Pulp changes from rapid maxillary expansion: A systematic review.

INTRODUCTION: This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopaedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME). METHODS: An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analysed with the NIH 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group' and the 'JBI for quasi-experimental studies' tool. The GRADE tool was used to assess the certainty of evidence. RESULTS: The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence. CONCLUSIONS: Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.

External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis.

BACKGROUND: Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost-benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control. METHODS: The protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger's tests. RESULTS: The search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity. CONCLUSION: More than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health.

Rural-urban differences in oral health among older people in Southern Brazil.

This study aimed to assess the association between oral health and rurality in an older Brazilian population. Population-based samples of 1,451 urban and 411 rural elders were obtained from two databases. Several oral health and related measures, including the number of teeth lost, use of dental prostheses, dental visits, self-reported oral health, and perceived need for a dental prosthesis, were compared. Oral health-related information was obtained by a trained research team with interviews conducted in the individuals' homes. Regression models were used to verify the association between living in rural areas and oral health outcomes after adjusting for possible confounding factors. The elderly population mostly comprised of women in rural or urban areas, and the mean age was 70 years in both locations. Less-educated individuals (without or with complete elementary schooling) were more common in rural regions than in urban areas. After adjustment for socioeconomic characteristics, living in rural areas was associated with a lower perceived need for dental prostheses (PR 0.68, 95% CI 0.56-0.84), poor self-reported oral health (OR 1.24; 95% CI 1.05-1.46), and having fewer teeth (ß -1.31; 95% CI -2.18 to -0.45). The place of residence had a significant impact on oral health indicators, with rurality negatively influencing oral health. These findings suggest that preventive and curative strategies for dental services may be needed for the Brazilian rural population.

Morphology of the palatal rugae before and after orthodontic treatment with and without rapid maxillary expansion and dental extractions.

BACKGROUND: The palatal rugae contribute to oral swallowing, taste perception, and speech. From a forensic point of view, the distinctive morphology of these structures can be used to support human identification. However, the morphology of the rugae may be altered by trauma or therapeutic interventions in the palate. OBJECTIVE: This study aimed to analyze the morphology of the palatal rugae before and after orthodontic treatment performed with and without maxillary expansion and dental extractions. MATERIALS AND METHODS: The sample consisted of 60 dental casts taken before (n = 30) and after (n = 30) orthodontic treatment from patients aged >18 years. The patients were treated with rapid maxillary expansion by using Haas appliance (n = 10), by extracting the maxillary first premolars (n = 10) and by using only conventional fixed orthodontic appliances (n = 10). All the dental casts were analyzed twice by two independent examiners that were blind for the type of treatment. RESULTS: All the differences between groups were statistically significant (P < 0.05). More alterations in the morphology of the palatal rugae were observed in patients treated with rapid maxillary expansion, whereas few alterations were performed in patients treated with no maxillary expansion or dental extractions. CONCLUSION: The use of palatal rugae for forensic purposes must be avoided in patients that underwent invasive orthodontic treatments, such as those founded on maxillary expansion and dental extractions.

Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis. / Prevalência de fluorose dental em regiões abastecidas com água sem suplementação de flúor no território brasileiro: uma revisão sistemática e metanálise.

This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a "literatura cinzenta". As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.

How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates.

The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Effectiveness of three age estimation methods based on dental and skeletal development in a sample of young Brazilians.

OBJECTIVE: This study compared three methods designed for age estimation. METHODS: A sample of 468 radiographs (234 panoramic and 234 carpal radiographs) collected from patients ranging from 5 to 14 years old (mean age: 11.27years old±2.27years) was used. Three age estimation methods: were applied: one founded on dental development, one founded on hand and wrist development, and a method combining both measurements. For each method, the mean error (ME), mean absolute error (MAE), root mean square error (RMSE), and mean percentage of absolute error (MPAE) were quantified. The methods: were compared based on their effectiveness for estimating age in relation to sex and age range. RESULTS: The data show that the method exclusively using the development of the hand and wrist had the highest error rates (ME: 1.28M, 1.85F; MAE: 1.64M, 1.96F; RMSE: 1.94M, 2.32F) for both males (M) and females (F). In males, the method combining dental and skeletal development obtained outcomes that were slightly better than the method founded on only dental development (MPAE: 6.99% and 7.47%, respectively). In females, the opposite result was observed (MPAE: 8.48% and 6.59%, respectively). The method founded exclusively on skeletal development significantly overestimated (p=0.001) the age (mean chronological and estimated ages: 11.27 and 12.88, respectively). CONCLUSION: The methods involving dental development provided more accurate age estimates of chronological age. The method exclusively based on hand and wrist development resulted in outcomes that were highly discrepant from the chronological age.

