.29; SD: 1.82). As for difficulties faced by children, question on "difficulty in pronouncing words" was the most significant (61.3%). Conclusion:The presence of clefts impacts the quality of life of children and their families, thus requiring strategies for the reestablishment of aesthetics, function and psychological support for such individuals...

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social / Impact of severe early childhood caries on quality of life related to oral health of preschool children in social deprivation

A cárie precoce na infância, especialmente a sua forma severa, caracterizada pela natureza aguda e agressiva, pode produzir impactos negativos na qualidade de vida da criança, como dificuldade na mastigação, diminuição do apetite, perda de peso, dificuldade em dormir, alteração no comportamento e diminuição do rendimento escolar, entre outros. Além disso, a qualidade de vida da família da criança portadora desse tipo de cárie também pode ser afetada, pois os quadros de dor e desconforto causados resultam em perdas de dias de trabalho dos pais, gastos com tratamentos odontológicos, alteração nos padrões de sono e estresse. O objetivo deste estudo foi avaliar o impacto da cárie precoce severa na infância na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) de crianças pré-escolares de creches públicas por meio da Escala de Impacto da Saúde Bucal na Primeira Infância, versão brasileira do Early Childhood Oral Health Impact Scale (ECOHIS). Um único examinador calibrado (kappa=1,0) avaliou, por meio do índice ceo-s, a saúde bucal de 116 crianças entre 3 e 5 anos de idade, as quais foram incluídas em um dos três grupos de estudo: "livre de cárie", "cárie precoce não severa" e "cárie precoce severa". Os pais responderam ao ECOHIS, para avaliar sua percepção em relação à QVRSB de seus filhos, além de um questionário sobre condições socioeconômicas. A QVRSB foi mensurada por meio dos escores total e por domínios do ECOHIS. Análise descritiva, teste de Mann-Whitney, teste de Kruskal-Wallis, teste do quiquadrado e regressão múltipla de Poisson com variância robusta foram utilizados. Dentre as crianças avaliadas, 38,8% eram livres de cárie, 27,6% apresentavam cárie precoce não severa e 33,6% apresentavam cárie precoce severa. Em relação ao escore total do ECOHIS, a cárie precoce severa na infância teve um maior impacto negativo na QVRSB em comparação aos grupos livre de cárie e cárie precoce não severa (p<0,001). Em relação à subescala da criança, houve diferença estatisticamente significativa entre o grupo "cárie precoce severa" e os outros grupos em todos os domínios, com exceção do domínio de auto-imagem / interação social. Nos domínios da subescala da família, houve diferença significativa entre os grupos "cárie precoce severa" e o "livre de cárie" em todos os domínios (p<0,001); já entre os grupos "cárie precoce severa" e "cárie precoce não severa", houve diferença estatisticamente significativa somente no domínio de angústia dos pais (p<0,001). A análise multivariada mostrou que a cárie precoce na infância e a idade dos pais foram significativamente associadas à QVRSB (p<0,05), independentemente das demais variáveis do modelo. A presença de cárie precoce severa na infância resultou em maior impacto negativo sobre a QVRSB (RPaj=6,016; IC95% = 3,12 -11,56; p<0,001), enquanto pais mais velhos relataram melhor QVRSB (RPaj = 0,603; IC95% = 0,428-0,850; p = 0,004). A presença de cárie precoce severa na infância teve um impacto negativo na QVRSB de crianças pré-escolares e de suas famílias. (AU)

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on the quality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child's family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares's preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to "caries-free" and "not-severe early childhood caries" groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for the one of self-image / social interaction. In the family subscale domains, there was statistical significance between the "severe early childhood caries" and the "caries-free" groups in all domains (p <0.001), whereas between the "severe early childhood caries" and "not-severe early childhood caries" groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent's age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 ­ 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families. (AU)