Effectiveness of CPP-ACP and fluoride products in tooth remineralization.

OBJECTIVES: To compare the effectiveness of the casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) in the in situ remineralization of enamel exposed with two different degrees of preformed enamel lesions. METHODS: One hundred and sixty 3 × 3 × 2 mm human enamel slabs were demineralized and divided into two subgroups according to the baseline surface hardness (SH = B1≤150 and B2 >150). During each of four 10-day experimental periods, 10 participants wore intra-oral removable acrylic palatal expanders with four human enamel slabs with preformed lesions (B1 and B2): CO1 and CO2-Control: silica dentifrice without fluoride; MP1 and MP2: MI Paste; MPP1 and MPP2: MI Paste Plus; and FD1 and FD2: Fluoride dentifrice. The Knoop hardness test (50/15s Micromet 2001, Buehler) was performed after demineralization (B1 and B2) and after treatment (T1 and T2). RESULTS: SH was higher in all treatment groups, when compared with the controls, except for CO2 (Mann-Whitney Wilcoxon Test; p < 0.05). The %SH was similar between MPP2 and FD2 and between MPP2 and MP2; however, FD2 and MPP2 products were more effective in microhardness recovery. In B1, all treatment groups were similar. CONCLUSION: MPP and FD are more effective in preventing demineralization in enamel subsurface lesions.

Effect of dentifrice containing fTCP, CPP-ACP and fluoride in the prevention of enamel demineralization.

OBJECTIVE: To evaluate the effect of different fluoride- and calcium- and/or phosphate-containing products on their ability to prevent enamel demineralization under pH cycling conditions. MATERIAL AND METHODS: Enamel bovine specimens were assigned to the following groups: G1-MPP (MI Paste Plus, 0.2% NaF, Recaldent™, GC Corporation Tokyo, Japan); G2-FD (Crest™ Cavity Protection, 0.243% NaF, Procter & Gamble, USA); G3-CLP (Clinpro™ 5000, 1.1% NaF, 3M ESPE, USA); and G4-CO (Control without fluoride, Silica-based dentifrice; Daudt Ltda, Brazil). The specimens were soaked in demineralizing solution for 6 h and remineralizing solution for 18 h alternatively for 10 days. The toothpaste was prepared with deionized water in a 1:3 ratio (w/v) for three minutes daily. The solutions were renewed every 48 h. After cycling, enamel changes were analysed by percentage change of SMH (%SMH) and energy-dispersive X-ray spectroscopy (EDS). The %SMH value observed for G3-CLP (2.9 ± 39.2) was higher than that found in G4-CO (-13.0 ± 20.7), G1-MPP (-8.9 ± 20.9) and G2-FD (-3.9 ± 27.1). The %SMH was similar for all treatment groups (one-way ANOVA and Tukey's HSD; p < .05). The pH, Ca2+ and Ptotal in the remineralization solutions were not different among all groups (Kruskal-Wallis; p < .05). At 24 h, the Ca2+ concentration in the demineralization solution was significantly lower in G1-MPP. Ca2+ concentration increased in all groups after 48 h, except for G3-CLP. The EDX quantitative analysis showed that the atomic % of elements is lower level at G4-CO. CONCLUSIONS: The Clinpro™ 5000 demonstrated having the most protective effect against demineralization; however, the % SMH was similar for all groups.

Accuracy of pen-type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth - an in vivo study.