Correlating skeletal and dental developmental stages using radiographic parameters.

The demand for age estimation of living and deceased children considerably increased in the last years. It was mainly justified by the growing globalization trend and the enlarged amount of violent crimes involving young victims. The present research aims to correlate skeletal and dental developmental stages using radiographic parameters. Lateral cephalometric (n = 576) and panoramic (n = 576) radiographs taken in the same moment were used to asses skeletal and dental development according to the methods of Hassel and Farman (1995) and Bacetti et al. (2002), and Demirjian et al. (1973), respectively. Likelihood-ratio test was used to verify the positive prediction in correlations between developmental stages. Spearman's correlation coefficient was calculated between skeletal and dental developmental stages, as well between estimated and chronological ages. Higher prediction in correlation for the skeletal starting stage (stage 1) with stage E in mandibular canines, and with stage D in mandibular premolars and second molars was detected. Higher staging correlations were observed considering the mandibular left second premolar (0.652, p < 0.001 for the technique of Bacetti et al.; and 0.646, p < 0.001 for the technique of Hassel and Farman). Despite the correlations between skeletal and dental developmental stages, the results must be carefully interpreted once it reached moderate values (<0.652). Further researches must test different classifications of skeletal and dental development, in order to verify the possibility of replacing one technique for another with stronger correlation.

[Satisfaction with life, dental experience and self-perception of oral health among the elderly]. / Satisfação com a vida, experiência odontológica e autopercepção da saúde bucal entre idosos.

The scope of this article is to analyze the relationship between satisfaction with quality of life, self-perception of oral health and experience with dental surgeons. The study is cross-sectional epidemiological in structure with a sample of 326 elderly individuals over 60 years of age living in a city in the north of the State of Rio Grande do Sul, Brazil. The instrument for data collection was a self-administered questionnaire with queries relating to self-perception in oral health (OHIP - Oral Health Impact Profile), Quality of Life Satisfaction scale and sociodemographic issues. The findings showed that the elderly with higher levels of quality of life satisfaction manifested an enhanced perception of their own oral health as well as a better perceived image of dental surgeons and less anxiety about their experiences with the dentist. It was proven that both the self-perception that the elderly have about oral health as well as their experience with dentists is associated with the quality of life satisfaction of the elderly. The results have important implications for decision-makers and formulators of public policy.

Oral complications in hospitalized children during antineoplastic treatment / Complicações bucais em crianças e adolescentes hospitalizadas durante o tratamento antineoplasico

INTRODUCTION: Normal cells are also affected during antineoplastic treatment, including oral mucosa cells, which potentially causes oral complications. OBJECTIVE: This study aimed to assess the prevalence of the main oral complications and the oral hygiene index in children and adolescents aged 5 to 12 years, who received chemotherapy and/or radiotherapy. METHODS: It is an observational prevalence study performed in a hospital in Southern Brazil. Data were collected from 21 hospitalized patients with a self-application questionnaire for the responsible persons of children and with an intraoral clinical examination. The indicators used were DMFT (decayed, missing, and filled teeth) for dental caries, SOHI (simplified oral hygiene index) for oral hygiene, and the presence of mucositis, xerostomia, and candidiasis. RESULTS: Most of the sample was male (57.1%) with average age of 8 years (sd 2.92), diagnosed with leukemia (47.6%). All patients received chemotherapy as treatment of choice and 38.1% received radiotherapy as part of the treatment. The results showed the presence of 61.9% of mucositis in patients and 28.6% of xerostomia. No patient presented candidiasis during clinical examination. As for dental caries, 66.7% of patients showed a DMFT from 4 to 16, which is considered high, and 38.1% of patients showed the presence of bacterial plaque and dental calculus. CONCLUSION: It is concluded that the main oral complications in children during antineoplastic treatment were mucositis and xerostomia. It was observed a high rate of dental caries as a consequence of an inadequated oral hygiene.

