Associação entre o estresse percebido dos pais e distúrbios do sono com o possível bruxismo do sono em crianças e adolescentes com transtorno do espectro autista: um estudo preliminar / Association between parents' perceived stress and sleep disturbances with possible sleep bruxism in children and adolescents with autism spectrum disorder: a preliminary study

O transtorno do espectro autista (TEA) é uma desordem do neurodesenvolvimento relacionado a problemas de interação social, dificuldades de comunicação, prática de comportamentos repetitivos e sensibilidade sensorial. Crianças e adolescentes com TEA podem apresentar maior ocorrência de problemas de saúde bucal, como o bruxismo do sono. Existem poucos estudos avaliando o bruxismo do sono nesses indivíduos, embora seja um problema significante nessa população. Assim, este estudo tem como objetivo investigar a associação do possível bruxismo do sono (PBS) em crianças/adolescentes com TEA com o estresse percebido dos pais/responsáveis e com distúrbios do sono da criança/adolescente. Foi realizado um estudo transversal com crianças/adolescentes com TEA, de 5 a 19 anos de idade, e seus pais/responsáveis na Fundação Centro Integrado de Apoio ao Portador de Deficiência (FUNAD) na Paraíba. Os pais/responsáveis responderam a um questionário sociodemográfico e de características da criança/adolescente, que coletou dados sobre escolaridade, grau de parentesco com a criança, renda familiar, número de filhos, idade e sexo da criança, nível funcional de autismo e uso de medicamento para o TEA. O PBS foi diagnosticado a partir do relato dos pais/responsáveis sobre a presença do comportamento de ranger/apertar os dentes nas crianças/adolescentes durante o sono. A Escala de Estresse Percebido (BPSS10) foi utilizada para avaliação do estresse dos pais/responsáveis. O seu escore total pode variar de 0 a 40 pontos, sendo que quanto maior o escore, maior o estresse percebido. Também foi empregado o Sleep Disturbance Scale for Children (SDSC), para investigar possíveis distúrbios do sono nas crianças/adolescentes, que possui 26 itens, com 5 opções de resposta, sendo que uma maior pontuação no questionário representa uma maior severidade clínica dos sintomas. O SDSC ainda classifica os distúrbios do sono em seis categorias: (1) distúrbios de iniciar e manter o sono; (2) distúrbios respiratórios do sono; (3) distúrbios do despertar; (4) distúrbios de transição sono-vigília; (5) distúrbios de sonolência excessiva e (6) hiperidrose do sono. Os dados obtidos foram analisados estatisticamente no programa Statistical Package for the Social Sciences (SPSS), versão 22.0. Foram realizadas análises descritiva, bivariada e Regressão de Poisson não ajustada e ajustada (RP, IC=95%; p<0,05). A amostra preliminar do presente estudo foi composta por 50 crianças/adolescentes com TEA, sendo 84% (n=42) do sexo masculino. O PBS em crianças e adolescentes com TEA foi relatado por 28% (n=14) dos pais/responsáveis. A média do escore total do estresse percebido dos pais/responsáveis foi de 20,38 (±8,535) e de 48,84 (±17,552) para distúrbios do sono da criança/adolescente. O modelo final ajustado da Regressão de Poisson revelou associação entre o PBS e os maiores escores na Escala de Estresse Percebido dos pais/responsáveis (RP: 1,05; IC95%: 1,01-1,09; p=0,013); e das categorias de distúrbios respiratórios do sono (RP: 1,14; IC95%: 1,05-1,24; p=0,002) e de hiperidrose do sono (RP: 1,15; IC95%: 1,01-1,31; p=0,039) do SDSC. A prevalência do PBS em crianças e adolescentes com TEA foi de 28% e apresentou associação com maiores níveis de estresse percebido dos pais/responsáveis, além das categorias de distúrbios respiratórios do sono e de hiperidrose do sono da criança/adolescente.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder related to social interaction problems, communication difficulties, repetitive behavior and sensory sensitivity. Children and adolescents with ASD may have a higher occurrence of oral health problems, such as bruxism. There are few studies evaluating sleep bruxism in these individuals, although it is a significant problem in this population. Thus, this study aims to investigate the association between possible sleep bruxism (PSB) in children and adolescents with ASD with the parents/guardians' perceived stress and with children/adolescents' sleep disturbances. A cross-sectional study was carried out with children/adolescents with ASD, aged 5 to 19 years old, and their parents/guardians at Fundação Centro Integrado de Apoio ao Portador de Deficiência (FUNAD) in Paraíba. Parents/guardians answered a socio-demographic and child/adolescent's characteristics questionnaire, which collected data on schooling, degree of kinship with the child, family income, number of children, age and sex of the child, functional level of autism and use of medication for ASD. PSB was diagnosed based on parents/guardians' reports on the presence or absence of teeth grinding/clenching behavior in children/adolescents during sleep. The Perceived Stress Scale (BPSS-10) was used to assess the parents/guardians' stress. Its total score can vary from 0 to 40 points, and the higher the score, the greater the perceived stress. The Sleep Disturbance Scale for Children (SDSC) was used to investigate possible children/adolescents' sleep disturbances, which has 26 items, with 5 answer options, with a higher score on the questionnaire representing greater clinical severity of the symptoms. The SDSC further classifies sleep disturbances into six categories: (1) disorders of initiating and maintaining sleep; (2) sleep-disordered breathing; (3) disorders of arousal; (4) sleep-wake transition disorders; (5) disorders of excessive somnolence and (6) sleep hyperhidrosis. The data obtained were statistically analyzed using Statistical Package for the Social Sciences (SPSS), version 22.0. Descriptive, bivariate, and unadjusted and adjusted Poisson Regression analyzes were performed (PR, CI=95%; p<0.05). The preliminary sample of the present study was composed by 50 children/adolescents with ASD, 84% (n=42) male. PSB in children and adolescents with ASD was reported by 28% (n=14) of parents/guardians. The mean score of parents/guardians' perceived stress was 20.38 (±8.535) and 48.84 (±17.552) for children/adolescents' sleep disorders. The final adjusted Poisson Regression model revealed an association between PSB and higher scores on the Perceived Stress Scale by parents/guardians (PR: 1.05; 95%CI: 1.01-1.09; p=0.013); and the categories of sleep-disordered breathing (PR: 1.14; 95%CI: 1.05-1.24; p=0.002) and sleep hyperhydrosis (PR: 1.15; 95%CI: 1.01-1 .31; p=0.039) of the SDSC. The prevalence of PSB in children and adolescents with ASD was 28% and was associated with parents/guardians' higher levels of perceived stress, in addition to the categories of children/adolescents' sleep-disordered breathing and sleep hyperhydrosis.