BACKGROUND: The diagnosis of approximal lesions is limited due to the difficulty of direct examination of these areas. AIM: To determine the accuracy of pen-type laser fluorescence (LFpen) device, compared to digital bitewing (BW) radiography, in diagnosing approximal carious lesions in posterior primary teeth at cavitation and non-cavitation thresholds. DESIGN: A total of 46 children (aged 3-9 years) were assessed and 195 approximal surfaces of 184 primary molars were examined by digital BW and LFpen. Visual-tactile inspection based on the International Caries Detection and Assessment System (ICDAS-II) was used as the reference standard. All examinations were performed by the same examiner. Sensitivity, specificity, and accuracy were calculated. Spearman's correlation coefficients were calculated between LFpen and BW readings and the reference standard. RESULTS: Sensitivity, specificity and AUC were 81.8, 86.7, and 0.84 for BW and 49.1, 87.9, and 0.69 for LFpen both at non-cavitation thresholds. At cavitation thresholds, BW showed higher specificity (96.0), sensitivity (93.0), and AUC (0.98) than did LFpen (72.0, 86.9, and 0.82, respectively), but a lower correlation was indicated by LFpen readings. CONCLUSION: Bitewing had a better diagnostic accuracy and significantly outperformed LFpen in the detection of non-cavitated lesions. Similar results were obtained by the two methods at the cavitation threshold.

Preventive Effect of CPP-ACPF Paste and Fluoride Toothpastes Against Erosion and Erosion Plus Abrasion In Vitro - A 3D Profilometric Analysis.

PURPOSE: To evaluate the effect of CPP-ACPF paste and fluoride toothpastes on enamel subjected to erosion and erosion plus abrasion in vitro. MATERIALS AND METHODS: A total of 220 human enamel blocks were divided into eleven groups (n = 20): CPP-ACPF paste (MPP), potassium nitrate/sodium fluoride toothpaste (PE), sodium fluoride toothpaste (FD), fluoride-free toothpaste (SO) and control (erosion only with no paste or toothpastes; CO) according to the experimental design: erosion or erosion plus abrasion immediately after erosion (ERO+I-ABR) or 30 min after erosion (ERO+30min-ABR). For 5 days, the specimens were subjected to: (1) erosive challenge (EC) (cola drink, 4 x 5 min/day), topical application of the undiluted paste or diluted toothpastes (1:2 w/w) (4 x 1 min/ day) plus 1 h in artificial saliva (AS) between cycles and overnight; or (2) EC plus abrasion (4 x /60 s/day) performed with the diluted toothpastes (no MMP) plus 1 h in AS between cycles and overnight. Erosion depth was quantified through a 3D profilometer. Data were analysed using Kruskal-Wallis, Mann-Whitney and Wilcoxon tests (p = 0.05). RESULTS: CPP-ACPF paste and NaF toothpaste showed lowest enamel wear among groups and reduced tissue loss by 89% in erosion challenge. Abrasion led to higher enamel wear than erosion only (p = 0.030). ERO+30min-ABR had no protective effect when compared to ERO+I-ABR (p > 0.05). CONCLUSION: A high frequency of CPP-ACPF paste application (4x daily) is effective in reducing the effects of erosion. A waiting period before performing toothbrushing does not protect enamel against erosion regardless the composition of the toothpastes.

Effect of different application frequencies of CPP-ACP and fluoride dentifrice on demineralized enamel: a laboratory study.

PURPOSE: To evaluate the effect of different application frequencies of dentifrices containing CPP-ACP and fluoride on enamel demineralization inhibition using a pH cycling model. METHODS: A total of 120 enamel blocks obtained from permanent human third molars were divided into eight groups according to the treatment and number of times that the dentifrice slurry was applied (three or five times): Control--Dentifrice without Fluoride (CO3 and CO5); Fluoride Dentifrice (FD3 and FD5--commercial dentifrice 1100 ppm as NaF); MI Paste (MP3 and MP5--Recaldent) and MI Paste Plus (MPP3 and MPP5--Recaldent 900 ppm as NaF). The specimens were alternately soaked in a demineralizing solution for 6 hours and in a remineralizing solution for 18 hours for 5 days. The treatments were applied three or five times for 60 seconds after the de-remineralization period. The dentifrice slurries were prepared with deionized water, in a 1:3 proportion (wt%). Demineralized enamel changes were analyzed by surface microhardness (SMH) and 3D-profilometry. Data were analyzed by two-way and one-way ANOVA and Tukey's HSD post hoc test (α = 0.05). RESULTS: The percentage change of SMH (%SMH) was similar for all treatment groups except between MP5 < CO3 and CO5 (P < 0.05). The enamel samples treated with CCP-ACP topical paste showed smoother surfaces than those of control and fluoride dentifrice.