INTRODUÇÃO: Durante o tratamento antineoplásico, células normais também são afetadas, incluindo assim, as células da mucosa oral, o que potencialmente causa complicações orais. OBJETIVO: O presente trabalho teve por objetivo avaliar a prevalência das principais complicações bucais e índice de higiene oral em crianças e adolescentes submetidas à quimioterapia e/ou radioterapia. MÉTODO: O delineamento é do tipo observacional de prevalência realizado em um Hospital do Sul do Brasil. Foram coletados dados de 21 pacientes de 5 a 12 anos de idade em tratamento, a partir de um questionário auto aplicativo para os responsáveis pelos pacientes e um exame clínico intraoral. Os indicadores utilizados foram o índice CPOD (dentes cariados, perdidos e obturados) para cárie dentária, o índice IHOS (higiene oral simplificada) para Higiene Oral e a presença de mucosite, xerostomia e candidíase. RESULTADOS: A maior parte da amostra era do sexo masculino (57,1%) média de 8 anos de idade (dp 2,92), diagnosticados com leucemia (47,6%). Todos os participantes receberam quimioterapia como tratamento de escolha e 38,1% receberam radioterapia como parte do tratamento. Os resultados evidenciariam presença de mucosite em 61,9% e xerostomia em 28,6% dos pacientes. Nenhum paciente apresentou candidíase durante o exame clínico. Quanto a cárie dentária, 66,7% tem um CPOD de 4 e 16, considerado alto e 38,1% dos pacientes apresentaram presença de placa bacteriana e cálculo dentário. CONCLUSÃO: As principais complicações bucais evidenciadas durante o tratamento antineoplásico foram mucosite e xerostomia. Foi observado também um alto índice de cárie dentária, consequência de uma inadequada higiene oral.

Prevalência de fluorose dental em regiões abastecidas com água sem suplementação de flúor no território brasileiro: uma revisão sistemática e metanálise / Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis

Resumo Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a "literatura cinzenta". As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.

Abstract This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

Atypical Extraction of Maxillary Central Incisor for the Correction of Angle Class II Malocclusion / Extracción Atípica de Incisivo Central Maxilar en la Corrección de la Maloclusión de Angle Clase II

ABSTRACT: This case describes the treatment of Class II malocclusion in a patient missing one of the maxillary central incisors due to traumatic impaction. The treatment approach consisted in the extraction of the remaining maxillary central incisor, followed by diastema closure and re-anatomization of lateral incisors into central incisors. The results obtained were considered satisfactory concerning occlusal, aesthetic and functional aspects. This therapeutic approach may be used as an alternative for similar cases.

RESUMEN: Este caso clínico describe el tratamiento de la mala oclusión de Clase II en un paciente con ausencia de uno de los incisivos centrales superiores debido a impactación. El abordaje del tratamiento consistió en la extracción de este elemento dental y del otro incisivo central, seguido del cierre de los diastemas y reanatomización de los incisivos laterales en incisivos centrales. Los resultados obtenidos fueron considerados satisfactorios con relación a los aspectos oclusales, estéticos y funcionales. Así, esta planificación se puede utilizar como una nueva alternativa de abordaje terapéutico para estos casos.