Effectiveness of fluoride-containing toothpastes associated with different technologies to remineralize enamel after pH cycling: an in vitro study.

BACKGROUND: To evaluate the efficacy of fluoride-containing toothpastes with different technologies to remineralize artificial caries lesions in enamel. METHODS: Bovine enamel blocks were divided into three thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling with dentifrices). Enamel blocks were randomly distributed into five groups (n = 12): Fluoride-free toothpaste, Colgate Oral Care (NC); Arginine-containing toothpaste, Colgate Total Daily Repair (PC); Silicate-based fluoride toothpaste: REFIX technology, regenerador + sensitive (RDC), NR-5 technology, Regenerate Enamel Science (RES), and NOVAMIN technology, Sensodyne Repair and Protect (SRP). The specimens were submitted to a pH cycling model for 6 days. The efficacy of the toothpastes was estimated by calculating the surface microhardness recovery (%SMHR) and the fluorescence recovery (ΔFRE) with quantitative light-induced fluorescence. The cross-sectional micromorphology of the enamel surface was also assessed using scanning electron microscopy. Elemental analyses (weight%) were determined with an energy-dispersive X-ray spectrometer (EDS). The results were compared to that of the control (NC). Data were statistically analyzed (5%). RESULTS: %SMHR could be ranked as follows: RDC = PC = RES = SRP > NC. Significantly higher %SMHR and ΔFRE means were observed after enamel treatment with RDC (22.7 and 46.9, respectively). PC (%SMHR = 18.8) was as efficacious as RDC to recover the surface microhardness with a significantly lower mean of ΔFRE (19.5). Only RDC was able to promote the formation of a mineralized layer on the surface of enamel enriched with silicon on the surface. CONCLUSIONS: The silicate-based fluoride toothpaste containing REFIX technology demonstrated greater efficacy in the remineralizing artificial caries than the other products.

Influence of energy drinks on enamel erosion: In vitro study using different assessment techniques.

BACKGROUND: Dental erosion has become a relevant public health problem in recent years and is related to the increase in the consumption of acidic beverages. Objective: The aim of the present study was to evaluate the erosive potential of energy drinks on dental enamel using an in vitro erosion model. MATERIAL AND METHODS: Thirty-eight blocks of human enamel were divided into four groups: G1- TNT Energy Drink®(n=8), G2- Red Bull® (n=10), G3- Monster Energy® (n=10), and G4- Coca-Cola® (n=10) (positive control). For the chemical analysis, the pH values, titratable acidity, and buffering capacity of the beverages were measured in triplicate. For the erosive test, the specimens were immersed in the beverages (5ml/block) for 30 minutes at room temperature with gentle shaking. Initial and final surface microhardness values were measured and the percentage of the loss of surface microhardness was calculated. Profilometry (surface loss and lesion depth) and mineral loss analysis (quantitative light-induced fluorescence) were performed. The data were analysed statistically using ANOVA followed by the Bonferroni correction, Pearson's correlation test, and multiple linear regression (p<0.05). RESULTS: The energy drinks had pH values ranging from 2.36 to 3.41. The lowest titratable acidity value was recorded for Monster Energy® and the highest was recorded for TNT Energy Drink®. All energy drinks had buffering capacity values higher than Coca-Cola®. Analysing the eroded enamel surface, the specimens submitted to TNT Energy Drink® had the greatest percentage loss of surface microhardness, surface loss, depth, and mineral loss, followed by those submitted to Red Bull® and Monster Energy®. Surface loss was the only predictor of mineral loss (p<0.001). CONCLUSIONS: Based on the study model employed, all the energy drinks examined were erosive to tooth enamel and TNT Energy Drink® had the worst behaviour. Key words:Energy drinks, tooth erosion, tooth demineralisation, hardness tests, quantitative light-induced fluorescence.