Psychometric Properties of the Portuguese Version of the Quality of Life in Autism Questionnaire (QoLA).

The aim of this study was to cross-culturally adapt and validate of the Brazilian Portuguese version of the Quality of Life in Autism Questionnaire (QoLA) among parents of children ASD. The translated version was administered to 91 parents (Male: 4, Female: 85, other: 2) of individuals diagnosed with ASD. Among these, 22 completed the questionnaire twice, providing data for the assessment of test-retest reliability (ICC). The B-QoLA score ranged from 41 to 122, with a mean (SD) of 74.3 ± 18.5 in Part A and ranged from 22 to 94, with a mean (SD) of 61.6 ± 16.4, in Part B. Cronbach's alpha coefficient was 0.94 for Part A, 0.92 for Part B and 0.94 for total B-QoLA, indicating excellent internal consistency. Test-retest reliability was assessed using the intraclass correlation coefficient, which was 0.96 for the total scale, 0.94 for Part A, and 0.95 for Part B. Part A-X2 (df) = 297, (167), X2/2 = 1.7, CFI = 0.85, TLI = 0.84, GFI = 0.78, AGFI = 0.75, and RMSEA (95%CI) = 0.09 (0.07-0.11); Part B-X2 (df) = 297, (167), X2/2 = 1.7, CFI = 0.85, TLI = 0.84, GFI = 0.78, AGFI = 0.75, and RMSEA (95%CI) = 0.09 (0.07-0.11), thus indicating moderate fit of the model. The Brazilian version of the QoLA shows encouraging psychometric properties on each of the two subscales, showing strong internal consistency and good construct validity.

Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives.

The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Responsiveness of the B-ECOHIS to detect changes in OHRQoL following dental treatment of children with autism spectrum disorder.

The Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) is an oral health-related quality of life (OHRQoL) questionnaire. This paper aims to investigate the responsiveness of the B-ECOHIS to dental treatment in individuals diagnosed with autism spectrum disorder (ASD) and determine if dental treatment has an impact on OHRQoL. The survey targeted 27 ASD individuals aged 4 to 14 years attending the Acolher Project of the University Federal Fluminense. This project provides children and adolescents with disabilities with oral health services. A group of randomly selected caregivers self-completed the B-ECOHIS before and 14 days after their children's dental treatment. The dental treatment included meticulous screening, preventive treatment, and restorative treatment. Responsiveness was assessed by investigating the effect size (ES) and standardized response mean (SRM). Wilcoxon test was used to evaluate internal responsiveness (distribution-based approach). The B-ECOHIS showed significant changes in the total score (p<0.001) and in all domains. The ES of the total B-ECOHIS after treatment was 1.28 and ranged between 0.70 and 1.14 for the domains. The SRM for each of the domains was large, except for the symptom domain. The B-ECOHIS is sensitive and responsive to ASD individuals undergoing dental treatment. Individuals with ASD showed improvement in their OHRQoL score after dental treatment.

Effect of CPP-ACP on remineralization of artificial caries-like lesion: an in situ study.

The purpose of this double-blind, randomized, crossover in situ study is to compare remineralization of preformed enamel lesions by casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) and fluoride dentifrice products. During each of four 10-day experimental legs, 10 participants wore intraoral removable palatal acrylic appliances with four human enamel slabs with preformed lesions. A 0.03-mL treatment paste was dripped extraorally onto the enamel blocks once a day for 3 min. The four randomly allocated treatments were as follows: CO- Control: silica dentifrice without fluoride; MP: MI Paste; MPP: MI Paste Plus and FD: Fluoride dentifrice - 1100 ppm F as NaF). Knoop surface hardness (SH) test was performed in three stages (T0 - sound enamel, T1 - after preformed lesion, and T2 - after treatment) and the cross-sectional hardness (CSH) test was performed after treatment using a 50-gram Knoop load for 15 s. Knoop hardness number (KHN) was similar between treatments. %SHr was significantly higher in the MP, FD, and MPP when compared to CO group (Kruskal-Wallis and Mann-Whitney tests, p < 0.05). Harder enamel was found in MP (75 µm) and FD groups at 75 to 175 µm. Treatment with DF, MP, and MPP promoted an increase of 20.27%, 19.24%, and 14.71%, respectively, in Integral Hardness Change (ΔIHC) when compared to CO (p<0.05). Remineralizing agents (MP, MPP, and DF) were able to inhibit demineralization of human enamel subjected to high cariogenic challenge in situ. DF had the greatest preventive potential against the progression of carious lesions.