Unhas das mãos como biomarcador para fluorose dentária / Fingernails as a biomarker for dental fluorosis

INTRODUCTION: Biomarkers indicate levels of a particular chemical agent in the environment studied, which may be useful for monitoring health status, and nails may be major indicators of fluoride. OBJECTIVE: To evaluate fluoride concentration in the fingernails of children as a biomarker for fluoride exposure. METHODS: Twenty students were selected, aged 4-5 years old. Their nails were cut at 15 and 45 days (two collections), and the fluoride concentration in the nails was analyzed with the ion-specific electrode (Orion 9409) after rapid diffusion with HDMS. RESULTS: The total fluoride mean of the samples was 3.68 μg F/g (sd 1.44), ranging from 1.39 μg F/g to 7.81 μg F/g. Eleven children (55%) brush their teeth three times a day, but only three children (15%) swallow toothpaste. CONCLUSION: There is a high prevalence of fluoride exposure in the fingernails of the children studied, presenting risk of developing dental fluorosis in permanent teeth.

INTRODUÇÃO: Os biomarcadores indicam níveis de determinado agente químico no meio estudado, os quais podem ser úteis ao monitoramento do estado de saúde, podendo as unhas serem importantes indicadores de flúor. OBJETIVO: Avaliar a concentração de flúor nas unhas das mãos de crianças como biomarcador de exposição ao flúo.r MÉTODO: Foram selecionadas 20 escolares, com idade entre 4 e 5 anos. As unhas foram cortadas aos 15 e 45 dias (duas coletas) e a concentração de flúor nas unhas foi analisada com o eletrodo íon específica (Orion 9409), após difusão facilitada por HDMS RESULTADOS: A média total de flúor das amostras foi de 3,68 µg F/g (dp 1,44), variando de 1,39 µg F/g a 7,81 µg F/g. Onze crianças (55%) escovam os dentes três vezes por dia, porém, somente três crianças (15%), engolem dentifrício. CONCLUSÃO: Há uma alta prevalência de exposição ao flúor nas unhas das mãos das crianças investigada com risco de desenvolver fluorose dentária nos dentes permanentes.

Prevalence of TMJ pain symptom in adults and its association with predisposing factors / Prevalência do sintoma de dor na ATM em adultos e sua associação com fatores predisponentes

To estimate the prevalence of temporomandibular joint (TMJ) pain symptom and to verify its association with predisposing or perpetuating factors. Cross-sectional study of adult patients, with 488 medical records of patients assisted at the Clinics of the School of Dentistry of IMED, in the city of Passo Fundo, RS, Brazil. The data were collected through the anamnestic record based on patient self-report. The chi-square test at 5% significance level was used to evaluate the relationship between the outcome of TMJ pain and the variables. In addition, bivariate and multivariate Poisson analyses were performed at 5% significance level to confirm the associations, including to the multivariate analysis the variables with p ≤ 0.20 in the bivariate analysis. The prevalence of TMJ pain in this adult population was 21.52% (n=105).There was an association between TMJ pain and the variables of teeth clenching and habit of biting objects (p<0.05). This study concluded that the prevalence of TMJ pain symptom agrees with the mean prevalence found in the literature for studies with convenience samples, and teeth clenching and the habit of biting objects may represent perpetuating or predisposing factors for such condition.

Estimar a prevalência do sintoma dor na articulação temporomandibular (ATM) e verificar sua associação com fatores predisponentes ou perpetuantes. Estudo transversal de pacientes adultos, com 488 prontuários de pacientes atendidos na Clínica de graduação da Escola de Odontologia da IMED do município de Passo Fundo. Os dados foram coletados através da ficha anamnésica baseando-se no auto relato, do paciente. O teste do qui-quadrado, com nível de significância de 5%, foi utilizado para avaliar a relação entre o desfecho dor na ATM e as variáveis. E para confirmar as associações, foram realizadas análises de Poisson, bivariada e multivariada, com nível de significância de 5%, sendo incluídas na análise multivariada as variáveis com p ≤ 0,20 na análise bivariada. A prevalência de dor na ATM nessa população adulta foi de 21,52% (n=105).Encontrou-se associação entre dor na ATM e as variáveis apertamento dental e hábito de morder objetos (p<0.05). Neste estudo pode - se concluir que a prevalência do sintoma dor na ATM está de acordo com a média de prevalência encontrada na literatura para estudos com amostra de conveniência e os fatores apertamento dental e hábito de morder objetos podem ser perpetuantes ou predisponentes para tal condição.