Impact of untreated dental caries on oral health-related quality of life of children with special health care needs.

The oral health status of children with special health care needs (SHCN) can affect their quality of life wich domains of the Brazilian version of the Early Childohood Oral Health Impact Scale (B-ECOHIS). A cross-sectional study was conducted in children with SHCN (aged 1 to 9 years), who underwent an oral examination for the assessment of dental caries severity. Parents/caregivers answered two questionnaires, one on oral health-related quality of life (OHRQoL) - B-ECOHIS, and one on socioeconomic characteristics. Statistical analyses were performed using the Kolmogorov-Smirnov test, Mann-Whitney U-test, Poisson regression, Point-biserial correlation coefficient, and Cronbach's alpha. A total of 128 children participated in the study and OHRQoL was affected in 68.75% of them. The function domain in the Child Impact Section (CIS) had a higher mean value. Caries severity was associated with worse quality of life (p=0.001). Severe dental caries was associated with a negative impact on the OHRQoL of disabled children and of their families. The impact of untreated dental caries and severity of dental caries was associated with the CIS domains (except for the self-image/social interaction domain).

Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives

Abstract The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Individuals with special needs and their families' oral health-related quality of life.

To evaluate the impact of dental caries among Brazilian individuals with special health care needs (SHCN) on their families' oral health-related quality of life (OHRQoL). A cross-sectional study was carried out with a population-based sample of 227 subjects who were enrolled from the ACOLHER-PNE project conducted at the Fluminense Federal University. Parents/caregivers answered the Brazilian version of the 14-item Family Impact Scale (B-FIS) to assess the impact on family's quality of life (QoL). The main independent variable was dental caries experience, diagnosed according to the World Health Organization (WHO) criteria. The DMFT/dmft score was categorized into 0 = caries free; 1-2 = low; 3-4 = moderate; and ≥ 5 = high experience. Mother's schooling, age, sex, SHCN conditions, and socioeconomic factors were the other independent variables. QoL was measured through FIS domains and total score. Statistical analyses was performed using the Kruskal Wallis and Mann Whitney U tests and Poisson regression (p<0.05). The impact values observed in moderate and high caries experience were significantly higher than those found in subjects without caries and low level of parental emotions. Parents' years of schooling showed more impact on total score and on parental emotions. Older subjects showed significantly higher impact on total score and in all domains. The multivariate model demonstrated that families of older subjects (> 8 years old) experience a higher impact level compared to younger subjects (PR: 2.43; 95%CI: 1.80-3.29, p = 0.001). High caries experience and other socioeconomic factors were not associated with a greater negative impact on parents' QoL.

Toxina botulínica no tratamento de bruxismo severo em paciente com paralisia cerebral: relato de caso / Botulinic toxin in the treatment of severe bruxism in a patient with cerebral palsy: case report

Paralisia cerebral é um quadro resultante de lesão encefálica não progressiva que ocorre no desenvolvimento fetal ou primeira infância caracterizada principalmente por alterações no tônus muscular. Nestas pessoas, as estruturas de mastigação, como músculos e articulações tem repercussões graças aos distúrbios neuromotores. Bruxismo é uma atividade involuntária de contração muscular, de origem central, caracterizado pelo hábito de ranger ou apertar os dentes, sendo o hábito oral parafuncional que mais acomete esses indivíduos. Este artigo tem o objetivo de relatar o caso de uma paciente de 26 anos portadora de paralisia cerebral que procurou tratamento na clínica odontológica da Universidade Federal Fluminense. A paciente apresentava bruxismo severo e foi utilizada a toxina botulínica tipo A para o tratamento, como alternativa eficiente e segura. Pode-se concluir que as aplicações intramusculares de toxina botulínica foi um tratamento eficiente e seguro no relato de caso apresentado para o tratamento de bruxismo severo em paciente com autismo.

Cerebral palsy is a result of non-progressive brain injury that occurs in fetal development or early childhood, characterized mainly by changes in muscle tone. In these people, chewing structures, such as muscles and joints, have repercussions thanks to neuromotor disorders. Bruxism is an involuntary activity of muscle contraction, of central origin, characterized by the habit of grinding or clenching teeth, being the parafunctional oral habit that most affects these individuals. This article aims to report the case of a 26-year-old patient with cerebral palsy who sought treatment at the dental clinic of Universidade Federal Fluminense. The patient had severe bruxism and botulinum toxin type A was used for treatment as an efficient and safe alternative. It can be concluded that the intramuscular applications of botulinum toxin was an efficient and safe treatment in the case report presented for the treatment of severe bruxism in a patient with autism.

Anquiloglossia em bebês: da embriologia ao tratamento - uma revisão de literatura / Ankyloglossia in babies: from embryology to treatment - a literature review

Objetivo: o objetivo do presente estudo foi realizar uma revisão narrativa de literatura sobre a anquiloglossia em bebês, apresentando os critérios para diagnóstico, implicações na amamentação e formas de tratamentos. Fontes dos dados: foram realizadas, em abril de 2022, buscas nas bases de dados PubMed e Scielo, considerando artigos publicados entre os anos 1990 e 2022. Foram utilizadas como palavras-chave: frenectomy; babies; ankyloglossia; breastfeeding. A seleção dos trabalhos foi realizada através da leitura dos títulos e dos resumos. Após a aplicação dos critérios de inclusão e exclusão, 27 artigos foram selecionados, sendo eles pesquisas originais, relatos de caso e revisões de literatura. Livros textos nacionais também foram utilizados. Síntese dos dados: apesar de não existir um teste para diagnóstico considerado padrão-ouro, a triagem neonatal para investigação de anquiloglossia é uma obrigatoriedade nas maternidades de todo o país. Os testes para diagnóstico mais utilizados no Brasil são "Teste da Linguinha" e de Bristol. Não foram encontradas evidências científicas que relacionem a frenotomia e/ou frenectomia à melhora da amamentação. A abordagem multidisciplinar abrangendo dentistas, fonoaudiólogos, pediatras, consultores de amamentação, otorrinolaringologistas, cirurgiões e outros profissionais capacitados, deve ser considerada para delinear a melhor conduta clínica. Dentre as técnicas cirúrgicas, a frenotomia em bebês mostra-se como sendo a mais segura por apresentar menos riscos de complicações transoperatórios e pós-cirúrgica. Conclusão: faz-se necessário a realização de estudos controlados e com baixo viés metodológico sobre diagnóstico, tratamento e impactos da anquiloglossia na amamentação para padronizar e nortear a conduta clínica da equipe multidisciplinar responsável pelo binômio mãe-bebê no período puerperal.