How common is dry mouth? systematic review and meta-regression analysis of prevalence estimates

Abstract The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Resumo O objetivo do estudo é revisar sistematicamente a literatura afim de estimar a prevalência global de xerostomia/hiposalivação em estudos epidemiológicos. Uma busca eletrônica foi conduzida até Fevereiro de 2018 sem restrições de linguagem. Um total de 5760 títulos foram inicialmente identificados e somente vinte e nove artigos foram incluídos na revisão e meta-análise após dois revisores independentes aplicarem os critérios de seleção. Os artigos foram extraídos das bases de dados PubMed/Medline e Web of Science. Os critérios de elegibilidade incluíram investigações originais de estudos observacionais de base populacional os quais reportaram a prevalência de xerostomia ou dados que permitissem o cálculo da prevalência de xerostomia e/ou hiposalivação. Estudos realizados em populações com condições de saúde específicas, revisões de literatura, relato de casos e estudos antropológicos, assim como, conferências ou comentários foram excluídos. Tamanho amostral, localização geográfica aonde foi realizado o estudo, desenho do estudo, idade da população estudada, métodos de diagnóstico e o critério de avaliação para determiner xerostomia e/ou hiposalivação foram extraídos para a meta-análise e metaregressão. Análise de meta-regressão multípla foi realizada para explorar a heterogeneidade entre os estudos. A prevalência global estimada de boca seca foi de 22.0% (95%IC 17.0-26.0%). Uma maior prevalência de xerostomia foi observada em estudos realizados exclusivamente em populações idosas. Apesar de diferentes abordagens utilizadas para mensurar as condições de interesse, cerca de uma em quatro pessoas é acometida por xerostomia, com taxas mais elevadas sendo observadas na população idosa. Além disso, os métodos de mensuração podem ter super- ou subestimado os valores de xerostomia. Os achados do presente estudo salientam a necessidade de mais estudos acerca das existentes e novas formas de avaliação clínica, os quais serão úteis para determinar qual é a mais confiável para as perspectivas clínicas e epidemiológicas.

Maconha como a segunda substância psicoativa mais comumente usada entre estudantes / Emergence of cannabis as the second most commonly used psychoactive substance among students

INTRODUCTION: People use psychoactive substances (PAS) historically; however, from the 1960s on, this use has increased considerably, becoming known for compromising health and causing the death of millions of people every year. OBJECTIVE: This study aimed to verify the prevalence of psychoactive substances consumed by dentistry students, as well as to analyze the influence of sociodemographic variables and identify the level of life satisfaction among Dentistry students. METHODS: It is a cross-sectional observational study including 159 students of an educational institution in a city of southern Brazil enrolled in the eight course periods. They were anonymously asked to a self-administered questionnaire regarding sociodemographic variables and use of psychoactive substances (PAS), questions were adapted by the validated instrument called Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and the assessment of level of life satisfaction by the Satisfaction With Life Scale (SWLS). RESULTS: The use of PAS at some point in life had prevalence of 90.6%. Alcohol was the most used PAS by students, followed by cannabis. The use of drugs for depression showed association with alcohol and cannabis consumption, cannabis was predominately consumed by male . The majority of students reported dissatisfaction with life. CONCLUSION: The prevalence of PAS use is high among the Dentistry students interviewed. The PAS most consumed by students was alcohol, followed by cannabis, psychoactive drugs, and tobacco.