Objective: the aim was to conduct a narrative literature review on ankyloglossia in infants, presenting the criteria for diagnosis, implications on breastfeeding, and treatment options. Sources of data: a search was conducted in PubMed and Scielo databases, considering articles published between 1990 and 2022 in April 2022. The key words used were: frenectomy; babies; ankyloglossia; breastfeeding. The selection of the papers was made through the title and by reading the abstracts. After applying the inclusion and exclusion criteria, 27 articles were selected, which were original research, case reports and literature reviews. National textbooks were also used. Synthesis of data: there is no test for diagnosis considered gold standard, neonatal screening for ankyloglossia investigation is a mandatory in maternity hospitals all over the country. The most used diagnostic tests in Brazil are the "Martinelli Test" and the "Bristol test". No scientific evidence was found relating frenotomy and/or frenectomy to improve breastfeeding. A multidisciplinary approach including dentists, speech therapists, pediatricians, breastfeeding consultants, otorhinolaryngologists, surgeons, and other trained professionals must be considered to outline the best clinical management. Among the surgical techniques, frenotomy in infants is the safest because it presents fewer risks of transoperative and post-surgical complications. Conclusion: it is necessary to carry out controlled studies with low methodological bias on diagnosis, treatment, and the impact of ankyloglossia on breastfeeding, to standardize and guide the clinical management of the multidisciplinary team responsible for the mother-baby binomial during the puerperal period.

Responsiveness of the B-ECOHIS to detect changes in OHRQoL following dental treatment of children with autism spectrum disorder

Abstract The Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) is an oral health-related quality of life (OHRQoL) questionnaire. This paper aims to investigate the responsiveness of the B-ECOHIS to dental treatment in individuals diagnosed with autism spectrum disorder (ASD) and determine if dental treatment has an impact on OHRQoL. The survey targeted 27 ASD individuals aged 4 to 14 years attending the Acolher Project of the University Federal Fluminense. This project provides children and adolescents with disabilities with oral health services. A group of randomly selected caregivers self-completed the B-ECOHIS before and 14 days after their children's dental treatment. The dental treatment included meticulous screening, preventive treatment, and restorative treatment. Responsiveness was assessed by investigating the effect size (ES) and standardized response mean (SRM). Wilcoxon test was used to evaluate internal responsiveness (distribution-based approach). The B-ECOHIS showed significant changes in the total score (p<0.001) and in all domains. The ES of the total B-ECOHIS after treatment was 1.28 and ranged between 0.70 and 1.14 for the domains. The SRM for each of the domains was large, except for the symptom domain. The B-ECOHIS is sensitive and responsive to ASD individuals undergoing dental treatment. Individuals with ASD showed improvement in their OHRQoL score after dental treatment.

Influence of biofilm formation on the mechanical properties of enamel after treatment with CPP-ACP crème.

The study aimed to investigate the effects of bacterial biofilms on changes in the surface microhardness of enamel treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with and without fluoride. Human enamel blocks with incipient caries-like lesions were divided into four groups of 13: G1: Saliva (Control); G2: fluoride dentifrice (Crest™, 1100 ppm as NaF); G3: CPP-ACP (MI Paste; Recaldent™); and G4: CPP-ACPF (MI Paste Plus; Recaldent™ 900 ppm as NaF). The specimens were soaked in demineralizing solution for 6 h and remineralized in artificial saliva for 18 h alternately for 10 days. The dentifrice was prepared with deionized water in a 1 : 3 ratio (w/w) or applied undiluted in the case of the CPP-ACP group. The surface microhardness (SMH) was evaluated at baseline, after artificial caries, after pH cycling and treatment with dentifrices, and after incubation in media with Streptococcus mutans for biofilm formation. The biofilms were exposed once a day to 2% sucrose and the biofilm viability was measured by MTT reduction. The percentage of change in surface microhardness (%SMHC) was calculated for each block. The data were analyzed by nonparametric test comparisons (α = 0.05). The %SMHC values observed in G2 were different from those of G1, G3, and G4 (p < 0.05). After biofilm formation, %SMHC was positive in G2 and G4 when compared to G1 and G3, but resistance to demineralization after biofilm formation was similar in all groups. In conclusion, the presence of biofilms did not influence the treatment outcomes of anticaries products.

Effect of fluoride dentifrice and casein phosphopeptide-amorphous calcium phosphate cream with and without fluoride in preventing enamel demineralization in a pH cyclic study.