INTRODUÇÃO: O uso de substâncias psicoativas (SPA) é uma prática utilizada pelo homem desde seus primórdios. Entretanto, a partir dos anos 60, teve seu consumo substancialmente aumentado, e se tornou conhecida por comprometer a saúde e ocasionar a morte de milhões de pessoas todos os anos. OBJETIVO: O uso de substâncias psicoativas é uma prática utilizada há muitos anos, porém, a partir dos anos 60, teve seu consumo substancialmente aumentado. O objetivo deste estudo foi verificar a prevalência do uso de substâncias psicoativas entre estudantes de Odontologia, bem como analisar a influência das variáveis sociodemográficas e identificar o nível de satisfação com a vida entre os estudantes. MÉTODO: O delineamento é do tipo transversal composto por 159 estudantes de Odontologia de uma instituição de ensino de um município do sul do Brasil matriculados nos oito períodos do curso. Os sujeitos forma submetidos anonimamente a um questionário autoaplicável com perguntas referentes a variáveis sociodemográficas, uso de substâncias psicoativas (SPA) adaptadas pelo instrumento validado Teste de Triagem para Álcool, Tabaco e Substâncias (ASSIST), e a avaliação do grau de satisfação com a vida, a partir da Escala de Satisfação com a Vida (ESVC). RESULTADOS: O uso de SPA em algum momento da vida teve prevalência de 90,6%, sendo, o álcool, a droga mais consumida, seguida pela maconha. O uso de medicamentos para depressão mostrou associação ao consumo de álcool. O consumo de maconha também esteve associado ao uso de antidepressivos, sendo a maconha mais consumida pelos homens. A maior parte da amostra relatou insatisfação com sua vida. CONCLUSÃO: A prevalência do uso PAS é alta entre os estudantes de Odontologia entrevistados. O PAS mais utilizado pelos alunos foi o álcool, seguido de maconha, drogas psicoativas, e tabaco.

Information gaps on oral cancer and how should we fill them: proposals based on a survey of southern brazilians / Lacunas de informação sobre o câncer bucal e como preenchê-las: propostas enbasadas em pesquisa com sul brasileiros

The purpose of this research was to ascertain the population's knowledge about oral cancer and propose permanent actions incorporated to the Primordial Prevention Measures. Materials and Methods: There were apply questionnaires in 120 patients of a Basic Health Unit, and most the sample were female and the aged was between 18-82 years. Results: The results showed that most of users don't know adequately about the oral cancer, of which, some believe it's a communicable disease, others believe it's not even a disease. Users know some of the risk factors, but they don't know how to perform self-examination of the mouth. Conclusions: It is suggested the incorporation of three new actions to Prevention Primordial Measure, including the creation of a permanent program in Elementary and Secondary Education Schools, encouraging in favor of self-examination of the mouth and against the use of tobacco and alcohol; the training of dentists from the public care about the actions of measures in Primary and Secondary Prevention; and the integration of effective communication about the actions of measures in Primary and Secondary Prevention.

O objetivo desta pesquisa foi verificar o conhecimento da população sobre o câncer bucal e propor ações permanentes incorporados às medidas de prevenção primárias. Foram aplicados questionários em 120 usuários de uma Unidade Básica de Saúde, sendo a maioria da amostra do sexo feminine, com idade entre 18-82 anos. Os resultados mostraram que a maioria dos usuários não possui conhecimento adequado acerca do câncer bucal, dos quais, alguns acreditam que é uma doença transmissível, outros acreditam que não é uma doença. Os usuários demonstraram conhecer alguns dos fatores de risco, mas eles não sabem como realizar o auto-exame da boca. Sugere-se a incorporação de três novas ações para a prevenção Medida Primordial, incluindo a criação de um programa permanente nas Escolas em nível fundamental e Médio, incentivando a realização do auto-exame da boca e contra o uso de tabaco e álcool; a formação de dentistas do atendimento público sobre as ações de medidas em prevenção primária e secundária; e a integração de uma comunicação eficaz sobre as ações de medidas em prevenção primária e secundária.

Perception of laypersons and dentists regarding esthetic facial changes: a systematic review / Percepção estética de leigos e cirurgiões-dentistas em relação às alterações faciais: uma revisão sistemática

The need for greater understanding of subjective standards of beauty is important when combining a successful dental plan with the real needs of patients. This study aimed to perform a systematic review to assess whether dentists are more critical in assessing facial esthetics than laypersons. The cross-sectional studies selected compared dentists and laypersons regarding the perception of facial changes through photographs. The survey was conducted in four databases (PubMed, SciELO, LILACS, and OpenGrey) with no restriction of time or language, and was assessed by two reviewers who were based on the PVO strategy. Then, a manual search through the references of the selected articles was performed in order to find surveys that did not fit in said search strategy. The examiners assessed the risk of bias and quality in individual studies. The process of data synthesis was performed through a descriptive analysis of the selected studies. Three relevant articles were selected from an initial total of 979 articles collected. Most studies found that dentists were more critical than laypersons; however, facial modifications were different. Only one survey manipulated the changes on a computer, while the others worked with changes on the patient. Given the methodological diversity of the studies, it was not possible to establish a parameter to validate the results presented.

A necessidade de uma maior compreensão dos padrões subjetivos da beleza é importante quando se combina um plano odontológico de sucesso com as necessidades reais dos pacientes. Este estudo teve como objetivo realizar uma revisão sistemática para avaliar se dentistas são mais exigentes na avaliação da estética facial do que os leigos. Os estudos transversais selecionados compararam dentistas e leigos em relação à percepção de alterações faciais através de fotografias. A pesquisa foi realizada em quatro bases de dados (PubMed, SciELO, LILACS e OpenGrey), sem restrição de tempo ou de idioma, e foi realizada por dois revisores que utilizaram como referência a estratégia PVO. Em seguida, foi realizada uma busca manual através das referências dos artigos selecionados, a fim de encontrar pesquisas que não se encaixavam na referida estratégia de busca. Os examinadores avaliaram o risco de viés e qualidade nos estudos individuais. O processo de síntese dos dados foi realizado através de uma análise descritiva dos estudos selecionados. Três artigos relevantes foram selecionados de um total inicial de 979 artigos coletados. A maioria dos estudos revelou que os dentistas eram mais críticos do que os leigos; no entanto, as modificações faciais eram diferentes. Apenas uma pesquisa manipulou as alterações em um computador, enquanto as outras trabalharam com mudanças no paciente. Diante da diversidade metodológica dos estudos, não foi possível estabelecer um parâmetro para validação dos resultados apresentados.

Reliability, efficacy and reproducibility of the cervical vertebrae maturation index (CVMI) / Validade, efetividade e reprodutibilidade do índice de maturação das vértebras cervicais

Assessing skeletal maturation is an important determinant of successful orthodontic treatment planning for children and adolescents. While several methods are used skeletal maturation assessment, the hand-wrist radiograph is one of the most widely used. However, it does require additional exposing growing patients to additional radiation. Information on skeletal maturation can also be retrieved after evaluation of cervical vertebrae, which are commonly portrayed on the lateral cephalometric radiographs included in standard orthodontic documentation. By means of a systematic review of the available literature, this work aimed to verify the reliability, efficacy, and reproducibility of skeletal age determination based on the evaluation of cervical vertebrae. The LILACS, SciELO and PubMed databases were searched using the keywords "cervical vertebrae" and "cervical maturation". Only texts in Portuguese, Spanish, and English published in the last 10 years were selected. Twenty-nine full articles were retrieved and critically appraised. According to these references, the Cervical Vertebrae Maturation Index appears to be a valid, reliable, and reproducible method for skeletal maturation assessment and may substitute the analysis of hand-wrist radiograph in orthodontic treatment planning.

A determinação da fase de maturação esquelética é ponto fundamental no tratamento ortodôntico de crianças e adolescentes, e muitos métodos são utilizados com este objetivo, sendo a análise da radiografia de mão e punho o mais comumente difundido no meio ortodôntico. Entretanto, esta informação também pode ser obtida por meio de radiografias cefalométricas laterais, com base na avaliação das vértebras cervicais, eliminando a necessidade de exposição a mais de radiação e o custo associado de novos exames. O objetivo deste trabalho foi checar, com base na literatura, a confiabilidade, a efetividade e a reprodutibilidade do método de estimativa da idade esquelética, por meio das vértebras cervicais. Para tanto, foi realizada uma revisão crítica da literatura, utilizando as palavras-chave "vértebras cervicais" e "maturação cervical". Foram encontrados 29 artigos nas bases de dados LILACS, PubMed e SciELO. De acordo com as referências encontradas, o Índice de Maturação das Vértebras Cervicais pode ser considerado um método válido, confiável e reprodutível na análise da maturação óssea, podendo ser utilizado na prática ortodôntica, em substituição à análise da radiografia de mão e punho.