OBJECTIVE: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complexes are anticariogenic and capable of remineralizing the early stages of enamel lesions. The use of fluoride prevents dental decay and the association of CPP-ACP with fluoride can increase remineralization. To evaluate the effect of CPP-ACP and CPP-ACPF creams associated with a fluoride dentifrice to prevent enamel demineralization in a pH cyclic model. MATERIAL AND METHODS: Previously selected by surface microhardness (SH) analysis, human enamel blocks (n = 56) were submitted to daily treatment with dentifrice in a pH-cycling model. The enamel blocks were divided into four groups; G1: Crest™ Cavity Protection - Procter & Gamble (1,100 ppmF of NaF); G2: Crest™ +MI Paste (MP) - Recaldent™ GC Corporation Tokyo, Japan); G3: Crest™ + MI Paste Plus (MPP) - Recaldent™ 900 ppm as NaF, GC Corporation Tokyo, Japan), and G4: control, saliva. Specimens were soaked alternatively in a demineralizing solution and in artificial saliva for 5 d. The fluoride dentifrice, with proportion of 1:3 (w/w), was applied three times for 60 s after the remineralization period. The undiluted MP and MPP creams were applied for 3 m/d. After cycling, SH was re-measured and cross section microhardness measurements were taken. RESULTS: The SH values observed for the groups G3 (257±70), G1 (205±70), and G2 (208±84) differed from the G4 group (98±110) (one-way ANOVA and Tukey's post hoc test). There were no differences between the groups G1xG2, G2xG3, and G1xG3 for demineralization inhibition. The percentage of volume mineral showed that, when applied with fluoride dentifrice, MPP was the most effective in preventing enamel demineralization at 50 µ from the outer enamel surface (Kruskal-Wallis and Mann Whitney p<0.05). CONCLUSION: Fluoride dentifrice associated with CPP-ACPF inhibited subsurface enamel demineralization.

Effect of silver and resin reinforced glass ionomers on the enamel microhardness after exposure to cariogenic biofilm

Objective: To assess the superficial microhardness of enamel-restorations margins of glass ionomer cement reinforced with silver (RS), modified with resin (RI) and composite resin (CO) after cariogenic biofilm. Materials and Methods: Thirty bovine enamel blocks with standard cavities were divided into three groups according to the materials used: RI (Riva Light Cure™, SDI), RS (Riva Silver™, SDI) and CO (Filtek™ Z350 XT, 3M). Half of each enamel block surface was covered by acid resistant varnish. After that, the blocks were exposed to Streptococcus mutans biofilm. The varnish was removed from the blocks and superficial microhardness (MDS) was measured (Knoop, 50 g, 15 s), with five indentations, 100 µm from each other in three different directions. The data were analyzed by the Shapiro Wilk, Kruskal Wallis and Mann Whitney tests (p<0.05). Results: MDS analysis indicated that in 50 µm distance from the restoration, RS group obtained hardness gain (6.31±0.01), unlike RI (-0.36±0.05) and CO (-11.43±0.02) groups that demonstrated significant loss (p<0.05). In other distances did not observe statistical difference between the groups. Regardless of the distance up to 450 µm, significant high total mineral gain was observed for RS group compared to the CO group; however, RS and RI presented similar enamel microhardness. Conclusion: All glass ionomers increased microhardness of enamel blocks even in contact with cariogenic biofilm. Although only the silver reinforced glass ionomer prevented demineralization at the margin restorations in 50 µm from the margin.