Agreement between orthodontists in the diagnosis of sagittal facial patterns / Concordância de ortodontistas no diagnóstico dos padrões sagitais da face

The cephalometric analysis has assisted orthodontics in describing face features in terms of numbers/angles, but these results are not always consistent with ideal individual patterns. Some orthodontists have made use of subjective analysis as an auxiliary method in the diagnosis; however, the consistency of the reproducibility of these methods has been questioned. Hence, this study aimed to verify whether the diagnosis of sagittal facial patterns can be accomplished with a reliable reproduction. This is an analytical observational study including an initial sample of 120 teleradiographs and 120 photographs in lateral norm of patients from the Graduate Program in Dentistry, Faculty of Health of the Methodist University of São Paulo. First, a previously calibrated examiner separated the photographs into three Sagittal Facial Patterns (Pattern I, II and III). Thus, it was obtained three groups comprising 45 photographs for the Pattern I; 45 photographs for the Pattern II and 30 photographs for the Pattern III. After this initial selection, the cephalometric analysis of 120 teleradiographs was performed using measurements of ANB and SN-GoGn angles. From this second analysis, it was selected only the photographs in which the result of subjective analysis matched the cephalometric analysis, totalizing a final sample size of 52 photographs. These 52 photographs were separated and set on an album to be reassessed by 19 orthodontists, in order to observe or not an agreement between the facial patterns among professionals. The kappa test analyzed the level of agreement of 19 professionals in relation to the cephalometric reference. The degree of agreement between professional judgment and cephalometry was found to be 73.08%, and the result of the kappa test was 0.59 (moderate agreement). Taken together, the accuracy in the diagnosis of facial pattern by means of subjective facial analysis demonstrates that the subjective method is reliable for clinical use.

A análise cefalométrica auxiliou a ortodontia a descrever numericamente as características da face, mas nem sempre estes resultados condizem com os padrões individuais ideais. Alguns ortodontistas utilizam análises subjetivas como método auxiliar no diagnóstico, porém a reprodução do método é discutida. Sendo assim, o trabalho objetiva verificar se o diagnóstico do Padrão sagital da face é possível de ser realizado com reprodução confiável. Trata-se de um estudo observacional analítico com uma amostra inicial de 120 telerradiografias e 120 fotografias em norma lateral de pacientes pertencentes ao Programa de Pós-Graduação em Odontologia da Faculdade da Saúde da Universidade Metodista de São Paulo. Primeiramente, um avaliador, previamente treinado, separou as fotografias nos Três Padrões sagitais da face (Padrão I, II e III). Dessa forma obtiveram-se três grupos compostos por 45 fotografias no Padrão I; 45 fotografias no Padrão II e 30 fotografias no Padrão III. Após essa seleção inicial foi realizado a análise cefalométrica das 120 telerradiografias desses pacientes utilizando as medidas dos ângulos ANB e SN.GoGn. A partir dessa segunda análise foram selecionadas apenas as fotografias em que o resultado da análise subjetiva coincidiu com a análise cefalométrica resultando em um novo número amostral final de 52 fotografias. Estas 52 fotografias foram separadas e montadas em um álbum para serem reavaliadas por 19 ortodontistas com o intuito de observar ou não a concordância dos Padrões Faciais entre os profissionais. Para a análise de dados utilizou-se o Teste Kappa com o intuito de analisar o nível de concordância dos 19 profissionais com a referência cefalométrica. Dessa forma, o grau de concordância entre a avaliação profissional e a cefalometria encontrado foi de 73,08% sendo o resultado do Teste Kappa de 0,59 - considerado moderado. Conclui-se que existe exatidão no diagnóstico do padrão facial por meio da analise subjetiva da face, o que demonstra que este método subjetivo é confiável para a utilização na prática clínica.