Objetivo: Comparar a desmineralização nas margens da interface dente/restauração utilizando cimento de ionômero de vidro modificado com resina (RI) e reforçado com prata (RS) e com resina composta (CO) após desafio cariogênico. Materiais e Métodos: 30 blocos de esmalte bovino com cavidades padronizadas foram divididos em 3 grupos de acordo com os materiais utilizados: RI (Riva Light CureTM, SDI), RS (Riva SilverTM, SDI) e CO (FiltekTM Z350 XT, 3M). Metade de cada superfície de esmalte restaurada foi protegida com verniz ácido-resistente. Os blocos foram expostos ao biofilme de Streptococcus mutans. O verniz foi removido dos espécimes com algodão e álcool para mensuração da microdureza superficial (MDS - Knoop, 50 g, 15 s), através de 3 linhas com 5 indentações em cada e 100 µm de distância entre elas. Os dados foram submetidos ao programa SPSS 20.0, teste de normalidade de Shapiro Wilk, Kruskal Wallis e Mann Whitney (p<0,05). Resultados: A análise da MDS demonstrou que na distância de 50 µm da restauração, o grupo RS apresentou ganho percentual de dureza (6,31 ± 0,01), diferentemente dos grupo RI (-0,036 ± 0,05) e CO (-11,43 ± 0,02) que apresentaram perda significativa (p<0,05). Nas demais distâncias, não foi observada diferença estatística entre os grupos. Conclusão: Todos os cimentos de ionômero de vidro aumentaram a microdureza superficial total dos blocos de esmalte mesmo após exposição ao biofilme cariogênico. No entanto, apenas o grupo RS impediu a desmineralização a 50 µm das margens de restaurações submetidas a biofilme cariogênico.

Scanning electron microscopy analysis of microstructure of the adhesive interface between resin and dentin treated with papain gel.

AIM: The aim of this in vitro study was to observe and compare the microstructure of the adhesive interface between resin and dentin treated with Papacarie® using scanning electron microscopy (SEM). MATERIALS AND METHODS: Totally, 10 human dentin slabs were randomly distributed into two groups. The control group (n = 5) was subjected to etching with 37% phosphoric acid for 20 s and washed for 30 s, dried with absorbent paper, and the bonding agent was applied along with low viscosity resin. In turn, the experimental group (n = 5) was subjected to the same procedure, but Papacarie® (Fσrmula and Aηγo, Sγo Paulo, Brazil) was added for 30 s prior to etching. Adper™ Single Bond 2 (3M ESPE, Sγo Paulo, Brazil) adhesive was applied to both groups following manufacturer instructions. The specimens were prepared for observation under SEM with ×1.000, ×2.000, ×2.200 and ×5.000 magnification. The micrographs were evaluated with respect to the formation of the hybrid layer, thickness, shape and length of the tags and microtags. RESULTS: In the experimental group there was the formation of more fine hybrid layer and tags with average of similar length to the control group; microtags in less number and without formation of lateral branches. The resin tags presented conical, smooth and uniform characteristics. CONCLUSIONS: When Papacarie® was used prior to the application of a bonding agent it could interfere with the formation of the hybrid layer without changing the length of the tag. Moreover, the morphology in the experimental group was found to be more uniform and regular.

Effect of CPP-ACP on remineralization of artificial caries-like lesion: an in situ study

Abstract The purpose of this double-blind, randomized, crossover in situ study is to compare remineralization of preformed enamel lesions by casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) and fluoride dentifrice products. During each of four 10-day experimental legs, 10 participants wore intraoral removable palatal acrylic appliances with four human enamel slabs with preformed lesions. A 0.03-mL treatment paste was dripped extraorally onto the enamel blocks once a day for 3 min. The four randomly allocated treatments were as follows: CO- Control: silica dentifrice without fluoride; MP: MI Paste; MPP: MI Paste Plus and FD: Fluoride dentifrice - 1100 ppm F as NaF). Knoop surface hardness (SH) test was performed in three stages (T0 - sound enamel, T1 - after preformed lesion, and T2 - after treatment) and the cross-sectional hardness (CSH) test was performed after treatment using a 50-gram Knoop load for 15 s. Knoop hardness number (KHN) was similar between treatments. %SHr was significantly higher in the MP, FD, and MPP when compared to CO group (Kruskal-Wallis and Mann-Whitney tests, p < 0.05). Harder enamel was found in MP (75 μm) and FD groups at 75 to 175 μm. Treatment with DF, MP, and MPP promoted an increase of 20.27%, 19.24%, and 14.71%, respectively, in Integral Hardness Change (ΔIHC) when compared to CO (p<0.05). Remineralizing agents (MP, MPP, and DF) were able to inhibit demineralization of human enamel subjected to high cariogenic challenge in situ. DF had the greatest preventive potential against the progression of carious lesions.